What do to when a friend is having a major depressive episode *right now*?
October 25, 2011 5:28 PM   Subscribe

What do to when a friend is having a major depressive episode *right now*?

I'm good friends with a trio of roommates who live nearby. "Beth" is having a hard time right now dealing with a bad break-up and general mental health ups and downs.

Last night, I got a call from one of them around 9 pm saying that the police had just stopped by looking for Beth. She had apparently called her sister minutes prior, crying from a bar and talking about how she was going to take a bunch of pills because no one cared about her, etc., and how she wanted to make her ex feel horrible for ignoring her.

We mobilized and started driving in circles around Boston until midnight trying to find her, and I started calling her over and over again, and when I could get her on the phone, I slowly worked out where she was (initially planning on sleeping in the park and then out drinking at a bar that - shame on them! - still served her even though she could barely walk). We ultimately ran into another friend of hers and he helped us get her home. It turns out that she'd taken a couple klonopin with a bunch of bourbon and got, well, what happens when you do that.

I stayed over last night and came over today (armed with hangover cures and distractions!) to keep an eye on her. While I'm typing this, I can hear her on the phone upstairs with some other friends and family alternately threatening to harm herself and talking about how miserable she is or guilt-tripping the crap out of them, and talking about how she's going to make her ex take her back (or feel like a jerk when she kills herself - she really keeps emphasizing how much she wants a reaction out of that guy...) BTW, I should note here that the guilt-tripping part is totally out of character for her; it really is just another part of this depressive episode.

Despite the anger and depressive episode she's going through right now, I don't *think* she's a danger to herself right now, though I am slightly worried about how she keeps saying she's going to swallow all of her pills. But my friend is miserable and I don't really know what to do - she's not currently agreeing to be checked in anywhere when others have suggested it (since "they'll only put [her] on the same pills she's already on") and I don't know how long it will take for her to pull out of this, if she even will on her own. She knows I suffer from depression, so she'll listen to me and accept hugs and reassurance, but that really doesn't help for more than a few minutes at a time. And while I'm glad to sit her with her as much as I can, I can't be here indefinitely.

So literally, askme, what do I do right now?
posted by anonymous to Health & Fitness (27 answers total) 4 users marked this as a favorite
Can you take all pills away from her now, please!

She is talking suicide and even if you don't think she'll go through with it she should be carefully watched, admitted to a psych ward ASAP. You are presumably not a psychologist with a lot of experience in determining how suicidal people really are. You are a wonderful friend for doing all that you've been doing but it's time for her to get professional help. Do her parents or other older relatives live nearby? If so, they'd be the best people to make sure she gets to a safe place.
posted by mareli at 5:34 PM on October 25, 2011 [3 favorites]

Talking about suicide is an emergency. Do not rely on what you think might happen - she is not rational and has already harmed herself. She needs to be under professional supervision.
posted by SMPA at 5:36 PM on October 25, 2011 [1 favorite]

Check out some resources here.
posted by mareli at 5:38 PM on October 25, 2011

N'thing SMPA.

I was adviced by a therapist who works with at-risk populations to always report when a suicide threat is made. If they're doing it to get attention, they will learn not to call wolf. If they're considering it, they will get the help they need. In this situation there is no downside.
posted by politikitty at 5:45 PM on October 25, 2011 [5 favorites]

While you are trying to figure it out, if she has a lucid, rational moment, could you convince her to give most of her pill to you to hold?
posted by Vaike at 5:50 PM on October 25, 2011 [1 favorite]

I would try listening to her and understanding what this guy meant to her that she is so upset. Not necessarily "doing" anything, but really sitting with her and understanding the heart of her upset, feeling it with her and letting her know that you're here and you can see what it means to her. She seems to be desperate to be heard.
posted by dolce_voce at 5:55 PM on October 25, 2011

This is actually pretty serious. Many depressed people think about suicide and ultimately come to no harm. But your friend has suicidal ideation, a plan for killing herself and the means (pills, alcohol) to carry it out. Having those three factors puts her at much higher risk of death. You can't watch her 24 hours a day. She needs emergency care. If she won't agree to seek it voluntarily, I would take her to the ER or call an ambulance.
posted by embrangled at 5:56 PM on October 25, 2011 [2 favorites]

In most places, having threatened to hurt herself and specifying a means is enough to get her put in a crisis unit involuntarily. I would talk to her again about going voluntarily but if she refuses, you should call emergency services, who can and should take her. Another option is to see if you can convince her to go to an emergency room and they will call for a psych evaluation. Be specific when you tell them what she has said. This is very, very hard to do but you truly are doing the best thing for her in the long run.
posted by tamitang at 6:08 PM on October 25, 2011 [6 favorites]

The klonopin alone, if she isn't taking anything else that's depressing her respiratory system, probably wouldn't actually kill her. But an overdose of klonopin with alcohol could certainly do it. You also need to know whether there's any Tylenol around, or anything else containing acetaminophen, like Vicodin or certain cold medicines, because a "cry for help" overdose of Tylenol by itself will kill people. It's extremely toxic to the liver. If you can't turn the house into a locked ward for her, though, you should really get her to a hospital at this point, even if she doesn't want to go. She's already said the magic words.
posted by Adventurer at 6:18 PM on October 25, 2011

could you email the mods with a general location so people can give you resources specific to your situation?
posted by nadawi at 6:23 PM on October 25, 2011

Sounds like Boston or environs nadawi "driving in circles around Boston." OP, call 911. All the signs here are bad.
posted by sweetkid at 6:31 PM on October 25, 2011 [2 favorites]

oh duh. i read that three times and didn't take it to heart somehow.

OP - call the 24 hour hotline. they'll have a better idea if your friend should be committed (with or without her approval). they'll know all the local laws, and hopefully what hospital would be the best solution. at the very least, they should know who will have this info if they don't.
posted by nadawi at 6:41 PM on October 25, 2011

that's actually not how a lot of samaritans hotlines work ( I have volunteer experience in NY). I can't really talk about what they DO do and I'm not 100% sure about Boston, but...if you call them, don't expect referrals. They'll be helpful and sympathetic, but don't expect referrals. I stand by calling 911.
posted by sweetkid at 6:46 PM on October 25, 2011 [2 favorites]

1. Make her promise not to hurt herself for the next 24 hours.
2. Make her promise not to hurt anyone else for the next 24 hours.
posted by raccoon409 at 7:05 PM on October 25, 2011

1. Make her promise not to hurt herself for the next 24 hours.
2. Make her promise not to hurt anyone else for the next 24 hours.

This is really dangerous advice. You don't want to create some kind of pact with someone in such a vulnerable state. This is why you need a professional to help.
posted by sweetkid at 7:18 PM on October 25, 2011 [2 favorites]

I still think you should call a suicide hotline. At the very least someone there might give you the courage to call 911 if you're waffling about it. The AFSP has A national suicide helpline with people who are trained to deal with situations like these. Good luck to you. You are a good friend. Take her seriously, and try not to deal with this alone. There are organizations and people trained to handle this far better than you can alone.
posted by pazazygeek at 7:38 PM on October 25, 2011 [2 favorites]

I still think you should call a suicide hotline. At the very least someone there might give you the courage to call 911 if you're waffling about it.

Definitely agree with this. Just in my experience they're not going to tell you exactly what to do. But they will give you some great support.
posted by sweetkid at 7:40 PM on October 25, 2011

Nobody, not even her, can tell you when this is going to pass on its own. At this point you can't know whether she would say she's fine just to get you out of her hair. How long are you guys going to be available to watch her and make sure she doesn't drink (she absolutely cannot drink) or take anything? Are you spending the night in her room, awake? You're not psych nurses and the house isn't safe for somebody having a suicidal crisis. She's threatening to kill herself. "They're only going to give me the same pills" is hopeless depressive nobody-can-help-me bullshit. She needs to go to the hospital and it doesn't matter if she doesn't want to, because you can't take care of her and you can't trust her brain when it's in this state.
posted by Adventurer at 9:07 PM on October 25, 2011 [2 favorites]

OP, please give us an update through a mod at some point when appropriate-- hope you and your friend are OK.
posted by sweetkid at 9:18 PM on October 25, 2011 [2 favorites]

Please bear in mind that what happens with a lot of people who commit suicide is that they seem *better* for about twenty-four hours beforehand. The risk here is that she seems to 'brighten' and calm down, and you and your friends are persuaded to leave her alone just when she's in the most danger. You will probably not be best placed to assess whether this is what is happening.

"They're only going to give me the same pills" is hopeless depressive nobody-can-help-me bullshit.

I am just repeating this for truth. Somebody in this state is not in a good position to judge how likely it is that medical care will help them.
posted by Acheman at 2:24 AM on October 26, 2011 [2 favorites]

Point out to her that overdosing on her pills is likely to cause organ damage, not death. Tell her you're taking her to hospital so she can talk to a doctor before she's caused that damage, not waking up after. Then wrap her up warm, make sure she's hydrated and fed, and take her to the hospital. Explain the advantages of signing herself in rather than being signed in involuntarily. Don't utterly dismiss her objection that "they're only going to give me the same pills" — the hospital doesn't have the power to cure her, and she won't believe you if you tell her it does. What the hospital may be able to do is calm her down, stop her damaging herself for a short period of time, and make referrals to people who may be able to assist her in staying alive. Those latter two arguments won't sound persuasive to her right now. That's why you're taking her to the hospital rather than asking if she wants to go.
posted by westerly at 5:33 AM on October 26, 2011 [1 favorite]

Point out to her that overdosing on her pills is likely to cause organ damage, not death.

Please don't do this. It's possible that if you point this out, she'll work out that she could be utilising more lethal methods. Knowledge about the relative effectiveness of different methods is not safe information for a suicidal person to have.
posted by Acheman at 7:08 AM on October 26, 2011

From the OP:
Hey guys - when we'd chatted with the police that her sister had sent the night before, they'd told us they couldn't forcibly take her away for an evaluation if she hadn't actually done anything to seriously harm herself, so we didn't think calling 911 again was going to be a viable option. She also wasn't agreeing to go voluntarily for an evaluation. That's when I wrote this post - we weren't sure what our other options were besides watching her, and I couldn't find anything definitive online.

We called around a bit yesterday and finally got a doctor on the phone who told us we *could* have her taken away forcibly even if she hasn't yet taken a dangerous number of pills, and in particular, when we called 911 again last night, the operator remembered us from the night before and put this into their systems as an overdose emergency to actually get emergency personnel out to the apartment to evaluate her. (And actually, by that point, she had taken 5 more klonopin in one sitting and I'd had to wrestle pill bottles out of her hands. She's still pretty feisty when doped and there was no way we could have gotten her out of the house on our own.) In any case, it still wasn't certain that they were going to take her until she suddenly popped a handful of other pills from a bottle I missed right in front of them while I was still trying to talk her into agreeing to go with them.

She's in the hospital now and seems to be doing much better. I still don't know how I feel about how difficult it was to get my friend the help she needed, but I'm glad she's got it now. I hope that knowing to be persistent when calling 911 helps someone else help their friend later on down the line.
posted by jessamyn at 7:48 AM on October 26, 2011 [6 favorites]

Thank you so much for updating. You've done the right thing.
posted by Acheman at 7:58 AM on October 26, 2011 [2 favorites]

Thanks for the update! You're a great friend, and good on you for your persistence.
posted by sweetkid at 8:08 AM on October 26, 2011

You did the right thing. Thank you. I have found this article about How Not to Commit Suicide very helpful.
posted by theora55 at 8:32 AM on October 26, 2011

Thank you for taking care of your friend. Thank you.
posted by Specklet at 10:41 AM on October 26, 2011 [2 favorites]

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