How to help teenager with depression?

October 31, 2007 9:41 PM

An adolescent relative in her senior year of high school is suffering depression, and recently spoke to a psychiatrist about suicide, which resulted in her near-hospitalization. She's taken Zoloft, and done some therapy -- what now?

She became depressed over a year ago, and it looks to have been at least partly situational, with various family pressures to succeed and so on perhaps combining with some kind of genetic tendency towards depression.

This past summer she suffered a kind of nervous breakdown that caused her to briefly not complete a summer internship, and then she seemed better for a while. Now she told her psychiatrist she felt suicidal, and was nearly hospitalized.

She's been taking Zoloft for a year now, though she stopped for a month or something a few months ago. She's been in therapy with this psychiatrist for a month and a half, and feels a mild rapport with him.

She is otherwise quite functional: good grades, extracurriculars, etc. She claims not to know the cause of her depression, and she also claims that she knows it is irrational. She nevertheless maintains that there is a "black hole in her heart," and at various previous times has wanted: 1) to be away from everybody in some far away, anonymous place (though her internship was in such a place and did not help...though there *were* other people her age there), 2) to take a year off before college, 3) to have what she thinks is a more fit body (she feels that she is fat, and she probably is objectively overweight).

This is a random bunch of facts, but the question is: what else can we do to help her or she do to help herself?

Perhaps cognitive-behavioral therapy as opposed to the more traditional psychodynamic kind she's undergoing now?

An isolation yoga retreat (she likes yoga)? A trip around the world?

Some kind of major volunteer activity that would expose her to the plight of poor people elsewhere and enlarge her perspective?

The year off from college is no problem at this point, but what can she do now to better her depression and hopefully graduate from high school?

posted by anonymous to health & fitness (14 comments total)

I've been through clinical depression and SSRIs.

You may not want to hear this, but the way your post is framed is very much what can I do to force her to get better? The answer is, not much.

She's taken the very important steps of getting on a drug regimen and seeing a therapist of any stripe. I would say that your role to push her into something probably ends there. As a parent? adult relative, your role now is probably something that you should frame in a more reactive or Rogerian way.

The She claims not to know the cause of her depression graf in particular just signals to me pressure to make her spit out some sort of magical "root cause" which you can then eliminate. This is a) sort of the way men try to help women, and b) maybe sort of the way that umbrella parents try to fix their childrens' lives. I'm just sayin'. I would think hard here about how difficult you're making it for her to find her own path out of this situation.

In short I would try to, y'know, "be there" for her, do a lot of listening, and don't make your relationship about playing twenty questions. Certainly, you shouldn't be asking us for suggestions to give to her, unless she's solicited them herself, though I fully understand the impulse to want to do so. I would just expect a reaction like "You told your friends on the INTERNET?!"

If anything, she probably needs attention that does not revolve around her depression, her plans for the future, her recent fuck-ups and whatnot. I'm sure you have an inkling what that is. A visit to the zoo, a domestic animal, a redecoration project. Or just "space". The main thing you should give her is that you realize she's becoming an adult and you have confidence that she can find her way out of this.

OK, let's see now if I'm out on a limb or the first blow in a pile-on. ;-)
posted by dhartung at 10:00 PM on October 31, 2007 [5 favorites has favorites]

It sounds like she already has competent medical care. Her doctor will help her recover as best as modern science can.
posted by TeatimeGrommit at 10:20 PM on October 31, 2007

Been there, done that...and by done that I mean am still trying to sort out this mess.

There is very little you can do to help her get better aside from being there for her. Like dhartung said, the attention should not be about her depression, etc. Be there to talk about it if she brings it up. But don't take her out to dinner and then start with the "So, how are you doing?" interrogation.

Exposing her to the plight of poor people elsewhere could "enlarge her perspective." It could also make her feel like an absolutely terrible person, for being so sad when she is so fortunate.
posted by gembackwards at 10:28 PM on October 31, 2007

I agree with dhartung. Too much pressure to "fix it" will result in her retreating more into herself. Depression is, at its worst, intangible. The person who has it may or may not know why. My guess is that she knows the cause, but her fear is that if she explains it to someone, it might be minimalized, i.e. "Oh, that's silly." or "It's not that bad." I'm not saying you would do this intentionally, but that's what she might be thinking, especially when she says she knows it's irrational. She's taking the right steps as far as talking to someone.

The first month of therapy can be tricky. You said she was on Zoloft for a while but stopped taking it. Why did she stop and did she do so under a doctor's care? Is her new doctor working with her to find a new med? The first few appointments usually center around finding out the patient's history and talking about meds and how the patient is adjusting to them, which might be why she only feels a mild rapport with him. There's not a whole lot of working through the problems as much as giving the doctor a bunch of facts to work with. If two or three months from now she still feels the same way about her therapist, I would suggest maybe finding someone else for her to talk to. She has to feel like she can trust and even like her therapist in order to get down to the horrible things she's feeling. I spent almost two years with a therapist who was utterly useless and it got me nowhere.

One more thing, sending her for a trip around the world or even a yoga retreat is a bad thing. It's a fight-or-flight response and it will only teach her to run from her problems. Also, the problem is within her so having a change a scenery isn't going to help in the long-term. I doubt you'd want her to have a panic attack or fall into a depression when she's across the world. Plus, it will only lead you to feel more helpless when the things you do for her don't help her get better.
posted by firevoice at 10:29 PM on October 31, 2007

so she is a high school girl, not happy about her body and feels like she's missing something... i would be interested to know what her love life is like. it can't be easy having those feelings about yourself and then going in to school every day only to see the 'hot' girls get all the attention from the boys. just my observation from the info you gave...

as far as how you can help... be there for her. don't force her to do anything she doesn't want to do.


.//chris
posted by hummercash at 10:37 PM on October 31, 2007

The only thing I can think of to suggest is to help lighten her burden a little bit. When I was going through a rough patch, I was supposed to be moving house...in the end my family had to come finish it for me because I just couldn't handle it any more.

Because of that, however, I knew exactly what to do when I saw my younger sister going through the same kind of stuff.

(In her case, she needed to get a bunch of things done before she left for school, like shopping for cutlery. So I drove her to Ikea, made sure she picked out everything she needed...basically provided some structure without all the hassling and worry that she would have gotten from the 'rents about 1. the stuff she still needed to do, 2. the stuff she was going to have to do once she got to school, or 3. how she was feeling/what she was going through.)

Basically what I'm saying is, stick with her and support her as she works through this rough patch and learns how to function with depression. And nthing dhartung.
posted by lhall at 10:41 PM on October 31, 2007

She's doing a lot of wonderful, active things to help herself -- seeing a therapist, doing yoga, admitting when she's worried about hurting herself, maintaining her activities (and presumably her social network?).

That's really quite an accomplishment.

Tell her so. Keep telling her so.

Encourage her to keep relying on her own remarkable coping skills. Let her know you're around if she wants help with anything.

But keep reminding her how much she's accomplished on her own and how good her own instincts are, rather than trying to solve her problems for her.
posted by occhiblu at 10:42 PM on October 31, 2007 [2 favorites has favorites]

There are really good posts above so I'll try to keep it brief-

Perhaps some sort of pampering for 'no reason' type gift or activity you can do together? Massage? A pricey ultra healthy meal and yoga session?

If not pampering then something task oriented. Help her clear a few of the nigglingly annoying little things off her (probably voluminious) 'Stuff to Do' list.

This could be something like lhall's Ikea trip, or some other assistance to encourage a sense of achievement. If you can feed back something to her that she's said to you that could be considered a goal, show her you are listening:

"You mentioned the other day your pillow was getting worn out. I got you a voucher to Good-Sleepware-Store and thought we could go get one this Saturday, maybe have lunch afterwards. What do you reckon?"

At times like this small helpful acts can clear a lot of the pressuring mental jabber, which is the stuff that really wears you down.
posted by gerls at 1:00 AM on November 1, 2007

She claims not to know the cause of her depression". This is probably because she doesn't. This is a perfectly normal reaction to feeling depressed when a far as anyone can tell there is no disastrously wrong thing in one's life. No-one is going to magically find an answer the seventeenth time you ask what's wrong if they didn't know the first sixteen. Try believing her when she says she doesn't know. Accept that she would really like to know, because her life feels wrong to her as well as to those around her, and is spending time every day trying to work it out herself and has already asked herself a thousand times every question you could come up with that you think might identify that cause of the depression, and that you asking those questions is not going to put any kind of different spin on it that will magically cause her to understand and be cured.

... and at various previous times has wanted: 1) to be away from everybody in some far away, anonymous place. This is probably at least in part because of annoying people asking annoying questions like 'what's the matter?'. Any not-normally-annoying person can temporarily fall into that category by being annoying. Stopping being annoying will go a long way toward reinstatement in the 'not-annoying' category. Asking any questions about anyone else's relationship with any kind of medical professional is pretty much guaranteed to cast someone as annoying to me (unless it's a case of 'hey, I need to see an xyzologist, how do you get on with Dr A?').

If the apparently perfectly normal question 'would you like a cup of coffee?' is met with 'umm, I don't know, do I? maybe?', and possibly tears, the solution is not to press any further but to say 'that's ok, I'm making one anyway so I'll make one for you too, and if you don't want it you don't have to drink it'. That's not a metaphor, by the way, it's an example of how to deal with one specific situation. You could probably adapt and extend it for use as a metaphor if you wanted, but that's up to you and this advice does not come with any guarantee.
posted by Lebannen at 3:07 AM on November 1, 2007

TeatimeGrommit paints (inadvertently?) a sad picture.

Perhaps some sort of pampering for 'no reason' type gift...

I was a pretty suicidal teen-ager at one point (fine now, though it took some time and doing -- rapport is great but not necessarily curative), and yes, it doesn't hurt to make with the nice.

She's sick. If she had cancer, nobody would think of the 'expose her to the plight of...' sort of idea. They would, however, think of nice gifts, calling frequently and generally 'being there,' and periodically taking her somewhere to do something fun and interesting to get her mind off her illness.

For stuff that looks more like helping, though, you can ask her about practical problems, and try to help solve those. Which see "like shopping for cutlery." Doing very basic things can be very difficult when you're depressed. If her hair's a mess, it might not be that she doesn't care anymore, but that calling for an appointment to get a trim was too difficult recently. Just haul her along next time you see your own stylist without making a big deal out of it. That sort of thing.

I don't think a trip/retreat is such a bad idea, but I obviously don't know your relative. If the money's there, it's worth offering.
posted by kmennie at 3:32 AM on November 1, 2007

yes, the best thing to do is treat her as if she were ill, because she is. you can "snap" someone out of a bad mood or bad mindset with some sort of enlightening activity, but true depression is different. the chemicals in her brain are out of whack and the wiring's gone bad. it's like losing your ability to speak after a stroke.

that said, the thing to do is be supportive. the retreat might be helpful, depending on how long she can be away from her therapist. also, keep reinforcing her life-affirming decisions.
posted by thinkingwoman at 4:17 AM on November 1, 2007

Three things:

Exercise is a real cure for depression.
Don't dismiss her desire to get fit. Exercise is one of the most useful treatments ever found for depression. Maybe her desire to exercise is grounded in dissatisfaction with her body, but that won't prevent her from getting an endorphin rush and feeling great after a good cardio workout. And you say she is overweight. Adding some exercise sounds like it would be good for her physical and mental well being.

Let her relax. Right now.
Maybe she deserves a break - good kid, good student, good at extracurriculars, that's a lot of things to work hard to be good at. Does she feel like she has to do too much to please you or meet the world's expectations of you? It's OK for her to drop something after school if it would help relieve some pressure, as long as she's not wholly withdrawing from the world. Obviously, this must be her decision. But back her, if she makes it.

Let her wait to go to college.
Don't dismiss her desire to take a year off before college. Colleges don't do a very good job at coddling and looking after depressed and suicidal people. The results can be tragic.

I enrolled in college in the midst of a deep depression, and my first two years are a blur of misery and horrible grades. I'm not sure that a year off would have cured my mental illness, but it would have given me a break from a life of academic overachievement and it would have also given me a new perspective.

If she chooses to take a year off, two things are happening: she gets to feel control over her life, because she made a decision rather than continuing down the path laid out for her at birth; she gets a year for self-study and self examination where she can really focus on tackling her depression.
posted by croutonsupafreak at 6:32 AM on November 1, 2007

In my experience, depression makes tend to withdraw from people. Even though outwardly I play the curmudgeon role, when someone calls me up to spend time with me, I'm delighted. It's really nice that someone actually takes the time to just be with me and put up with my shit. Just be with her and be don't judge. Or find some people that do.

I wouldn't do any of the things that have to do with other people - yoga retreat, plight of the poor children, etc. If someone were to do that for me, I would just feel worse, i.e. "So there's all these poor people in the world who have it really truly bad, and here I am in the first world with everything they want and that makes me a bad person for not being able to appreciate it."
posted by kpmcguire at 7:41 AM on November 1, 2007 [1 favorite has favorites]

Is she seeing a therapist in addition to the psychiatrist? Because when I went through something similar (mid-20s, not a teenager) my psychiatrist wasn't the person I actually wanted to talk to about stuff. He was more interested in trying to evaluate my physiological and mental/emotional response to the medications.

My therapist, on the other hand, wanted to get in there and get at the dark stuff. I could and did talk to her about anything. And while I realize the meds helped me get some relief from the omnipresent pain so that I could do the work with the therapist, I would've never made it to where I am today if I had only been seeing a psychiatrist.

Maybe hers is different but it would certainly be worth trying to make sure she's talking to the right person/people to help her in her specific situation.
posted by hapax_legomenon at 9:27 PM on November 1, 2007