Help me help a friend struggling with long-term depression.

November 12, 2009 7:09 AM

Friend with depression (treated with meds), seems to have plateaued with any progress and still occasionally thinks of suicide. I am there for him as much as possible but it kills me to see him like this. Is there anything I should know, or that I could do or say at the right time to help him move forward?

Asking anonymously because he knows I use this forum.

A bit of background:
he's suffered depression (chemical and situational at first) for about five years now.
He is a good person with a good amount going for him, but, of course, he doesn't see that - however, should he be able to come out of this, he's got a lot of raw goods that can help him live a happy, productive life.
He is on medication, but not in therapy - he was in the past, but it was only a finite amount of visits as allowed by his insurance. (If he would go back, I don't know - I am considering trying to get him to think about it, but know it would be a slow process if he would ever agree.)
He seems to want to get better sometimes - he's adopted a few behaviors that help (meditation when overwhelmed by anger, for example, much better communication with a very few friends).
Clearly, he's got one of the things he should be doing (meds) down, and maybe some of these other things point to good signs for wanting recovery - but he's not doing anything else I know of (regular sleep, good food, exercise, reaching out to more than just me) to help.
And he's still thinking of suicide - not imminently, I believe, but there was a plan recently, and I think he's just delayed that plan.

Basically, he's mostly functional, but obviously still struggling so much and for so long that something's got to give - either he's going to do everything he can to feel better, or he's going to give up. I have no idea which it will be.

Also, I live very far away - I cannot be with him, as much as I want to be, so our contact is limited (and obviously non-physical, so no touching, hugging, eye contact, etc).

I have never struggled with something this deep, so my question is this: are the signs pointing to him wanting to get better or not (or can one even tell from this)? Should he be receptive to suggestions/advice, what should I bring up? I'm completely clueless about what he should do to eliminate this despair (I've suggested omega 3's/B vitamins in the past to augment the meds, and obviously exercise, eating right, etc, but I'm fairly sure he's followed none of these things on a regular basis, just giving in to the lows instead), but am desperate for him to take the right steps.

Is there anything I can do that I might not be doing?

I realize this may turn out to be a situation where I have to just let him know I'm there for him and hope he makes a positive choice. It's agonizing, but I will do it, as I have done in the past. But if there is absolutely anything in the world I can do for him, I will do it. Please help me help him.

(Also, if you just have an anecdote that might calm me a bit, I would sincerely appreciate it. He knows I am always available for him, but there are times when not being proactive just drives me insane with worry. Despite my efforts, there are days when this interferes with my own life.)

posted by anonymous to Health & Fitness (13 answers total)

Ask to a professional. Please.
posted by milnak at 7:09 AM on November 12, 2009 [1 favorite]

If he's got the willingness to keep on fighting toward medicinal armistice with that illness he might 1) live through this and 2) actually find the key or a key toward living a happy life. It's a remarkably dispiriting march, especially if/when nothing you've tried works well for you, again and again, but there absolutely is a medication or medications which will help him deal, and absolutely is a regimen which he can adapt and/or adopt in his life to bring him more ease. Plant this in his mind again and again, that there IS a way. I found this idea in a book I read, the author was insistent that there absolutely was a way to find help, and that if I was still suffering I somehow had to find the jam to reach out again, to walk past shrinks who told me that it was as good as it was going to get, etc and etc. One shriink and one therapist who believed in me and, more, believed that I could find happiness or peace or whatever it is just kept on walking me through all this jive -- I was lucky to have found myself in their care, I'd pretty much given up by then but they never did. They saved my ass, for sure; I owe them all.

Best of luck to your friend, and good for you for your kindnesses and love for a friend.
posted by dancestoblue at 7:23 AM on November 12, 2009

I've been in a similar situation. I have (or had) a friend who has been in a deep downward spiral for years, losing her job(s), holing up in her apartment, taking drugs, and generally being self-destructive, despite the fact that she has pretty much everything in the world going for her. Eventually, I had to step back, and pull away from the relationship because I couldn't handle the worrying. I wanted things to get better for her so much that I came to the point of having a nervous breakdown myself. I had to pull back, and cut things off and go into therapy. I hope our rift isn't permanent, and that she gets her act together, but right now I realize I've given everything I have to give. The bottom line here is that you can't save anyone but yourself. You need to worry about you first.
posted by dortmunder at 7:31 AM on November 12, 2009

First, I'm seconding milnak's comment. I would also suggest that this friend not be left alone. If necessary, your friend should be taken to the emergency dept of the nearest hospital.

You're a good friend.
posted by jmmpangaea at 8:12 AM on November 12, 2009

I can only offer anecdotes: My friend inherited his genes from his father, who told his son "I'm going to drink until I don't wake up," and proceeded to do just that. My friend, a very sweet, caring, lovable man, used drugs to self-medicate and died of an accidental overdose at age 29. From my point of view, a total non-drug user, it was the most bewildering thing in the world. I couldn't understand it one iota. Whaddya mean, you're just going to lie on the couch instead of looking for a job? In your field, it's pretty easy to get one! Whaddya mean, you have to drink to numb your pain just because your boss reprimanded you? My boss reprimands me all the time, and I don't have to do that. Whaddya mean, you're out of toilet paper because you spent your last few bucks on...? After a few naive missteps, I did everything right to help him (supported him when he went to rehab, refused to enable him when he didn't), but I too went insane with worry because I felt so powerless over the situation. It just made no sense. It was just so obvious (to me) what he should do, but he wasn't doing it. Even when he died, I was still bewildered by it...whaddya mean, you relapsed? Now you're dead, and you can't do anything. What kind of stupid thing was that to do?

The only thing I could say to myself was, I wasn't him. I couldn't know what he went through, I couldn't do his rehab for him, I couldn't yell at him and say, "just DECIDE to get better!" Humanity doesn't seem to work that way. Today I feel good about the help I gave him, but I know that we can't change all the wrongs in the world. It would be so nice if we did.
posted by Melismata at 8:28 AM on November 12, 2009

I was in your friend's shoes for years.

One thing I need to stress out - you are not his keeper. It is heartwarming to hear how someone can be that concerned about a friend. But ultimately it is his issue and there is only so much you can do. Yes, it is like telling fire not to be hot but you have to realize that before you get burnt out yourself like dortmunder was saying.

YMMV but a couple of things that I appreciated when I was in a funk:

1. A show of concern. We are children. No grand gesture is necessary but a simple call and simple words of encouragement go far. And like children we need it, crave it, consistently. You might think it's not getting through and your friend might not be able to show his appreciation, but to me anyway things like that were like glimmers of starlit sky on a cloudy and cold night.

2. To feel needed. Functionally that is. I remember feeling really good when a friend of mine asked me for help in a house project. After telling myself what a worthless piece of crap I was over and over again, it's a breath of fresh air to know that I could contribute, however little that was. And at the very least it got me out of the house.


And yes - he is getting better. At the very least, have faith that he is. It's the pygmalion effect or the self fulfilling prophecy. Let him know that you have faith in him. Let him know that however bleak he thinks things are, there is light at the end of the tunnel.
Of course use your own judgement when things obviously deteriorate and intervention might be needed.

Good luck to you and your friend.
You warm up my heart.
posted by 7life at 8:47 AM on November 12, 2009 [1 favorite]

I feel like I have to clarify my last comment. I don't mean for you to be willfully ignorant about his true situation. But rather to show an attitude to him that yes indeed you think he can get and is getting better. Your enthuasiasm, outlook, and faith will hopefully be infectious.
posted by 7life at 8:54 AM on November 12, 2009

Hi - it's a bit complicated, you know. He's obviously in pain and this hurts you as well. You need to kind of step a little back and understand that his process is his and yours is yours. A little perspective goes a long way. Other than this, I would be available to him if he was more or less stabilized and interfacing with a support system (group, therapist) as well. Underneath this depression there is something else - the root of the matter. Most likely abuse, trauma, abandonment or betrayal - these cause the most damage and manifest as depression. He needs to get to a place of rising above. That will be the marker for live as opposed to ending it.

How motivated he is in healing will determine the recovery. A lot of self-will and focus is needed here. Support from peers (those in the same boat) is helpful, but I'd have to add the spiritual dimension as well - where he can see himself an integral part of the Bigger Picture and that his presence is much needed and all that he is undergoing now is part of the learning process (and that is not something that is very popular to hear).

Usually getting him out of the house into new activities, such as art therapy, - will introduce a new direction and energy that could provide a stepping stone for HOPE which is what everyone in the field is aiming for. Something to wake up for, something to strive for and some kind of satisfaction gained from being productive.

Do wish you the strength to be you and to support him when needed and to know the difference between the two and still show him you care. Fine line. Use care. Good luck.
posted by watercarrier at 9:08 AM on November 12, 2009

As you mentioned in your question, "timing" is important. There ARE some very important, concrete things you can do, that may (only may) help him at the critical time. It's a lot of pressure, but in situations like this, where the potentially suicidal person reaches out to a very small number of people, its important that somebody know what to do at the right time. This is particularly true for people who are not currently in steady therapy or under other consistent supervision.

Despite wanting to, you can't be there all the time. And really, the timing is up to him. You can't fix this problem. You may not even have much luck in shoving it in the right direction. You can only reach him if and when he decides he wants to be reached. There is little chance, if he is serious about suicide (and we should consider everyone who mentions suicide to be serious about it), that you can say something that will "break through" and radically change his emotions. My heart goes out to you, because you want so bad to make a difference in his life day-to-day. You want to be there, to say the right thing to clear the fog. But you can be an even more effective friend than that. Here is what you do:

If he has had a previous plan for suicide as you said, he probably has a current plan. Nearly everybody that commits suicide does. It's rarely spontaneous except in accidental cases. So, assume he has a plan. And here is the hard part, make sure that plan involves you. Make a deal with him, that before he goes through with the act he will contact you. Not just try, but actually speak with you. Let him know that you take his desire to end his life seriously, but as one of his closest friends, you would like him to respect your wishes and friendship enough for him to at least speak to you one last time. Make him promise. Make him say it. You make this deal when he is in a non-crisis state of mind. You do not need to make a big deal out of it, other than to let him know you are extremely serious and will hold him to his promise. The chances are very high that he will agree to this. He cares about you. And in his darkest, most confusing time, it gives him the chance to care about you back. He wants this. And with a clear head, it will be a manageable promise for him to make. It will also be a very difficult promise to break if he sees any faint ray of hope for himself in his darkest time.

So when he calls you, you have a plan of action ready. You have a script you have devised with a suicide prevention specialist...many current phones make it very easy to conference in a third party if that turns out to be an option. You have a list of numbers of immediate calls to make to get him help. You basically make it so that at that moment, you don't need to do much thinking. You just have a pre-planned way of handing the situation over to people that can do the hardcore business of saving his life and preventing his suicide when he is most ready and likely to carry through with it. He may resist your efforts. You don't care. You will get him the help he needs when he needs it most. If you do not think you can handle being the one he calls, the one who is part of his deal and promise, ask him to make that promise with somebody else. Hear this: there is no shame in not being up to the task of doing this. But if you aren't, you can help him find someone who is.

So...now you can be sure you will be there for him when he really needs you, and wants you. You can give him what you know he needs when he needs it. In calling you, he is asking your help as best he can and is telling you he is ready to accept it. And you will be ready. And you will make a difference in his life.

Good luck. Please seek help from professionals to make your plan or learn more about helping him in other ways. He will be glad he has you to call at this moment. And he will carry your number in his wallet. I still have one in mine.
posted by nickjadlowe at 10:01 AM on November 12, 2009 [1 favorite]

and still occasionally thinks of suicide.

I do not mean to underplay this is any way but to be perfectly honest, when they do those mental health intakes and the question is asked "Do you ever have thoughts of suicide?" my answer has been "Duh" for about 25 years now.

I have a personal theory that there's a suicide gene or something, and that its absence or presence creates two distinct camps: the possibility of taking your own life either exists for you or it doesn't. It would genuinely never occur to my partner, even at his lowest - the idea simply does not exist for him in any kind of concrete way, and he's not exactly a chipper person. It does for me, in that it feels like it's always an option, and pretty much always has.

But contemplating it is different than planning it is different than doing it. There is a definite escalation distinction there. So, I think it's important to find out if he's gone beyond musing over the relative merits of absenting himself from the universe to actually having some kind of plan for doing that before you become overly focused on that one outcome of severe depression.

Having said all of that, there is that high suicide rate among males in the US and certainly you do want to stay aware of this issue. I'm not in any way meaning to belittle this situation if you feel like it's a real threat.

And thank you for asking but I assure you there is zero danger of my taking my own life any time soon - no need to flag my post for crazy.
posted by DarlingBri at 12:26 PM on November 12, 2009

Pretty much everyone who's depressed "wants" to get better, but the horrible thing about depression is that seeking treatment requires the very motivation and hope that the depression destroys. From what you've said, though, it's impossible to tell what he actually wants, and apart from that, what he's actually willing to do. Especially from so far away.

I've been in a similar situation to yours. He was severely depressed and I was very far away, and eventually he totally withdrew and wouldn't even answer the phone. I was crazy with worry. I would call his office and hang up after he answered just to make sure he hadn't killed himself. Eventually he got back in contact with me, apologized, and said he was doing much better - he'd started seeing a cognitive behavioral therapist, and it really changed his life. I was relieved, but also floored - six months prior, I had bought him a copy of Feeling Good (something I recommend you do, too, despite this story) and he refused it, saying it was all bullshit, he didn't need a self-help book, blah blah blah. In the end, he had to make the decision for himself. Which leads me to my next point:

You are a good friend. But also keep in mind there's only so much you can do. You can support him, advise him, and reiterate how much you care for him. If he's an imminent threat to himself, you might be able to get him temporarily admitted. But you can't magically make him un-depressed, and unless you plan on sedating him and handcuffing him to the bed, you can't prevent him from killing himself if he's set on it. You're not responsible for him: he's an independent human being who has the right to his own choices. Of course you start thinking, "Well, he's mentally ill, he's not in his right mind," and while that may be true, in practice, it doesn't matter: he'll still ultimately make his own decisions anyway. The idea that you can stop him if you just figure out how, if you just do this one little thing, is an illusion.

It may be worthwhile to seek out Al-Anon or CoDa meetings in your area. Al-Anon is for friends and family of alcoholics, but the principles apply to anyone with a self-destructive loved one, and you will almost certainly recognize yourself there.
posted by granted at 12:56 PM on November 12, 2009

You know, upthread I thanked that shrink and that psychotherapist for hanging in with me, and they do deserve the thanks, too, both of them. But I've been away from this keyboard all day and it's been sortof weighing on me, that I've got to thank my oldest sister also, and my friend Roger, and my AA sponsor, and the guys that I'm lucky enough to sponsor.

My oldest sister has championed me all my life, she was pretty much my parent when my were so hurting and nutty and broken from their own pain, who loved me through all the ups and downs of mental illness, and alcoholism also, and my recovery from those. Such as I have recovered from them. Roger, my friend for 20 years now, in the depths of that last pit of hell I was in, maybe six years ago, or seven, whatever -- he would actually call me, tell me he was coming over with his dog (I of course told him not to, so ashamed of the chaos I was living and also so locked down, barricaded behind the doors and window shades of this condo), he called me, gave me fifteen minutes, then knocked on the door, and took me for walks. I was 49 years old and my friend took me for walks. Unreal. A true friend, a diamond. My AA sponsor, though he does not have this manic depressive illness and doesn't fully 'get' it, he hung in with me regardless -- here's a guy twenty years sober, yeah, but I'm crying all the time, I'm lost and broken, and it doesn't make sense unless you're in the life also. He was there for me anyways, he hung in, and he still does. The guys that I sponsor -- it was vitally important for me to show competence in this way; though I could hardly wipe my own nose I was still very able, and very willing, also, to help others negotiate their own alcoholism / drug addiction / lifes ups and downs, etc and etc.

I have always had guns and always will, and I've had them in my mouth more times than I'm going to tell you, and looking around the room -- now THERE'S a sunny moment for you. It's interesting, for sure. As above, please don't anyone start jumping up and down here, it's been twenty years, no, twenty-two, five years clean and sober. But I do have a sense of the terrain,it's just brutally painful, that's all. And like Melismata said above, you just can't get your head around it unless you've been there, or at the very least worked in the field for a long, long while. But your friend is talking to you, you're on the inside, and that's a huge thing, or would have been for me -- I was deeply ashamed of it, I almost couldn't tell anyone about , not unless I could tell they'd walked it also and/or they were deeply accepting.

It's one hell of a slice of life, and it absolutely can be too much. Do take care of yourself. That last time I went nuts, seven years gone now, it was behind spending too much of myself in the service of another, giving too much -- it's like spending money you don't have, and then the checks start bouncing; it was just too goddamn much for too goddamn long at too goddamn close a range. (Go ahead, go get your older sister committed for schizophrenia, twice in two years Live in your wacky -- loving, yeah, but wacky -- parents home as you do it, go and get yourself deep deep deep into the broken heart of your family and stay there, working your ass off, hard as ever you've worked; I recommend it.) (Worse, maybe, I kept on having to go to Phoenix to do all this shit -- jesus christ I hate that town! What a fucking drag!) I broke like a crystal ship hitting a concrete floor when it all came down, seven years ago this week. And I thought that I knew something about manic depression. Ha! It was the only time (so far -- ha ha!) that I hit a psych hospital ER in helping myself. It was interesting.

I do go on -- sorry! Take care of yourself, that's all, don't spend more than you have, and you're the only one who knows where that line is, and probably you don't even know sometimes. AlAnon, for sure, if you're so inclined. Prayer, if you believe in it, and maybe if you don't -- it's grounding, for me, I'd never have made it through those years back/forth to Phoenix long enough to go nuts after had I not been praying my ass off, my knees digging into that desert gravel in the starlight, out behind my parents place.

Last. If you can laugh with him -- not at him but with him -- about the horror show he's living just now.. Well, I can't say, for him. For me it was just the best, some good old black humor, gallows humor, shared -- great fun. I mean, it's gonna happen anyways, why not laugh when you can, right? That's maybe the point of AA meetings, damn sure one of them, that deep understanding and gut laughter when non-alcoholics think it's the grimmest thing they've ever heard.

Thank you again for being the friend you are. It means the world.
posted by dancestoblue at 4:35 PM on November 12, 2009

Seconding what dortmunder said. It sounds to me like you have a lot of caring and empathy for your friend, but it is really not your problem to solve. I think you need to step back, detach from the situation, and get your own mental health in order. If it still affects you, consider therapy for yourself. Getting deeply entwined in another's mental health problem can be so damaging to oneself.
posted by exphysicist345 at 7:38 PM on November 12, 2009