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Can you help someone whose depression keeps getting worse?
March 16, 2010 6:48 PM   Subscribe

One of my best friends just tried to kill herself. She has clinical depression, but she got help for it a year or two ago and I thought it was under control. Was that a delusion? Can people suffer from depression that can never be treated or controlled?

My friend made a suicide attempt two or three years ago, in high school, and was diagnosed with clinical depression. I wasn't in the country so I don't know all the details, but she spent at least two months in a psych ward and was on medication and seeing a counsellor or therapist after she left.

She moved in with me to live on campus last September and she seemed fine, but over the past few months she stopped attending classes and just lay in bed watching shows or playing games; this might have been triggered by a rejection from someone she had a crush on, which she took really hard, or by a visit from her asshole father. I asked her if she was talking to her counsellor about things and she said yes, more or less.

Then last Sunday while I was away I found out from her sister that she had been off her meds for a while and that she had tried to commit suicide. She is in the temporary psych ward of the hospital now, and I am planning to go see her on Friday. But I don't know what to say or do.

She said in her suicide note that the depression keeps coming back worse and worse and she can't stand the pain anymore. Can't she be helped? I thought that getting counselling, getting medication, all that, would be enough for life to be bearable for her. I thought the psych ward wouldn't have let her out the first time unless they thought she would be okay. Am I wrong? Can people just get more and more depressed until they finally succeed at killing themselves? What can I do for her, if anything?
posted by daelin to Health & Fitness (17 answers total) 4 users marked this as a favorite
 
First, going off the meds was kinda not a good thing for her to have done. And unfortunately depending on what kind of depression she has, suicidal ideation is simply part of the illness. That having been said, with work, good docs, and willingness to tweak meds, etc. a lot of folks are able to recover and do well.

As for what to say or do, treat her normally, follow her lead, and don't be afraid to joke around with her if she seems up to it. She will possibly feel embarrassed or ashamed, and if you can let her know that you are okay with HER that will help more than you can possibly know.

Depression does suck, and it's a hard battle to fight. But having a good social support system is invaluable and if you can be part of that, she is blessed.
posted by St. Alia of the Bunnies at 6:52 PM on March 16, 2010 [1 favorite]


IANAD. If she's prescribed meds, she needs to take them whether or not she is feeling better or worse. Going off meds and experiencing withdrawal symptoms can leave a person in a worse position than the one they started in. There's no guarantees they will work, sadly, but going off the meds sounds like it was the bigger trigger here rather than rejection or her father. Then again, I do not know the timeline nor what caused what. But if wants to be better she will take the medication and be honest with her doctor about its effects. Does it make her feel worse? Then it needs to be changed. Psychopharmacology isn't like taking an antibiotic or a pain-killer. It's inexact and requires specific balance and lots and lots of communication between doctor and patient.

Can people just get more and more depressed until they finally succeed at killing themselves?

This is entirely personality-dependent. Everyone experiences and expresses clinical depression differently. Some people get so depressed they try to kill themselves. Some succeed. On the other hand, there are those who cannot even summon the strength to make an attempt.
posted by griphus at 7:02 PM on March 16, 2010


Can people just get more and more depressed until they finally succeed at killing themselves?

Yes, but it's much rarer now that we've got some handle on treatment.

I thought the psych ward wouldn't have let her out the first time unless they thought she would be okay.

The wouldn't have let her out if they thought she was an immediate danger to herself or others. How could they predict two years into the future? Old issues resurface, a medication stops working (the old SSRI poop-out phenomenon), etc.

Most people with depression can be successfully treated for it, but it's a condition that can resurface at any time and needs to be watched. One of the tools that therapy teaches is how to observe your own thoughts and get a handle on when you're getting depressed again.

There very much is hope for you friend, but it may be a long road before she feels OK again.
posted by Tell Me No Lies at 7:03 PM on March 16, 2010


I thought that getting counselling, getting medication, all that, would be enough for life to be bearable for her.

But some would argue a merely bearable life is not worth living, and perhaps that is the crux of the problem. Counseling is merely the tip of an iceberg of the path to recovery. Medication is hit or miss because scientists only have a partial understanding of depression.

IIRC, there are studies that show statistically, the longer a suicidal patient is in the psych ward, the less chance they have of an eventual/overall recovery.
posted by polymodus at 7:05 PM on March 16, 2010 [1 favorite]


Can people suffer from depression that can never be treated or controlled?

Yes, it's possible. Sadly, as with other illnesses, illnesses of the brain that manifest as mental illnesses are not always treatable. But it's hard to know what happened here - she says the depression came back, but she was off her medication, so maybe that's the simple explanation, and that going on it again and staying on it will keep her well. That seems more likely than that she was getting more depressed while on the meds.

People make the same mistake that people with purely physical ailments make - they feel better, they stop taking their medication, they get worse again because they were never cured. Difference is, it's hard to know when they are "cured" of the depression or whatever.

There's no reason to despair, because there's no reason to think that the meds didn't work. If they didn't, there are lots more to try. Be supportive when you see her and tell her how much she means to you. But don't feel that it's ultimately in your power to prevent her from trying again to commit suicide, because it's not, and it would be a terrible burden to put on yourself.
posted by Dasein at 7:06 PM on March 16, 2010


Oh, and speaking as someone who has been there, it is very hard to tell when you're depressed whether it's getting worse or not. As griphus mentioned above committing suicide takes some motivation and effort, things which are often very difficult for the severely depressed. Ironically, it's when people are feeling slightly better that they can get organized for a suicide.
posted by Tell Me No Lies at 7:07 PM on March 16, 2010 [3 favorites]


It's good that you are going to visit her, and (as said above) just be yourself when you do. Of course you are nervous. Just walk in and let things unfold. Don't feel there is any pressure on you, or that there is anything to accomplish. The support you lend can be as simple as just being there in the moment with her, seeing if she needs anything. Treat it as hanging out.

Can people just get more and more depressed until they finally succeed at killing themselves?

Obviously it happens. Don't worry about that when you visit. She's in good hands if she's in the hospital.
posted by marimeko at 7:09 PM on March 16, 2010


Things can get really bleak at times. Especially if there's any external source of stress and anxiety such as school and/or work. IMHO, there's no happy pill, based on my own experience with medications. Her exercising more, eating right, and having the comfort of a good friend such as yourself, is likely better for a long-term solution, while having an independent councilor to vent things she may not want to share with friends and family.
posted by hungrysquirrels at 7:13 PM on March 16, 2010


a look towards the rich and famous who have killed themselves after a battle with depression shows that this disease doesn't care who you are and sometimes doesn't care how hard to fight against it.

as far as helping - just love her, without guilt and without pretense. realize, though, that her disease is hers and you can't take that burden from her, you can't fix her, and whether she stays on her meds or not, she is her own responsibility.

it sounds bleak, but depression is a bleak illness.
posted by nadawi at 7:41 PM on March 16, 2010 [1 favorite]


When they released me after my one and only 72 hour hold, as I got in the elevator, the attendant that was walking me out said (unsolicited by me), "Take care, because next time, they will keep you here a lot longer." I snapped back, "Oh, I'm great now, I am never coming back." She just stared at me without a smile or a nod or anything, like a cop on a cop show listening to a junkie caught red handed saying that they'll never use drugs again. That silent stare did as much for me as about anything else to drive home the seriousness of depression and what hard work it was going to take to live through it. Most of the people on the ward with me, and in my inpatient group had been through multiple attempts.

One thing that helped me was a new psychiatrist with a new diagnosis of bipolar depression rather than my prior diagnosis of major depression. With the new meds, my mood lifted to where I couldn't seem to go back down into that really really low mood anymore. But that was not enough. The thing that helped the most was learning how to challenge and replace the mental habits that perpetuated and deepened the depression. The three months in a partial inpatient group (going 3-5 times a week, 6 hours a day) taught me how to live with the disease. The drugs do help, but only like a cast on a broken leg. The real, lasting healing had to come from inside. And it has lasted.

So, what I am trying to say? Yes, you can be okay one day/month/year and ready to check out another. Consider a second opinion on the medical diagnosis. Get intensive help if available, especially if this is the second time. As a friend, be a part of a committed, reliable support network for her.
posted by buzzv at 7:52 PM on March 16, 2010 [3 favorites]


One way to stop someone from committing suicide is to just listen to them. Get their mind off of it subtly. Invite them to hang out, show that you enjoy their presence and appreciate them. Don't go full-on suicide prevention mode, that just makes them defensive and steels their resolve to carry out the act. Just talk to them about things they like and really listen to them, and be sincere. Don't agree with everything, give your opinions as normal. This is the only way to make someone feel valued, not like some depressed freak.
posted by mnemonic at 7:59 PM on March 16, 2010 [1 favorite]


Depression is a relapsing disease. It gets better for a while, and then it gets worse for a while. Many of us stay on antidepressants long after we have "recovered," because there is evidence that long-term antidepressant use helps prevent relapses. (So yes, going off her meds was the wrong thing for her to do.) With the right combination of antidepressants, therapy, lifestyle shit, etc., it's possible to stay un-depressed for a very, very long while. But it's a little like "recovering" from cancer. There's always the chance it will come back, and a lot of us alternate between happy and not-so-happy for big stretches of our lives.

The trouble is, when you're in the bad part of a depressive episode, you forget about the happy bits of your life. All you can remember is the not-so-happy bits. That's where the despair comes from. You know how sometimes, when you have a really bad headache, you sort of forget how not having a headache feels? The bottom of a depressive episode is like that for all the things that make life worth living.

For me, when I'm in that spot, being reminded of the happy times I've had in the past with friends is very important. Because without the reminders, hard though it is to understand, I do forget.

So you might do a little reminiscing about the good times. Letting her know that you cherish those memories of her, and reminding her that she had those good times, might be a helpful thing to do.
posted by nebulawindphone at 8:57 PM on March 16, 2010 [1 favorite]


daelin: "But I don't know what to say or do. "

"Hi friend! How are you? I'm glad to see you. Can I do anything for you?"

Depression is something you have to fight on a daily basis. There are better times and worse times, but take heart; with the right combination of medication and therapy, the better times will get longer and the worse times will get shorter.
posted by IndigoRain at 1:25 AM on March 17, 2010


Serious depression changes your brain. The more serious depressions one has, the worse it gets. For some of us this is a battle that will never end. Social support can be a huge help, as can meds and counseling. Good luck to your friend. Bless you for not deserting her now, many people feel angry at people who attempt suicide and withdraw their friendship.
posted by RussHy at 4:36 AM on March 17, 2010 [1 favorite]


I’ve been in your shoes a few times daelin. I have a very dear friend with severe major depressive disorder who’s had several suicide attempts. The answer to your big question “Can you help?” is yes. Being there for your friend, reminding them why they are valuable, helping them to think about the times when the depression wasn’t as overwhelming can help.

Some people are med resistant with depression. My friend has been on every, and I do mean every medication on the market for depression and then some. Right now he’s doing pretty stable on a blend of things, but it doesn’t make the depression go away. Try thinking about it like a life long disease, you have to treat it everyday. A round of counseling, a stint in a psychiatric hospital might get someone stable, but that doesn’t mean treatment stops or the disease goes away. If your friend were diabetic or had a heart condition and stopped taking her medication no one would be surprised she ended up in the hospital. It’s not all that different with mental illness.

Therapy can help, but it has to the right kind of therapy. Cognitive Behavioral Therapy is what the current research is showing is most effective in treating MDD, the problem is that not everyone knows how to do this well. Finding the right therapist can take a while. In my friend’s case he went through over a dozen mental health professionals (most of whom practiced a “tell me about your mother” style of therapy) before he found one that was helpful. That being said his current therapist has helped him tremendously so hold out hope.

When you go to see your friend she might be feeling guilty or embarrassed. Be there to support her and let her know that you still care for her. Let her know you’ll be there for her when this is all over, maybe make plans for something you can do together. Knowing that her suicide attempt hasn’t cost her your friendship is going to help. Oh and maybe take a good book, some comfy socks, her toothbrush whatever the hospital will let you bring to her.

As a side note, I’ve more than once had to lie and say I was a relative to even get to see my friend while he was under a hold so you might want to call and see what the policy is wherever your friend is right now. It has always amazed me at how the places where people are put on involuntary holds seem to be the most isolating and depressing places on the planet. You’re presence will definitely brighten it up for her.

Also make sure you take care of yourself. Having a loved one go through something like this takes a toll on you too. You might want to look into some counseling for yourself. Feel free to memail me if you want to talk.
posted by Palmcorder Yajna at 8:05 AM on March 17, 2010 [1 favorite]


She said in her suicide note that the depression keeps coming back worse and worse and she can't stand the pain anymore. Can't she be helped?

Possibly, hopefully. She should talk to her psychiatrist about whatever problems her meds were causing her that made her go off them. Generally speaking, the meds aren't something that you should just take until you feel better again, though some people get okay at managing that sort of thing. Mostly they're something you need to keep taking: when you stop and they leave your system, you'll feel depressed again.

I thought that getting counselling, getting medication, all that, would be enough for life to be bearable for her.

Bearable doesn't mean happy, and for some people that in itself is depressing. Counselling and medication aren't magic bullets, either. Some counsellors suck, or just don't approach things in a way that meshes with a particular patient. There are several kinds of medication for depression as well, and all different "cocktails" of medication. I don't think I've ever heard of a depressed person being pleased with the results of the first medication they try. It usually requires a lot of tweaking and trial and error with the psychiatrist.

I thought the psych ward wouldn't have let her out the first time unless they thought she would be okay. Am I wrong?

This question kind of breaks my heart, if only because I wish it were that easy, or that people actually have as much control and predictive power over it as you thought they did. I'm guessing this friend of yours is the first and only person you've known very well that's been depressed, right? This sort of situation, with the being better and then being worse, is common. Deciding to go off meds even though you shouldn't is common. In all likelihood these things will happen again, not only to your friend but also to any other depressed people you meet. It takes a lot of hard work to manage it, and then to get to a point where it doesn't feel so much like hard work anymore.

When they let someone out of a psych ward, it just means they don't think they're going to try to kill themselves terribly soon. That's really all it means. Evaluating that is hard enough as it is; there's no foolproof way to tell, and it comes down to somebody's best guess based on the patient's behavior and the things they have said, and then whatever medication has been administered and how it seems to be working (seems being the operative word). Some people are so desperate to get out of the psych ward so they can kill themselves that they'll say the things they know they should say to get released, and act the way they know they should act. And some people do kill themselves soon after being released. Some people get put back in the psych ward soon after being released. Some people get put in the psych ward multiple times during their life.

I kind of get the vibe from this question that you had the idea that psychiatry is entirely like other sciences, in that you do a certain thing and you get the expected result and that's that. If that's the case, let me just reiterate: it's not that clearcut. There aren't "expected" results so much as results you hope for. Different medications have different effects on different people. There is no medication that will ensure that someone doesn't kill himself, and even if there were, there's no guarantee that any individual person will definitely stay on that medication. When a patient is released from a psych ward, they're released with the full knowledge that the patient is an autonomous individual and, in a basic sense, is capable of making decisions we'd rather they didn't.

To really ensure that a person doesn't kill himself you'd need to take away his free will. We can't do that, technologically or morally. Short of that, there's always a chance that a person will kill himself. Just because there are doctors and psych wards and all this other stuff involved doesn't change that fact, it just (hopefully) improves the odds.

Can people just get more and more depressed until they finally succeed at killing themselves?

That is exactly why there are suicides. If it were not, there would not be suicides.

What can I do for her, if anything?

Be there for her. Listen to her. Don't judge her or her treatment (not implying that you have, but a lot of people do this and it makes the person more depressed so I always stress this). Your friend needs to know that there are people who care for her and believe in her ability to have control over her life, especially when she's surrounded by a lot of people who, by necessity, are taking control for her right now. So leave the controlling to the doctors. There will be other people too, non-doctors, in your friend's life that are uncomfortable letting her have freedoms or take control of her life because they sincerely don't believe she can do it; not because they're horrible people, but they're scared of what will happen as soon as she's out of their sight. I have a lot of sympathy for how they feel but in the mind of the depressed person, it can perpetuate the idea that they're helpless. It's hard to feel worthwhile when everyone treats you like you're fragile instead of strong, and treats you like someone for whom lots of things must be done instead of someone who can do things for yourself.

Don't confuse this with "tough love" -- don't do "tough" anything with a depressed person. Rather, it's an assumption that the person can and will get control over things that should come across in your interaction with them. That's just normal love. It's expressing optimism instead of worry -- and that's just in your demeanor, not even words. While it's true that depressed people have to "learn to love themselves," having people around who have confidence in them is huge. I've done my best to be this to some people who don't seem to have a lot of other people like that around them, and it seems to help a lot. It can be hard when you're scared for them, and hard to stop worrying, but you can do it.

After knowing a ton of depressed people and having some horrible depressed episodes myself, it's just tons easier to believe in yourself when it seems in line with what the rest of the world believes about you. When the rest of the world doesn't seem to believe in you and you try to believe in yourself, you tend to feel like a fool. It'd be nice if one could summon up a "fuck what everyone else thinks" attitude in those times when it's most needed, but depression tends not to work that way. When I would try that with myself, it'd just get warped into, "What's the point of living in a world where I'm the only one who believes in me anyway?" So believe in her.

I gave some more advice along this vein in a previous comment.
posted by Nattie at 1:21 PM on March 17, 2010 [3 favorites]


I thought that getting counselling, getting medication, all that, would be enough for life to be bearable for her.

Despite what we tend to think and despite what your friend's note said, suicide in depression is not always necessarily an issue of life having become unbearable. That's to say - it's not necessarily due to feelings, or due to a 'pain feeling'.

I've never made a suicide attempt, but I've felt suicidal in the past. I've thought carefully about why, and I think it was the 'logical' following through of my depressed thoughts and beliefs. My thinking went something like: "I am utterly, utterly pathetic and I do not deserve to be alive. Therefore, killing myself would be the right thing to do.

As people, we make decisions based on what seems to true to us. This holds true in mental illness. It's just that sometimes the actions of people suffering though a mental illness seem indecipherable because we can't see the thinking behind them. (And it's really hard to explain that thinking. It's almost untranslatable.) Unfortunately, depression doesn't just alter our emotional landscape; it changes the way we think. Someone above mentioned that it can be very hard to tell when you are depressed or when you're depression is getting worse. This is absolutely true. When I suspect that my depression is getting the upper hand, I 'check in on' my thinking. If dark thoughts or hopeless thoughts keep popping up, that's how I know for sure. Then, I have to ignore what seems true to me until the depression passes / is treated.

This is really just my own experience, but I hope it contributes to your understanding of suicide and maybe, your friend.
posted by kitcat at 3:33 PM on March 17, 2010


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