How can I help my depressed friend when he's keeping it a secret?

October 7, 2013 4:57 PM

Hi all, I need your advice. My friend Todd recently told me that he's suffering from depression, and that he has been for many years. He says sometimes it's not too bad, but sometimes he feels so rotten that he doesn't even leave his room to get food and goes hungry for days. That sounds like a dangerous level of depression to me, and I am afraid for him. Todd is a really close friend and super important to me, and I want to help him as much as I can. We live thousands of kilometers apart these days. How can I help from so far away? Snowflakey complications inside.

He tried antidepressants before and they made it so he couldn't connect with his art, so he stopped taking them. He's an artist and art is the most important thing to him - he says it's what makes his life worth living. Any possible solutions must recognize the centrality of art to his life. This really must not be fucked with.

Todd lives in rural Canada. Getting to the doctor's office requires a car, which he doesn't have. So to get to the doctor he would have to find someone who could give him a drive. Figuring out a medication regimen is likely to require a number of doctor visits, is it not? The prospect of regularly begging people for rides is off-putting to him - and I totally understand that. It's a socially awkward situation that requires a lot of mental energy, very much the sort of thing that's extra hard when you're depressed.

Todd does live with one of his parents. I think Parent might be able to arrange the rides, but Todd doesn't want Parent to know about his depression. Parent has a mental illness as well, and Todd doesn't want to upset Parent.

Todd has been keeping his depression a secret, and plans to continue doing so as far as I know. This makes getting help extremely difficult. How can you get help from your family and community without telling them what's wrong?

I've tried to come up with some helpful suggestions for him, but I know how hard it can be to do much of anything when you're depressed. The automatic reaction to any suggestion is "I can think of a bunch of reasons why that won't work." I made my suggestions anyway. Can you think of anything else?

Things I have suggested:

* confide in someone geographically nearer to him, so they can watch out for him

* get on different antidepressants - talk to a doctor who understands how crucial being able to create art is to his wellbeing, and work to find a prescription that doesn't interfere with his creative process (having no car is a problem for this one)

* exercise/physically active hobbies

* cognitive therapy

* I gave him a copy of a CBT self-help book that helped me, and exhorted him to read it. He said he would try to push himself to read it.

* CBT in person with a psychologist? is that expensive?

* meditation

* surround himself with things that make him happy

* vitamin D supplements (he sleeps in the daytime and hardly spends any time in the sun ever)



(Identities have been changed and post is anonymous for confidentiality reasons.)

posted by anonymous to Health & Fitness (10 answers total)

Not to answer your question with a question, but does he want help? Is it possible he actually doesn't, and is coping pretty okay with the depression via his art and connection to his family?

The reason I ask is, these are great suggestions you're offering, but if he's not interested, you could be a great support to him by just listening, which also saves you the heartache of trying to help fix his depression. If he is interested, is there any way he could borrow the car without saying specifically that he's going for mental help? Could, I don't know, a cover story about chiropractic visits or something get him the transport he needs to see someone to start on meds?
posted by mittens at 5:25 PM on October 7, 2013 [4 favorites]

Just how rural is "rural Canada"? Are there restaurants and town infrastructure within, say, food-delivery-people distances? One thing you could do to help him is look into his local options for public transportation to that hub, and things like rideshares and driving services from that hub to the closest city or area where doctors might be. There are, these days, ways to connect virtually with people who are willing to drive you places for a fee that aren't taxis, in many areas. He'd just have to get into town first. There may be a local bus or shuttle, or he could ask his parent to take him into town for "errands" and to "get out of the house" and not go into further detail. Sometimes it's enough to know your options, when you feel trapped like that. And sometimes, actually getting out of the house to change your space is enough to stave off the beginning of those dips into room-hiding lows. You might also be able to find places that will drive out and deliver food to his house, and take credit cards online, for minimum human interaction. Could he use his art as a reason to get into town?

I think that his telling you is a really excellent step he's taken in working to break out of the patterns he's been living in thus far. It's quite possible that he'll continue to do different things than he has in the past. His trust in you is heartening - trust your own instincts in this situation.

If you're willing to splurge on him, you could buy him a medical lightbox. But I don't think that's your responsibility, and depending on this person it might not be your place, either.
posted by Mizu at 6:12 PM on October 7, 2013

There is a phenomenon in Japanese society currently referred to as "hikikomori" individuals, usually younger people who do not leave their rooms for months or years or more because of something like social anxiety (I think?) That condition might not be directly relevant to Todd's situation as it seems to be tied to aspects of Japanese culture, but maybe it would be helpful for him to read about coping strategies that hikikomori employ.
posted by XMLicious at 6:31 PM on October 7, 2013

Teletherapy (online psychotherapy) might be an option. He wouldn't even have to leave his room. Here's an article that references some options (NYT)
posted by aspen1984 at 6:44 PM on October 7, 2013 [3 favorites]

I would agree with mittens. Unless he's specifically asking you for help or really gives hints at wanting help, I wouldn't approach it as your problem to fix. Because, it isn't. You haven't noted if it's actually hindering his life. The best you can do is be supportive, listen, and just be there. But I would really try to hesitate from trying to continuously offer "solutions."

Depression can be draining and it's a common symptom for depressive individuals to constantly sleep, feel fatigued, or not have energy to leave the room.

Also I have to chime in on the mention of hikikomori. I used to extensively study the subject and from what the OP described, this doesn't seem to describe that. Hikikomori are usually super socially paranoid and so rife with social anxiety it's hard for them to talk to anyone in person, even sometimes with their parents. They purposely don't leave the house for months or even years. It's not so much depression as social anxiety and sometimes synonymous with otaku, which are individuals with super obsessive hobbies and usually chose to only obsess over their hobby than interact with others.
posted by xtine at 8:44 PM on October 7, 2013

You mentioned he goes hungry for days - can you make him a care package with nonperishable items that require minimal effort to consume? I'm thinking granola bars or something along those lines that just requires ripping open a package and then eating. If you can find something that meets those criteria that's relatively wholesome in terms of nutrition, that could at least take care of one need. He could keep a stash in a bedside drawer.
posted by Terriniski at 9:35 PM on October 7, 2013 [1 favorite]

Well, I have been and am in Todd's position, and there's really not much you can do from a distance. When I'm depressed I'm more likely to accede to local stimuli than I am a voice on a phone, no matter how well-meaning or concerned that voice is.

I like the idea of sending food. It feels good to have physical evidence that someone out there gives a shit.

If Todd won't tell his Parent that he's in trouble and refuses to take medication... for me, I guess it would depend on how dire I thought the situation was. If I felt a person was in imminent danger I might call someone that person knows even if I might consequently lose that friendship. On the other hand, I've had people do things like call my parents or the police on me and it didn't really lead to anything. My parents ignored the message and laughed about it later and the police dropped me off at psych intervention where they made me wait 5 hours for a 10 minute interview then sent me home in a cab. But I'm in the US; I have no idea if or how this would be different in Canada.
posted by xyzzy at 10:54 PM on October 7, 2013

Have him tell his mum he is going to the doctor for a sprained weiner or something? In all seriousness, mum probably knows something is up.
posted by Mistress at 12:45 AM on October 8, 2013

I think you should contact the Canadian mental health association. Find out his local office contact information/services available (which usually include in-house visits, especially in rural areas) and find out how you can volunteer locally, helping a local Todd and becoming more informed about services that you can pass along to Todd.

If his illness is incapacitating him and he is unable to work he may be eligible for his provincial disability support programme. This would give him money to live on, not a lot, usually around $1,100 a month but also a tab with the local cab company for appointments.

Most importantly, do not make your relationship about "fixing" him. He is an adult, he can make his own choices and face the consequences of those choices, he does not sound delusional/a danger to himself. If he doesn't want to get better you have to respect that he has chosen his short-term goals over what you would think are more worthy long-term goals. If you find the relationship draining or unfulfilling you should step away for both your sakes. You do him no favours in pretending this is a normal friendship if you have become a defacto dumping ground for his problems he won't address and he does not reciprocate in giving back to the friendship. You may want to talk to a therapist yourself about setting healthy boundaries with your friend.
posted by saucysault at 6:08 AM on October 8, 2013 [1 favorite]

As to the costs of psychologists, in Ontario, psychiatrists are free and psychologists/therapists can be free depending on what agency they work for. Health care is a provincial concern - as well as a municipal/regional one too, perhaps people could direct you to specific agencies if you stated the province/region that Todd lives in.
posted by saucysault at 6:17 AM on October 8, 2013