What to do about my non-med compliant friend?
October 16, 2010 4:36 PM   Subscribe

My seriously depressed friend on the other side of the country has stopped taking his medication and seems to be spiraling deeper into depression. What should I do?

I live on the opposite coast of the US from my very close friend, J, who is 27. About 18 months ago, J stopped taking the medication that was keeping him afloat. After a month of increasing depression, he moved back in with his parents -- as in, he showed up at their house unexpected and announced that he was too depressed to live on his own any more. After another month of increasing depression, he attempted suicide and ended up in inpatient treatment for six weeks. His life was saved because his mother found him unconscious. His father wrote me a very emotional letter asking how I thought J could be helped, to which I responded with a long list of things that J had told me about his depression and the things I thought might help him. I asked that J never be told that I wrote the letter and that wish has been, by all indications, respected.

So J gets out of the hospital, goes on meds that seem to work, and lands a pretty great job. He develops an active social life, gets a dog, and buys a house. He is doing, by all appearances, better than I have ever seen him doing before. And then about three weeks ago, ominous signs started to emerge that things weren't so good anymore. He'd call me and mope about how lonely he was, how overwhelmed he felt. Now the moping has turned into undisguised weeping. Every weekend, he gets worse and worse.

Today, he finally confessed to me that he hadn't been taking his medications for six weeks. I encouraged him to start taking them again; he claims that they did nothing except make him gain weight and have weird dreams. I encouraged him to start seeing a therapist; he claims he would have nothing to say. I encouraged him to shower and brush his teeth; he says that he might later.

Generally, what can I do here? I am his closest emotional confidant. There is nobody local on whom he depends as much. His parents live 3 hours away, and he is quite dependent on them. They're aware of his increasing depression, but seem unsure of how to handle it. (There may be cultural factors here: his parents are immigrants from east Asia.) On the other hand, they're not aware that he isn't taking his meds. Which brings me to...

Specifically, should I tell his parents that he isn't taking his meds? I have every reason to believe that they would handle the situation so that J never finds out I gave them this information. My hope is that it would emphasize to them how urgent the situation has become. I can't help but feel that inaction here is particularly dangerous given his previous suicide attempt and the fact that he now lives alone.

Thanks in advance.
posted by CutaneousRabbit to Human Relations (22 answers total)
 
I would tell them in a heartbeat.
posted by LobsterMitten at 4:40 PM on October 16, 2010 [9 favorites]


And find out who's the doctor that prescribed the meds, and can the parents get in touch with the doctor for advice.
Maybe they can ask your friend to come visit, and while he's there they can take him to a doctor.
Maybe they can go to visit him and take him to a doctor.
posted by LobsterMitten at 4:44 PM on October 16, 2010


Best answer: If you think he is in danger, all loyalties and promises go out the window. He may never forgive you, but he will be alive to hold the grudge.

I don't think it's a coincidence that his only lifeline is on the other side of the country. He likely chose you to confide in because he thought you would be powerless to influence anything. His parents sound like good people. Get them involved.
posted by WhiteWhale at 4:47 PM on October 16, 2010 [14 favorites]


If he were in his right mind, what would he want you to do? I'd bet he'd want you to try & save his life.
posted by facetious at 4:50 PM on October 16, 2010


I encouraged him

Have you tried moving past encouragement to very directly saying "I need you to take your meds before I'll talk to you"?
posted by fatbird at 4:54 PM on October 16, 2010 [1 favorite]


Tell them right away. I was in a very similar situation with a friend who told me he didn't want his parents to know, but he was clearly not getting the help he needed and I couldn't do anything from halfway across the country. He told me later that he appreciated what I did, but even if he were still upset with me I wouldn't regret the decision for a second. Your friend is not in his right mind, he needs more support than you can give him. His parents might not be the best support on their own, but they might be able to get him to someone who will be.
posted by SugarAndSass at 4:58 PM on October 16, 2010


Definitely tell the parents. And/or if you know the name of his doctor, call him/her and give a heads up as well. My father (bipolar), in a different country from me, stopped taking his meds a while ago, and I asked both MY doctor and my therapist what I could do, and both said it was perfectly okay to call Dad's doctor and therapist and let them know I was concerned.
posted by lollusc at 5:01 PM on October 16, 2010


Response by poster: You're all right, of course. Composing an email right now. This isn't an everyday situation, and it's hard to know if my instincts are right.
posted by CutaneousRabbit at 5:02 PM on October 16, 2010


Tell his parents. His life is in danger.

Have you tried moving past encouragement to very directly saying "I need you to take your meds before I'll talk to you"?

I'm not a mental health expert, but telling someone who already may believe that they are worthless something that might well come across as: "you are not good enough to talk to in your present state" does not seem to me like the best of ideas.
posted by frobozz at 5:03 PM on October 16, 2010 [1 favorite]


Tell them. You can always work out problems afterward. You're being a good friend.
posted by StrikeTheViol at 5:12 PM on October 16, 2010 [1 favorite]


If you could share the diagnosis there would be two different answers.

If he was diagnosed with clinical depression and prescribed SSRI antidepressants, and these the meds we're talking about, he is clearly experiencing discontinuance syndrome. Not technically "withdrawal" (there's a minor technical difference but, in reality, it's the same thing). This can be severe enough to bring about suicidal ideation and other destructive behaviors. Frankly, it's probably not that he's "sick again" because he's not on his meds, but he is experiencing brain chemistry chaos.

If the diagnosis was depression with any Schizophrenic tendencies, he is actually sick again.

He needs the medicine either way -- but for two very different reasons. Many who stop SSRI antidepressants cold and experience severe depression think it is a return of original symptoms. While that's true in a few cases, the abrupt withdraw of the SSRI is the real culprit. Again, either way, he needs to be back on his medicine as quickly as possible. Maybe explaining Discontinuance Syndrome to him would help him to more clearly see it's not him, per se, but the brain storm due to halting the drug suddenly. For years many thought SSRI antidepressants were not addictive in the way benzos, etc. are. In fact, they can be even harder to withdraw from and the longer one is on them the more difficult the withdrawal. Whichever way you look at it -- this is serious and needs immediate intervention.
posted by Gerard Sorme at 5:16 PM on October 16, 2010 [1 favorite]


If at any time you believe he is in danger or placing others in danger, you can call his local police department and ask for a welfare check.
posted by zizzle at 5:29 PM on October 16, 2010


Best answer: Speaking as someone intimately involved with a person who suffers from severe depression, my advice would be to contact his family right now. I know that it may feel like a violation of your friend's trust, but if he's gotten this bad, it's more than you can handle on your own. Even if you were right there with him to hold his hand and try to make it better, it's too much for you to carry.

Call his family, and describe for them what has been going on.

He may be right about the meds not working, unfortunately. None of the medication my boyfriend has ever taken has done anything to improve his mood--the depression just seems to wax and wane on its own--and he's tried 3 different anti-depressants. It sounds like the meds were actually working for your friend, but don't be dismissive when he says they don't work, or try to just browbeat him into taking them again. Sometimes meds stop working. Maybe they stopped working and then he stopped taking them.
REGARDLESS, you should contact your friend's family, friends, anyone who might be close enough to help.

Also, find out what kind of emergency psychiatric services are available in your friend's area. Be prepared to tell his parents about what kind of mental health resources are out there if they seem confused as to what to do. They may have to make decisions that you can't, but at least you can try to make sure they're well-informed. Look on depression-support forums and stuff like that for tips on how to be, well, supportive. This might be helpful for the family, too.

If possible, try not to treat your friend like an invalid or a child through all of this. He may not be making rational choices, but try not to deprive him of his dignity. Treatment is less likely to be successful if it's forced upon him. Try to get him (through the power of persuasion from you, his family and anyone else who gives a fuck about him) to seek treatment voluntarily. It's difficult to reason with an illness, but it's sure worth a try.

He may just need a change of meds. He may just need to meet the right therapist. Tell him cognitive behavior therapy might be worth a shot as it's not just aimless talking, but, hopefully, practical instruction on how to learn to manage his thoughts and feelings so that he feels better.

Still, be prepared to call emergency services if you feel he is in immediate danger.

My heart goes out to you. I feel your pain more than you know. Good for you for being a good friend, and my very best wishes to you, your friend and his family.
posted by apis mellifera at 5:36 PM on October 16, 2010 [3 favorites]


Response by poster: Gerard, as far as I know, his diagnosis was severe depression (without schizophrenic tendencies). He was on an SSRI and did, in fact, quit suddenly. I'm planning to check in later tonight and will talk to him about withdrawal symptoms.

Zizzle, thanks for that piece of advice. I'll keep that in mind.

Fatbird, I'm not sure I could pull that off... I'm also not sure that his desire to talk to me would win if it were pitted against his depression.

All: thanks again for the advice. The email is sent.
posted by CutaneousRabbit at 5:37 PM on October 16, 2010


If at any time you believe he is in danger or placing others in danger, you can call his local police department and ask for a welfare check.

Too many police officers have no clue how to handle these kinds of situations. Police and mental illness issues too often end poorly. Call a hospital, Emergency Services (paramedics/fire), a mental health hotline, other friends even to get him to an ER. But be very cautious calling the police. This is just my opinion, but I have seen way too many of these cases end in tragedy due to poor training of local police in dealing with those who are having an acute mental health crisis. No offense to any officers here - simply anecdotal, but with years of experience.
posted by Gerard Sorme at 5:40 PM on October 16, 2010 [3 favorites]


I must second what Gerard Sorme wrote. I called the police instead of an ambulance (to save a few hundred bucks) when I feared for my boyfriend's safety. It's the only part of my decision to "call for help" that I regret. They put him in handcuffs. Perp-walked him into the hospital. It was humiliating and awful and set the tone for a pretty pointless 3-day stay in the psych ward. Cops are, of course, better than nothing, but try to get your friend to the hospital without their involvement if you can.
posted by apis mellifera at 5:50 PM on October 16, 2010


My own family's experience with the police in a similar, but in many ways far worse situation, is what got our family member the help she needed. She finally did something where a welfare check, or something similar, was required and it got her into a hospital where she got her meds, and then got her meds straightened out, therapy, and stabilization. And several months after that welfare check, she was able to return home (very legitimately needed the long stay).

So, anecdotal-ly --- the police handle these situations fine (and sometimes an ambulance is not the appropriate responder --- especially if other people are in danger).
posted by zizzle at 6:17 PM on October 16, 2010


CutaneousRabbit, you are a wonderful friend to do this. I know writing to his parents is hard, and you worry that J will be angry with you, seeing this as some kind of betrayal, but you are absolutely doing the right thing. His depression has overwhelmed him now, and he cannot see clearly. He needs his meds to get back on the right path. Do whatever it takes to point him in the right direction.

I wish more depressed people had friends like you.

J is very lucky to have you in his life.
posted by misha at 6:59 PM on October 16, 2010 [2 favorites]


Your instincts are right.

I once had to decide whether or not to tell my friend's parents that he was suicidal, knowing that they would likely institutionalize him and that he would almost certainly realize I had betrayed his trust, which would end our friendship and limit my future ability to help him, and feeling unsure of how much they would even be able to help him if I did say something.

So I understand how difficult your position is. But I was right to go to them, and you are right to tell your friend's parents that he is not taking his medicine.
posted by prefpara at 8:47 PM on October 16, 2010 [1 favorite]


I had an online friend that I'd never met in person, but I had her address. She told me she was going to kill herself and signed off AIM. I called her and she answered but refused to talk to me. I called the police in her city.

She was admitted to the hospital against her will and didn't talk to me (well, except for the once she screamed at me for calling the police) for about 2 years. Today, we have met in person and she's still my very good friend.

Tell his parents.
posted by IndigoRain at 9:14 PM on October 16, 2010


Agree: do everything you can to help this person. In this case, the threshold has been met: person with depression/suicidal problems has gone off meds. Even if they aren't suffering a relapse of the depression, going off of the meds too quickly and without knowing what will happen to themselves, will make someone almost literally crazy. If I am "well" and know that I'm just suffering discontinuation syndrome, I can grit my teeth through it. If I'm not well, not self-aware enough, or if I've got some reality issues, the head zaps and ragey moments are going to be real trouble.

If this person is really a friend, they will thank you when the are back to normal. They may not do it outright- that is a really hard thing to do for some people- but their return to normal behavior and communications with you will be the thanks you can see.

If they really do hold a grudge, they are either still not done with the healing/coping process, or they just aren't your friend anymore. Your reward in this case is simply that they are alive and able to enjoy life.

(and if you do happen to talk to this friend again before someone intervenes, DO NOT follow the advice to not talk to him until he takes his meds. People don't react well to ultimatums. All you can do is ask him to go to his parents or his doctor or even call 911 and ask for help. )

Too many police officers have no clue how to handle these kinds of situations. Police and mental illness issues too often end poorly. Call a hospital, Emergency Services (paramedics/fire), a mental health hotline, other friends even to get him to an ER. But be very cautious calling the police. This is just my opinion, but I have seen way too many of these cases end in tragedy due to poor training of local police in dealing with those who are having an acute mental health crisis. No offense to any officers here - simply anecdotal, but with years of experience.

Agree, and disagree at the same time. Most departments are trying very hard to increase knowledge and training on how to deal with these situations. But dealing with people who aren't in their right minds is really hard, especially for someone whose sworn responsibility isn't just for that individual's life and their own life, but also for the lives of everyone around. The police are usually the last ones on "the scene" and in that situation, there is no difference between a homicidal sociopath on the roof with a gun, and a nice, normal person having a psychotic break on the roof with a gun. They are both equally capable of hurting others.

The best way to avoid this kind of trouble is to intervene before the police are necessary. But remember this too: a handcuffed perp walk to the hospital is way better than getting thrown in jail for hurting a paramedic.
posted by gjc at 7:18 AM on October 17, 2010


A friend of mine has depression and was also suffering PTSD from his work with an international front-line aid organisation. One day he called me absolutely distraught and admitted to suicidal thoughts. Unable to do anything in person I called the head office of the of the aid organisation in our country and explained that one of their international workers was suffering badly and needed help.

The office contacted him and told him who had referred them. My friend was very angry at me as he had not yet made contact with our country's head office himself - he usually worked through a European office of the same organisation - and believed that he would never get work through our head office due to my call. I thought our friendship was over.

Some time after that he thanked me. Not only did they help him with a lot of free counselling from therapists who understood exactly what he had been through, but he caught up with some co-workers he'd known in Darfur who were now resident in our country, and socialising with them has aided him immensely. Best of all our country's office now began sending him on jobs and employs him to give lectures to students pursuing a course that will qualify them to work with this organisation, particularly about coping with the psychological strains of the work.

If another friend was in such need I would also intervene, even though I know it places the friendship at risk. Good on you for also putting your friend's needs above your own fears.
posted by Kerasia at 2:45 PM on October 17, 2010


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