Help my anxious girlfriend?

January 27, 2006 8:22 PM

How can I help my depressed/anxious girlfriend?

For a long time now (since before we started dating) my girlfriend has been mildly depressed and anxious. Since starting college (where we met), it's been getting worse. She's never been to a therapist, but judging by her behavior and research I've done on the internet, I'd wager that she's got some kind of an anxiety disorder coupled with mild to severe depression. She has panic attacks about big class assignments, giving presentations, and being called on in class; she's been losing weight and refusing to go out on the weekends; she often has headaches--things that, from what I can tell, are textbook symptoms of these kinds of disorders. Obviously, this puts a strain on our relationship (as well as her own personal/academic life); I feel like I'm losing the person I fell in love with to a sadder, angrier person.

My question is twofold: one, from the research I've done on the internet and here at AskMetaFilter, it seems like cognitive therapy coupled with drug treatment is the best option. Obviously, that's her choice to make, and she understands at some level that she has problems with anxiety and depression, but at this point, she won't even explore these options. How can I encourage her/convince her to seek help? I don't want to have to wait until she has a serious nervous breakdown, but I don't want to patronizingly suggest therapy, or one of the many books that have been recommended here. Two, assuming she continues to not seek help, what can I do or say that helps her? I'm hoping for answers from people who have had anxiety disorders themselves. What does it help to hear when you're feeling nervous or depressed? She hates it when I say "Everything's going to be OK" because she thinks it won't, but I don't know what else to tell her--most of her anxiety is irrational (not to her, obviously). Pointing out how irrational her fears are only works about half the time. As it is, I feel totally useless when she gets anxious.

Any help would be appreciated.

posted by anonymous to human relations (34 comments total)

It sounds like therapy would help her. It's not patronizing to suggest it -- it's genuine concern. You're scared for her, so you need to tell her that. Although you can't force her to go to a therapist, you can ask her to try it one time for you. If she agrees, you need to follow-up and find a therapist quickly. Don't rule out MFTs (Marriage and Family Therapits). They can be just as good as psychologists and are often less expensive. If the MFT thinks medication might be a good option for your girlfriend, s/he can refer her to a psychiatrist.

Another way to go about this is to suggest that you two go to couples counseling. If she's sad and angry all the time, I bet your relationship isn't going so well, so it might do you both some good. However, it might ease her into the idea of therapy. And if the couples counselor thinks your girlfriend needs individual counseling, s/he'll say so. Hearing it from this "objective" source might convince her it's a good idea.

As for your second question -- you can and should continue being supportive, but nothing you say is going to solve her problems or "fix" the situation until she decides to get the help she needs.
posted by zharptitsa at 8:47 PM on January 27, 2006

You can't really be sure what the best treatment will be for her; that's for a clinician to determine with her input.

BUt it may help if you mention to her that anxiety disorders are among the most treatable of any psychological issues. I had anxiety problems for a few years, and they responded to treatment with great success. Now that I know feeling that way is unnecessary, it's a great freedom. Let her know it is completely solvable, and not even through an intense talk therapy process -- sometimes, simple behavioral change is highly effective.
posted by Miko at 9:05 PM on January 27, 2006

zharptitsa: nothing you say is going to solve her problems or "fix" the situation until she decides to get the help she needs.

I respect the "go see a therapist" advice, but surely that isn't the only thing that will help... Sorry if this seems nitpicky.

Anyway... I think Anonymous is in a very difficult position.

You are not the father or the therapist, finding yourself in the wrong role in her mind could ruin your relationship.

You could argue that if it helps her through her problems it is worth the effort - let what will happen later take care of itself and all that. Fair enough, but you might find yourself 'on the short end of the stick' - becoming depressed yourself perhaps.

This really does point back at the therapist advice, of course. Involving her friends, or mutual friends, or helping her find new friends could help.
posted by Chuckles at 9:36 PM on January 27, 2006

I really meant 'becoming depressed and single perhaps'... Sorry to be so depressing. :)
posted by Chuckles at 9:38 PM on January 27, 2006

First of all, don't try to treat her. That's not your place.

Second, the Anxiety and Phobia Workbook and The Feeling Good Handbook are both very good. I recommend those as someone that really dislikes pop-psych books -- neither of those are anything of the sort. Both are recommended by licensed therapists.

I don't know of any other way than to just be blunt. She needs help, if what you are saying here is true.

And she can get help.

That last sentence is the one you need to get through to her: she does not have to live the way she is living. Anxiety is an eminently treatable problem. Ditto depression (for most people). If she can just make an effort to try and be better, she can actually live a much better life.

There are tests online with questionnaires for depression,mania, and anxiety screening: like this one here.

Maybe one of those would convince her. Even seeing a general practitioner is better than doing nothing. A subscription to an antidepressant and maybe an anti-anxiety drug might really help. A regular doctor can do both (mine did), as well as point her toward counseling and therapy and group treatments.

Exercise is very effective at warding off depression (almost as effective as anti-depressents). It is stressed constantly in Burns book mentioned above. So you could help her by trying to exercise together, especially if its something you can both enjoy.

For yourself, I'd try to be understanding. Depression is a lethal disease, and it can make people very irrational and very hard to live with.

When I got severe clinical depression and anxiety attacks for the first time, it was very clear to me something was very, very wrong, so I'm a little at a loss for someone that won't seek help.
posted by teece at 9:39 PM on January 27, 2006

Chuckles...fair enough. I should have said "until she decides to help herself." Although there are lots of ways to do that (not limited to eating better, getting better sleep, exercise, etc.) the symptoms that she is displaying seem more severe than those strategies alone can solve (at least at the beginning). At a minimum a few visits with a therapist can help her get a better idea of how to help herself.
posted by zharptitsa at 9:53 PM on January 27, 2006

Speaking as someone who knows anxiety/depression both as a personal experience and in a spouse, I would urge you to be very clear about what you want from the situation. And also to be aware that what you want may not be possible.

It is not at all uncommon for biological anxiety and depression to kick into high gear in the early twenties. If that's what is happening with her, then as you say psychotherapy and anti-depressants have a very good track record. That's the route I went, with reasonable results after a few years of effort.

My girlfriend at the time had the same issues but did not seek treatment. I was determined to be with her and ease her anxiety, with the mantra "I can't cure her, but I can help her while she heals" firmly in mind. In the long run this included marrying her, in hopes that a secure relationship would provide a base for her to work from.

I was fooling myself, of course. Her anxiety was in full flush, and paid very little attention to what I thought was stable. And the condescending attitude I had adopted towards her "irrational" fears didn't help the relationship one bit.

So here's the deal: it's highly unlikely that you can have a mutually respectful fulfilling relationship with someone who you consider (rightfully so, IMHO) to be mentally ill. So three choices...

1) Punt. Go find a woman who isn't on her way to a nervous breakdown.

2) Drop the "I don't want to be patronizing..." act, treat her like the big girl she is. Say "Your episodes of anxiety and depression are shaping up to be a long term problem for me. I would like you to do something about them." If she asks what, then you can mention therapy/drugs/etc. If that's not her cup of tea, offer to do yoga and meditation with her. Being able to drop into a meditative state is a wonderful release from anxiety, but it takes practice and no one else can do it for you. If she doesn't take you seriously enough -- i.e. she fails to do anything at all -- then I strongly suggest you see #1.

3) Learn to let her pain be her pain. If you're going to stick with her long term and she's going to continue to be depressed and anxious, you'd best learn to love her the way she is and not get ensnarled in her issues. Learn the serenity prayer and recognize her moods as something that you can't change. It does no good for you to be down on yourself ("useless") because her neuro-transmitters are malfunctioning.

I would suggest #1 or #2. #3 is good for your own health, but in the long run you really don't want to be involved with an anxious/depressed person. They're real bummers to be around.

Regards,

-T
posted by tkolar at 9:55 PM on January 27, 2006

It might help to find ways to reduce any stigma she might be holding against treating a mental illness. Many people still think they should be "tough enough" to will themselves out of the blues.

The way I understand it, constant stress (such as college) can trap the body & brain in a prolonged fight-or-flight mode that they're not designed for. This stress is to the brain as Homer is to his couch cushion - brain chemistry gets out of balance and we gradually lose the ability to bounce back to our original form. Medication and some gentle retraining of our thought patterns & habits can help fluff us back up.

She hates it when I say "Everything's going to be OK" because she thinks it won't ...
She'd rather have her feelings of the moment be validated, then be told that they are wrong. The facts may back you up, and everything may indeed turn out okay, but she still feels awful, and just wants you to understand that. Apparently women get this intuitively; we guys have to override our instinct to explain/solve/fix everything, and just be a heat-sink for her feelings.

If you offer to participate in any therapy, it shouldn't sound patronizing. But do take Chuckles' point seriously: "You are not the father or the therapist, finding yourself in the wrong role in her mind could ruin your relationship." This is insidious. It's tricky to be supportive without crossing those lines. Don't let the romance of the relationship slide, replaced with lots of logistical talk about remembering medication and modifying behavior and making it to appointments. There's nothing sexy in that.

Have you told her this?: "I feel like I'm losing the person I fell in love with to a sadder, angrier person."

That would certainly motivate me to take deeper look at myself.
posted by Tubes at 9:57 PM on January 27, 2006

Damn!
"She'd rather have her feelings of the moment be validated, than to be told that they are wrong"
posted by Tubes at 9:58 PM on January 27, 2006

I'm hoping for answers from people who have had anxiety disorders themselves.

I missed this on my first reading. When I got very depressed, "depression" was not a word in my vocabulary. I thought anti-depressants were for weaklings. I actively disliked therapists.

As a result, in the beginning I had no idea my problem was mental. It was complicated by the fact that my depression was not reactive -- there was no trigger. It was simply the result of a lifetime of dealing with stressful situations badly. I didn't even know that.

So I was convinced something was wrong with me physically, and I kept going to the doctor asking them what was wrong with me (usually only pointing out some physical symptoms). Finally, after doing this several times and being told I was fine, I really started to panic, and one of the doctors realized it and told me that I was severely depressed, after asking a series of pointed questions about my mental state (and to this day I'm very grateful that she was good enough at her job to do that. I owe her a lot).

That was actually all I needed to get better -- I only needed a diagnosis. It was still hard and took a couple of years to really become myself again. But that, coupled with reading books and going to a therapist, and realizing that I was not crazy, and that I was not alone, was all I really needed to start to overcome it. Further, my severe discomfort with needing help with my mental health made it much better for me to start with a regular MD. She prescribed anti-depressants, and checked up on me, and recommended me to therapists. That was very crucial for me. I would not have been able to get my mental health fixed up without that, I don't think. I literally thought admitting that I was depressed meant I was crazy. Luckily, I realized how stupid that was, with some help.

Maybe something like that would help your girlfriend. I really recommend just going to the doctor -- I would have never gone to a therapist if I hadn't been told by an MD that I should.

But the trouble is, you can't make her do that. Your situation is really tough. This advice is probably all you can do:

Q: I think that someone I care about has bipolar disorder/depression. What can I do?

A: Before doing anything, educate yourself on the symptoms of these illnesses. Then pick an appropriate time when you can quietly discuss your concerns with this person. Explain why you believe he or she should be screened for depression or bipolar disorder by comparing their behavior with the symptoms. Encourage them to seek help and resist the urge to function as a therapist.

Reassure them that you are having this conversation because you care about them and want to help them feel better. Remind them that they are not alone and that things can get better. Gather information for them to help them make a decision about consulting with a professional skilled at treating depression and bipolar disorder. Most of all, be supportive and caring.

posted by teece at 10:23 PM on January 27, 2006

a) When she's irrational, be unconditionally supportive of her, while trying not to support or augment her irrational thoughts. This is a tall order; it will keep you busy.

b) When she's rational, suggest things like "Have you thought about talking with someone about these things? You know, I mean, like, a professional." Because that's what she needs.

c) It's not your responsibility to repair her. It's not even your responsibility to stick around, if her illness is hurting you. Keep that in mind, and you won't get in over your head.

I wish you well.
posted by ikkyu2 at 10:57 PM on January 27, 2006

It could be chemical imbalance that the appropriate medicine would resolve. I closely know three people who were greatly helped by one of the serotonin reuptake inhibitors.
posted by semmi at 10:58 PM on January 27, 2006

"She'd rather have her feelings of the moment be validated, than to be told that they are wrong"

This is an important point. Having dealt with depression and anxiety for most of my life (though it's been well in hand for several years now, thanks to a combination of therapy/meds/yoga), I agree that simply being told "It's all gonna be OK," no matter how soothing the tone of voice used or well-meaning the intent, almost invariably does nothing. In fact, it's actually kind of crazy-making -- because when you're depressed and/or anxious, the feeling/belief that things ARE NOT going to be OK is absolutely all-encompassing. She may want to believe you when you say that, but she can't -- she's mentally and cognitively unable to process that idea in a meaningful way.

What do I advise you do? In the short run -- that is, in the midst of one of her panic/depressive episodes -- simply acknowledge her feelings and then ask questions from that vantage point. If she's having a panic attack, for example, try "I can tell you're really [worried/scared/upset] about this [exam/social gathering/conflict]. What can I do to [reassure/help/soothe] you?" That means you've given attention to her actual feelings (no matter how irrational they may appear to you) and allowed her to articulate what she immediately needs. That alone may go some way to alleviating her anxiety or sadness at that moment.

In the long run, though, it's clear (as you know) that she needs counseling and possibly medication. You can't make her do that (although it's natural for you to wish that you could!), but you can certainly encourage her to seek it out in a supportive, gentle, non-judgmental way. And yes, as others have noted, you're not obliged to stick around forever down the road if she ultimately refuses to seek out help. A healthy relationship has to work for both people involved.

Good luck to both of you.
posted by scody at 11:34 PM on January 27, 2006

First off, I'm going to echo the sentiment that telling your girlfriend that "everything will be OK" is crazy-making. Stop doing that. It's a meaningless phrase that tends to come off as patronizing.

When she's freaking out, validate her feelings. Tell her that you're sorry she's feeling bad and hug her. It doesn't matter if she's got a valid reason to feel sad; she feels it and that's that. Trying to use reason and logic to convince her that she's being irrational is just frustrating and kind of scary, because on some level she knows there's no good reason for her fear/anxiety/whatever and pointing it out probably just makes her feel more out of control (I know it does with me)

Then, when she's reasonably got her shit together, sit her down and tell her that you think she's depressed, that's it upsetting and frightening for you as well, and that you will help her in any way to can to get her to the doctor (call the number, drive there with her, whatever) so she can start getting better.

Hug her, tell her you love her, and tell her you want to get back the person you fell in love with. Then hand her the phone and the number for the school counseling/medical office. That's pretty much how I finally got help for depression, so I'm thinking it might work with her as well.
posted by stefanie at 12:25 AM on January 28, 2006

OK. Here I go, against the flow.

Maybe street drugs will help.

Has she ever dropped acid, or done ecstasy?

Those drug experiences were revelatory for me: I saw that I was in fact different from other people, that I was depressed, and that I did need to change. Enlightenment doesn't care how you get there. And if this is a developmental, situational thing, perhaps that short sharp shock will be all it takes to bring her out of it.

Therapists are like chiropractors: their only solution is more treatment.
posted by BitterOldPunk at 1:33 AM on January 28, 2006

There's an excellent book you might read to help yourself in this situation: When Someone You Love Is Depressed: How to Help Your Loved One without Losing Yourself, by Laura Epstein Rosen and Xavier F. Amador.

If your girlfriend had a broken arm, you wouldn't try to "fix" it. She needs professional help. Urge her to get it. Would she be willing to see a counselor at the student helth center? (Much less scary than a shrink.)

I've had bouts of severe depression, at times accompanied by anxiety, all my life. Therapy and medications have helped tremendously.
posted by Carol Anne at 6:30 AM on January 28, 2006

My anxiety was greatly helped by counselling and 8 months on Effexor. I got up the nerve to go to the doctor only after talking to friends who had done it themselves, who were willing to tell me what the doctor was going to ask me, what anti-depressants would make me feel like, and who told me exactly how it helped them. I had the impression that anti-depressants would make me like a zombie, when in fact the opposite was true -- they made me feel normal for the first time in a long time.

"Everything's going to be okay" never helped, because I knew that everything was going terribly wrong and that statement just made me feel like the speaker wasn't listening. However, it did occasionally help to have a friend say, "Wow, that is a lot of stress, but you only need to get through today. Worry about next week next week. If you can't work on it now, don't worry about it now. And if your presentation is crap, well, it's only X% of your mark and you'll survive. We'll have ice-cream either way."

It sounds like you've done research on this, and a lot of the things that you mention are definite warning signals (apathy, loss of appetite, anxiety, etc). Try to present that in a way that lets her know that you're concerned about her and not just attacking her for being a pain in the ass sometimes. She might take it that way anyways, simply because it's scary to consider that there might be something wrong with you, especially when it's something wrong in your brain. People tend to react defensively rather than gratefully at first.

And yes, as mentioned above, make sure to take care of yourself. She'll get help when she decides to. It's not your decision, and it's not your fault if she keeps sinking. Keep that in mind. Personally, I find it very hard to remember, but it is not our fault if our friends make bad or unhealthy decisions. We can offer help, but it's not up to us whether they take us up on it or not.
posted by heatherann at 7:21 AM on January 28, 2006

I have had an anxiety disorder for years, peppered with mild and severe depression. I think I may have had it as a child as well, I just wasn't aware. I finally was diagnosed in college and went through various treatments and therapists. It wasn't working. After college I finally found a treatment that does work. I've been on Paxil for years. It works wonderfully for me.

My suggestion to you is to openly engage her in her depression and anxiety, let her talk it out. My family on both sides suffers from these disorders and I grew up around people that were very open about treatment. In college, I continued to be open and engaged those that wanted to listen. It's not the end of the world and it's very treatable, your girlfriend just needs to find the right treatment. But it all starts with discussion.

From there, you need to think about her environment and health. Eating healthy, exercising, drinking lots of water, this is all very important. Is her home environment conducive to study? Can she get work done there? What about part time jobs? Does she have a job that drains the energy from her and takes all of her time?

I would love to talk to you more with this as I've had years and years of experience with this. It's a battle, but it's easily fought.

jstadum (at) gmail dot com
posted by brokekid at 7:26 AM on January 28, 2006

When I was struggling with depression and anxiety, I had no idea what the hell was going on. I constantly thought I was dying: my left arm ached and I could rarely catch my breath. I went to the doctor for a whole bunch of things: MRIs and joint problems and phantom pains. When I told him, and this was the only way I could word it, that I couldn't sleep (I stayed awake all night with the light on scared to death of living) he thought that maybe, just maybe, I might be depressed with anxiety.

Once I realized I was depressed, the doctor suggested Paxil. I was hesitant, I don't really like medications, and at the time I was so caught up with the idea that I was dying that I thought introducing any chemical to my delicate inner ecosystem was going to throw the whole thing off and I'd go into immediate cardiac arrest. I wouldn't even take asprin. I pridefully told him that I would not be taking the medication nor would I ever see a therapist. I told him that eating well and exercising and yoga (which I had yet to try) would cure me. He told me it wouldn't, and coerced me onto the Paxil "just to get on my feet."

I took the Paxil for one week. My mouth dried out, I couldn't really eat anything, and I felt vaguely zombie-like. One of the side affects of Paxil (and I researched the drug thouroughly) is ANXIETY. I felt like I was full of tiny butterflies. On the seventh day, I tossed them in the trash.

I haven't been back to the doctor. It's been about five years, and I'm fine. I took up running, yoga, and tai chi. The yoga and the tai chi were invaluable, amazing. They calmed my body, slowed and deepened my breathing. I researched anxiety and learned that my attacks were self-propelling: when I thought I might be on the verge of having an attack, it would make me nervous, the nervousness would trigger the "Oh no! I'm having another one!" feeling which would kick the adrenaline in and on and on until I was pale and couldn't hear anyone and shaking. When I figured this out, I was suddenly in control: you don't have to let it get past the first step.

Please help your girlfriend not just acknowledge that something is wrong, but help her out with specific information. Encourage her to move her body, to deepen her breath-- help her to be in control.
posted by simonemarie at 7:56 AM on January 28, 2006

When I went through my anxiety issues, I started out by going to the doctor for constant stomach pain. After several medications and tests, we discovered that there was nothing physically wrong with me. However the anxiety (which I thought was because I didn't know what was causing the stomach pains) did not go away. As a result, I was in a constant circle of increasing anxiety and pain. I went back to my doctor telling her that I had started having panic attacks (vs. just a low-grade, constant anxiety) and was prescribed medication. I reacted really badly to it and went back to my doctor. She gave me a different kind of medication that worked for me. I wasn't perfect, but I could function again.

What I think really helped was that my doctor referred me to something called "relaxation therapy". I don't know if it is the same everywhere, but what I went through was 45 minutes of guided breathing exercises, meditations and some light stretching. All of this was done to music in a darkened room with people lying on beds. After this session, we then went to a classroom and discussed stress and anxiety related issues for 45 mintues. One subject was discussed per session. I'd leave those sessions feeling hopeful and able to take on everything I needed to.

Eventually, I needed the medication I was taking less and less. (It was a "take as needed" med, not a "take regularly" med). I truly believe the relaxation therapy saved my life. I'm still using many of the practices today (a year later), and I haven't relapsed. That's not to say that I have never been anxious again, because I have, but I know how to deal with it so it doesn't become the all-consuming thing it once was.

Anyway, the point of me telling you all of this is that her doctor is a good first resource. Once physical causes are eliminated, she can ask her doctor for referrals to something more specialized for *her* needs. No treatment is 100% wrong or right for everyone. It may be hit or miss. Just don't give up and think it's going to go away on its own because it won't.

I really admire you for wanting to help her so much, and doing the research you are doing to try and help as constructively as you can. I remember my husband and parents feeling so helpless when I was sick - they wanted to help, but they just didn't know what to do with me, and I couldn't articulate what they could do to help. Just being there and listening to me helped a lot though. Doing the "administrative" parts of her healing (making appointments, driving her there etc.) may help too. (Make sure she is okay with you doing this and is aware of it. She may want to control this herself.) That way she can focus on her healing, not negotiating appointment times and scheduling.

One of the biggest things that I learned from all this is that so many other people have been through it, and got well. I wasn't shy about talking about it, and as a result, I heard so many stories from other people who went through the same or similar issues. (And it was a real cross-section of people, there was no stereotype. That was another eye-opener.) It reminded me that I wasn't weak, but that I was sick. And seeing those people talk about it as something that happened to them in the past made me realize that I would get well again.

I wish both of you the best of luck on your girlfriend's path to healing. Feel free to email me if you need to (it's in my profile).
posted by melissa at 8:08 AM on January 28, 2006

I have anxiety disorder, dysthymia, and panic attack disorder. I've had them all since I was about 12 (I'm 27 now), but steadfastly refused to seek any help until I was in my early 20's, the stubborn notion of "I can overcome this on my own" and my pride/denial led me down a slippery slope until I was suicidal, wouldn't leave my apartment except to go to work. I moved 700 miles on my own to Chicago, where I knew absolutely no one, when I was 21, and didn't return phone calls from friends or family for over 8 months. It got bad.

I eventually had a panic attack so severe it landed me in the emergency room via ambulance at 2 in the morning, unable to breathe. The doctor called my parents, with my permission. After that I was so miserable and tired I didn't even have the strength to argue with my family and agreed to see a therapist. I was quickly diagnosed and put on effexor, and my life did a 180. For four years I've been pretty much stable, well-adjusted, happy, social, calm, and content. I don't know how I went through 10 years of being so unhappy. It's not always perfect and I still struggle sometimes with depression and anxiety, but no more so than your average person, I don't think. I haven't had a panic attack since I landed in the hospital.

The same things don't work for everyone, of course. I don't go to therapy hardly at all, because I find the medications work well enough, and that my problem truly is more of a chemical imbalance than anything else- I don't really have any underlying "issues" to deal with and thus not much to talk about in therapy. My doctor understands this and I only see her a few times a year. It may be the same for your girlfriend, or she may be helped much more by therapy than meds. Me, I can't go off medication. I've tried it a couple times and within months I'm right back to where I was when I lived in Chicago. I'll probably have to take something for the rest of my life. Your girlfriend may not even need them, or only need them for a short time.

But a lot of what you wrote sounds like you could have been describing me 5 years ago, and I think it's pretty clear she needs to see someone, which you already seem to know. She also sounds about as fond of the idea as I was. I certainly hope it doesn't take ending up in the hospital to convince her to get help as it did me.

Point of note: it doesn't sound like she's having true panic attacks. Anxiety over tests, being called on in class- these anxieties have specific causes. Panic attacks come out of no where, at any time, and for no reason. You might be having an ordinary conversation with someone, and suddenly, without warning, you're terrified, your hands and upper lip are going numb, you can't breathe, can't stop sobbing. However, high anxiety can be no less debilitating and I wouldn't wish either condition on anyone.

So what can you do? Most of all- patience. Most people who are depressed are aware of how difficult they can be to deal with, and even more difficult to be in a relationship with. But they can't help it. I often felt in relationships like I was sabotaging them with my behavior and anxiety, my social withdrawal, and I really did not want to do this- but I couldn't seem to control it. It's just a further cause of more anxiety and it can be incredibly difficult. She may very well be scared to death of the effect it's having on your relationship, as much as you are. Reassure her, not with words, but just by being there, being understanding, and not abandoning her. This isn't to say you shouldn't do anything- suggesting therapy isn't patronizing if approached in the right manner, clearly out of your concern for her well being. If there's anyone you know, friends especially, who have gone through something like this an gotten help, try and get her to talk to them. Don't point out how irrational her fears are. She already knows this. Just be there for her.

Good luck with this. I'd be happy to go into more detail about my own experience if you want, my email address is in my profile. I know you have a lot to read here, from me and from others, and I hope some of it helps, but ultimately this is going to have to be her call when and if she seeks help, and on her terms.
posted by Meredith at 8:28 AM on January 28, 2006

One thing you can do *when* she is freaking out (other than listening and validating) is to gently ask how many times she has freaked out about X and how many times that fear has come true. It may not work for her (I don't know her), but my boyfriend does this and I've come to do it myself and it helps immeasuably. This is basically a wee bit of cognitive therapy.

Also, if you do decide to encourage her to see a therapist, I would recommend finding one and making the first appointment for her. When I was most anxious and unhappy, the effort of getting to help seemed utterly overwhelming. I would have been so relieved if someone had stepped in and managed for me at first.

Finally, I would stronly suggest attempting cognitive therapy and exercise first, and meds second. It has meant so much to me that I am teaching myself to manage what are sometimes reasonable fears on my own: it has reduced my anxiety to prove to myself that I can. Besides, anxiety responds very well to cognitive therapy and being free of the hassles of medication if possible are worth it. Unlike what Meredith seems to imply, all therapy is not "talk therapy" about underlying causes, etc.--cognitive therapy is not. And that makes a difference: your therapist wants you to not come back; s/he wants you to learn how to think in ways that benefit you. Personally, I have had a lot of success with some short-term therapy and then independent work with CBT books and loads of exercise.
posted by dame at 10:37 AM on January 28, 2006

Unlike what Meredith seems to imply, all therapy is not "talk therapy" about underlying causes, etc.--cognitive therapy is not.

This is probably true. I don't know anything about CBT and have never seen a cognitive therapist. I am only speaking from my own experience, which has been strictly limited to psychoanalytical therapy, for the most part. I don't mean to imply that there aren't other alternatives out there.

I may look into CBT for myself, after reading these comments.
posted by Meredith at 10:46 AM on January 28, 2006

First disclaimer: I have absolutely no formal education on the matter, aka I'm not a doctor of any kind.

My experience with people trying to do a diagnosis, either doctor or amateurs, is rather unsatisfactory. If anything I've
discovered diagnosis can be extremely difficult, but sometime really careful observation (without prejudices) can go a
good lenght.


For instance you report: panic attacks about assignment. I took the insufficient, but useful Wiki and read
Symptomps of panic attack are "trembling, shortness of breath, heart palpitations, sweating, nausea, dizziness, hyperventilation, paresthesias (tingling sensations), and sensations of choking or smothering."

This description alone DOES NOT tell you if ALL of the above symptoms should occour at the same time to have panic OR if
a number of them is needed to talk about panic ; that's why I think you could use the help of some serious professional.

You can help , but I guess you may NOT be able to help her alone because she may have fears of losing you IF she was to demonstrate
all the she feels/thinks..that may be an irrational fear, but a fear is a fear is a fear and it feels like a fear regardless of
it rationality or irrationality.

I advance this VERY wild hypothesis, based on your assertion that she has problems with school. It could be that she fears of being
seen as an underachiever : some people fear judgment of others, expecially judgment by loved ones ..it's for instance the displeasure one feels from hearing "you deluded me, I'm so much disappointed in you, I can't trust you no more" or something along
this line from a PARENT or some other trust figure. Sometime the will to please these fatherly/motherly/trust figure is so strong that the realization of NOT being able (for ANY reason) of producing expecte result (for instance A grades instead of B etc) starts FEAR of displeasing which could lead to manifestation of fear such as panic.

It could also be that your gf has an image of herself, deeply held, of being a good student..a very good one. It could be that she
gives A LOT of weight to her grades or to achieving certain objectives in a given time (an OK student, not a dropout so to speak)
BUT she may have encountere some problem...a bad professor, something she doesn't understand well....something that makes her afraid of NOT being herself...i'd call that an identity crisis, in which she no longer "knows" who she is BECAUSE part of her identity (of being a good student) is being disproved by difficulties. It is irrational, as even excellent students can fail and do fail , but the fear could be very strong.

Be patient, don't be judgmental about what's rational and what's not (you make mistakes, too...) and understand that she may not be and probably is not BATSHIT INSANE...irrational fear make people LOOK odd/crazy while they're NOT clinically so.
posted by elpapacito at 11:00 AM on January 28, 2006

I'm sorry if it seemed like I was picking on you Meredith. Not my intention.
posted by dame at 11:00 AM on January 28, 2006

Bitteroldpunk's advice is not good. I tried it when I was in college. Let's just say that if you have chemical imbalance issues, monkeying with the chemicals recreationally can make matters worse. (Yes, it was fun in the short term but I am probably paying for it now.)
posted by konolia at 11:12 AM on January 28, 2006

Dame: no offense taken at all, it was a valid point. I just wanted to underscore it.
posted by Meredith at 11:25 AM on January 28, 2006

>>>> I feel like I'm losing the person I fell in love with to a sadder, angrier person.>>>>
Tell her that.
posted by gt at 11:50 AM on January 28, 2006

I was in the exact same situation as your girlfriend several years ago. I've had depression and anxiety issues all my life but they got really bad after a couple of traumatic events that happened shortly after I graduated college. I'm better now - not perfect, but a lot more functional. Here is what helped me:

1) Figuring out ways to change things that bothered me. A big contributor to my anxiety is the feeling that I have no power to prevent myself from being hurt. Proving otherwise helps me not get anxious when things start to go wrong.

2) Exercise and yoga. Cardio exercise like running or the stairclimber are great immediate treatments for anxiety, and yoga (or other meditative practices) are good at preventing anxiety.

3) Improving my diet. I have a lot of issues with hypoglycemia that both contribute to and result from anxiety. Now I eat several small meals each day, avoid sugars for the most part, make sure I get enough protein, etc.

4) Staying active during the winter. I get quite depressed in the winter if I don't stay very physically active. It's tempting to climb into a cocoon and hibernate away from October to March, and it's hard to break the pattern once it's started, so I find the best thing is to get into the habit of exercising in the summer so that I can carry it into the fall and winter.

Therapy and drugs were two things that did not help me. I tried therapy for a while and got absolutely nothing out of it. The stuff I did was classical talk therapy, though, not CBT. From what I know of CBT, I'm a lot more optimistic about its ability to help anxiety disorders. I would strongly encourage her to investigate it if she's willing to try therapy. One bonus: CBT usually only lasts only a few, and it follows a pretty set curriculum that she can read in advance if she wants. That's easier for some peopel to swallow than the idea of doing an unbounded amount of classical therapy.

I tried Prozac once on the advice of my doctor. It was a complete disaster. Two hours after I took my first pill, I felt on-top-of-the-world high. An hour after that I had the worst hypoglycemic attack I've had in years followed by recurring panic attacks the rest of the day. I never took it again. As simonemarie said, anxiety is a side effect of SSRIs and it affects some people a lot more than others. Don't rule out SSRIs entirely, but do be aware that there is some risk that it will worsen anxiety.

Finally, your role in all of this: I completely agree with other posters' advice about not saying "it's going to be OK", and validating her feelings when she's in the middle of an anxiety attack. Such attacks are naturally self-limiting. They will eventually end on their own. You can help most by making her feel safe in the moment. As for everything else, your encouragement will be invaluable for her even if she doesn't seem receptive at the moment. If you can, go out and exercise with her, it's the thing that will provide her with the most immediate benefit. Talking about therapy is a good idea but be aware it may take some time for her to get used to the idea - especially if she was raised in an environment where admitting psychological weakness wasn't allowed.
posted by rhiannon at 1:17 PM on January 28, 2006

[Sorry in advance for the long response! I hope it's of some help, though.]

Anonymous, as I read your initial description of your girlfriend's situation, I couldn't help but think that it sounds exactly like my situation did a couple years ago, and a lot like what I've seen friends and significant others go through.

There are a ton of good responses here. In particular, the responses from teece and Meredith remind me of some of the things I'd forgotten about my major depressive episodes during my sophomore year of college. Just like teece and some others here, I had no idea what it was I was going through when I was in the thick of it. For instance:

-I began to find it almost impossible to complete work or make it out of bed many days—but since I've procrastinated on classwork from as early as first grade, that didn't strike me as odd.

-I also began to pick at the acne on my right cheek to the point where when I went home for winter break that year, my parents were horrified at the damage I was doing to my skin—but since I've had this OCD picking habit (albeit undiagnosed) ever since I came home from the hospital as a baby, I didn't see my then-behavior as out of the ordinary.

-Further, I was unbelievably angry and avoidant. I rarely visited friends anymore, even when they repeatedly asked me to come out with them—I would just sit in my room and wait for them to decide to come by, then indulge in righteous anger when they wouldn't. I would sit online for hours on end, making a big deal on my blog about tiny affronts in real life. I would also get into huge arguments with people in online forums about things like alcohol use or conservatism on campus.

-Finally, I was used to being sort of "separate" from my friends in high school, as my father was very overprotective—so when I began to recreate this separation with my college friends, I just figured there was something essentially wrong with me that made it so people didn't like me. It took me a long time to realize that I was artificially recreating the confines of my high school existence—and that there was no one keeping me separate from people but myself (and what I later realized was my mental illness).

I was in a long-distance relationship at the time with a guy I'd eventually get engaged to, (said engagement since broken off), and I think he had the same feeling you do, anonymous, watching me struggle. "I feel like I'm losing the person I fell in love with to a sadder, angrier person."

And like teece, when I had a doctor's appointment that fall I came prepared with a list of small physical symptoms that had been bothering me—but I didn't bring up the patterns of thought I was falling into because it just didn't occur to me that they were a problem.

Eventually, I began to suspect that I was depressed, but I thought I was above treatment—that I could just will myself out of it and get myself back on track. This line from Meredith's response summed up how I felt a lot then: "I often felt in relationships like I was sabotaging them with my behavior and anxiety, my social withdrawal, and I really
did not want to do this—but I couldn't seem to control it."

During that time, I didn't want to talk to people I used to know because I felt like I hadn't achieved anything at college—definitely nothing on par with the things I'd done during my overachieving high school days. What eventually started to pull me out of the hole I was in was that the university assigned me a progress counselor and forced me to meet with a dean after I got four incompletes that year. They listened to me, made me feel like someone actually cared about me, and helped me get organized and set goals for myself—some of the things a mental health counselor would have done, I think. I still wasn't entirely out of that hole, so I avoided the progress counselor at many points—but her influence did start to help. I applied to a couple of honor societies and got in, and started doing better in my classes, and eventually saw the opportunity to go for a top editor position at the student newspaper, so I went for that and got it.

After I'd taken a few calculated risks like that and come out on top, I started feeling more confident again, and I felt like I had things going for me. Spring of my junior year, I started to go out with friends more, and eventually tried drinking. (I'd previously been strongly averse to it for a number of reasons.) While drinking alcohol is sometimes likened to playing with fire for those who are depressed, I found that drinking helped me learn how to push aside some of the recurrent resentments and feelings of ill will towards others that were keeping me from seeking out social situations. So now I'm a second-semester senior, in my second semester running the newspaper here, and while I still get down from time to time and feel anxious, I've learned to better recognize my own personal warning signs and take steps to make myself feel better before the episode has time to develop.


So given those experiences of mine, and given your description of the situation with your girlfriend, I'd say this: your girlfriend may not be able to articulate or even grasp what's happening to her right now. You're in a bind, then—you need to help her come to realize what's happening to her, but you need to do that in a way that's non-paternalistic and very affirming. She may turn on you at times, or at least it may feel like she is—but you have to learn to separate that behavior where she pushes you or others away (part of her illness) from her actual feelings for you. You also need to remain mindful of the fact that your relationship may end at some point—i.e., as someone mentioned much earlier in this thread, that you may not necessarily be able to be her saving grace forever, even if that feels like something you want to do. You just have to do the best you can with the time you have with her—and don't forget to joke and laugh and create fun times whenever possible. Wherever point she's at, humor and warmth and understanding are very important.

For her part, she's going to have to learn how to recognize the warning signs herself—and so she's going to need, at very least, to visit a counselor of some sort. See if your campus has free counselor visits or ones with a very low copay—on my campus, for instance, you get something like eight free visits per year, and then following visits are $10 or $15 each. Perhaps visit one of these counselors yourself—they can help you come up with strategies for dealing with your girlfriend's struggles, and your decision to visit one may serve as a positive example for your girlfriend.

I can't think of any more specific advice right now, but hopefully my story will help fill you in on what it's like to be in a place like your girlfriend is in right now. If you have any more specific questions, you can certainly contact me via the information listed on the site in my profile.
posted by limeonaire at 2:34 PM on January 28, 2006

I dated a guy in college who had some serious issues with anxiety and depression that he masked until they got out of hand, so I am only saying this as someone who's been on the wrong end of this particular stick:

If this escalates, remember that you are not responsible for her or her choices. As has been said in countless AskMe threads, sometimes you have to set your own boundaries. Be prepared to do that. As someone who failed to do so at the right time, I can tell you it's hell when you don't. And I second limeonaire's advice to see someone yourself to determine how you will deal with this.
posted by Medieval Maven at 4:58 PM on January 28, 2006

My girlfriend is the one who finally got me to go to (mostly CBT plus Zoloft) therapy, for which I am grateful. She basically told me that my depression was making life hard for her and that she really wanted me to see a professional. I'd recommend that route. It's totally within your rights as a boyfriend/girlfriend to ask that she get herself treated. You can't force her to go, but you don't have to stay with her, either.

Part of the trouble with depression is that the very disease itself causes one to be reluctant to do the very things which will alleviate it. Sometime we just need a good (loving) kick in the ass.

The other thing you can do is offer to go to couples counciling.
posted by callmejay at 5:22 PM on January 28, 2006

Part of the trouble with depression is that the very disease itself causes one to be reluctant to do the very things which will alleviate it. Sometime we just need a good (loving) kick in the ass.

Absolutely true. With emphasis on the loving part of course.

Be respectful of her space but by all means try your best not to allow her to slip deeper into passivity or despair about her problems.

She may even get to hate you now for insisting she seeks help, but she'll thank you later for getting her moving in the right direction (and you'll thank yourself, whether you stay together in the end or not). It sounds like her problems are still very manageable, and she has the opportunity to make the decision herself and feel in control and able to choose. Emphasize that aspect, cos most likely she's not taking it in. Much better for her to seek help now than only get it when she's forced to by circumstances because things have gotten worse.

Everything's been said already, plenty of good advice - but I just want to add something else that may be obvious yet absolutely needs to be reinforced to people who are especially reluctant to seek help: make it clear to her she doesn't have to be stuck with the first option or first therapist she finds, reassure her that she will be still very much in control about that, and she need not be afraid to express her objections, in fact, she has to.

If she feels that particular therapist is not working for her, she needs to be aware she has an *infinity* of other choices, because what matters a lot more than the kind of therapy being pursued is the therapist themselves, their character and personality, their ability to be flexible and combine several approaches and adjust them to that particular person, and how well they both click off. She needs to give it a few tries of course to realise that, but she must not let a potential first disappointment stop her from trying with other professionals.

(Same with meds, of course. But meds aren't always necessary, and good therapy helps more in the long term anyway, giving her the right tools to cope on her own without becoming dependant).
posted by funambulist at 5:36 AM on January 29, 2006

Check this out.
posted by semmi at 1:48 PM on February 2, 2006