How do I help my depressed son?
March 9, 2006 8:04 AM   Subscribe

Me: "Do you think about hurting yourself?" My son: "Suicide? All the time." Help us please.

So, my son calls me at 8 am this morning as I pull into work. "Can you come home?" he asks. "Because I am having this lame breakdown."

Background on my son: He is a magnificent young man who I love beyond measure. He is 22, my stepson actually, we have been a family for 11 years. He lives with us and goes to college, where he does quite well. He spent the last year studying abroad. He has a huge outgoing personality that really attracts people and a first rate mind. He is very alternative, grew up in a big city living with his worthless father. He has lived with us 3 years.

I drive home and we talk. It turns out that he has fought depression for years and years. I had no idea. He self medicates with booze, nicotine, and pot, though not in very large quantities. (2-3 drinks a day he says, though I think more, pot a few times a week.) He has trouble focusing, has no ambition for school (though has done some good work in some of his classes anyway) and most of all feels overwhelmed by anxiety and self loathing. When people like or trust him, he says, he feels compelled to disappoint them. I held him while he cried and spelled it all out.

Many years ago someone told me that when a person is displaying this kind of behaviour, you should always ask them if they think about hurting themselves. I asked. He told me how, every day, he thinks about killing himself, usually by driving into something. He rejects it immediately, he says, but the thought comes back.

He wants to tough this out with some help from his family. I said no, we need professional help, and he is not dead set against it. Tomorrow we go to see the school counsellor. (Also, tomorrow I tell my wife!) So I think I am doing the right things.

What else should I be doing? What can I expect as he enters therapy (I guess). What do I need to know and do to be the best possible dad to my son right now?
posted by anonymous to Human Relations (63 answers total) 5 users marked this as a favorite
Sounds to me like you're doing all the right things already. He's lucky to have you, and I think he knows it since he chose you do confide in first.
posted by pmbuko at 8:15 AM on March 9, 2006

From somebody who was your son a few years back (sans the deadbeat father) sounds like you are doing a fine job.
posted by Pollomacho at 8:21 AM on March 9, 2006

You're doing great, as stated above.

It sounds like he may need medication, though, so seeing a medical doctor/psychiatrist may be better than just talking to the school counselor (though the school counselor may be able to give you a good referral to a young-person-friendly doctor).
posted by Gator at 8:28 AM on March 9, 2006

You sound very cool. I had a friend who struggled with depression and (from my perspective) it was kept a secret. He is no longer with us.
posted by craniac at 8:29 AM on March 9, 2006

Yes, openly and non-judgmentally communicating with him about his feelings, and showing him your unconditional love and support, are crucial. It would be great if he agrees to professional help, but remember that it must ultimately be his choice.

It's important to remember, too, to take care of your own emotional needs, so that you can better support him in his. There is a great organization called The Samaritans that has a hotline that offers befriending to people in crisis and to those supporting them. The phone numbers are on their website (Sorry, the link function doesn't seem to be working for me.)

If you want a friendly ear to listen to you, or if your stepson does, give them a call. They can also help guide you through things to do to help your son (although it sounds like you have an excellent start and an excellent attitude). Best wishes to you and your family.
posted by tentacle at 8:29 AM on March 9, 2006

Sounds like you're doing a terrific job -- you're listening and not judging or offering pat answers like "it'll pass" or "buck up." He feels comfortable enough to talk honestly about how he's feeling and how he's coping. This is half the battle.

As far as therapy goes, it can be quite beneficial. If your stepson continues to be as honest with himself, his family and the therapist as he is now, he'll hopefully be back on track in no time.

One thing I'd stress, though, is that you should not settle for a therapist your son's not comfortable with. They're providing you with a service, so make sure he/you click with them. Just like anything else, there are a few good, a few bad and a lot of mediocre out there.

Hang in there. You sound like a terrific stepdad. He's a lucky kid.
posted by Atom12 at 8:30 AM on March 9, 2006

[[Sorry, my US-centrism is showing. The Samaritans are an international organization; the link I supplied is for the US branch.]]
posted by tentacle at 8:31 AM on March 9, 2006

I am not an expert, and with a literally life-or-death situation like this, I would much prefer you get a professional's advice immediately, as I do not want to have someone's life riding on my opinion ...

I think, looking at it from an objective perspective, there are quite a few positive signs.

First, he reached out, and moreover felt comfortable reaching out to you, a stepfather with whom he has only had a familial relationship for three years. To me, this speaks very well of your relationship. Second, he is willing to seek therapy (or not dead set against it). This also speaks well.

I think you are doing an excellent job. I would continue doing what you can to preserve the oppenness of your relationship with your stepson. I would tell your wife immediately -- do not wait until tomorrow. I would definitely pursue both family and individual therapy.

Also, it seems to me upon reflection that the way he describes it, it appears he has a side of himself which argues against suicide, too. I consider this a good sign as well.

I do not know how you could tactfully ask him the following, but I think an immediate concern is to get a sense as to how seriously he is considering suicide. If he has made plans, for example, as to how to carry it out, or if the impulse to steer his car into a tree has proved strong, he may be an immediate danger to himself, and police involvement and/or involuntary committment may be needed to restrain him from actually carrying out the act. It does not sound as if that is the case, however -- but we don't know; we're not there. You need to inquire.

If his thoughts of suicide have just been a brief flicker of a death scene in his mind followed by immediate rejection, the danger may not be as immediate.

I wish you the best of luck. I have a feeling this will be one of those Ask MeFis where months or years from now, we're wondering how it turned out. If it would not violate your family's privacy, perhaps you could ask Matt or Jessamyn to post an update to MetaTalk and let us know how it turned out.
posted by WCityMike at 8:32 AM on March 9, 2006

I agree, you're doing great. The fact that he loves and respects you enough to talk to you about such deeply personal issues tells me that you're a good dad.

What to expect from therapy? Hard to say, because every patient-therapist relationship is slightly different. I think the best thing you can do is make sure he gets a good therapist he feels comfortable with, and make sure he sticks with it. And be there for him when he needs to talk or to have a shoulder to cry on, but you obviously already knew that.
posted by cerebus19 at 8:33 AM on March 9, 2006

It sounds to me like you did everything right.

What you did most right, it appears to me, was the years of trust and listening that let him understand that he could call you at 8 AM and inform you that he was having a lame breakdown. Imagine what would have happened if he was afraid to do that, or if he felt you might not care.
posted by ikkyu2 at 8:42 AM on March 9, 2006

He needed to have this breakdown before he could reach out for help. Thank God that you were in a position to take the drive home and were in a position to talk with him. Make sure he knows how grateful you are that he reached out - that it's NOT a burden at all, and that you're not disappointed in him. This time, right now, the door is open. This is the time to hook him up with someone who is knowledgeable and with whom he can connect. It may or may not be the school counselor - be aware that you may have to help him shop around for someone.

It may indeed be self-medicating, but 2-3 drinks a day plus miscellaneous drugs is a *lot* of substance use. IMO, anyone who sees him should take an interest in this aspect of his life - he may have a drug/alcohol problem. I know everyone thinks that the "problem" (depression or whatever) comes first, and the alcohol is a response to it, and if we can get rid of the depression, the alcohol will go away by itself. In my experience, the alcohol use needs to be addressed, as it compounds the depression/anxiety, rather than helping with it.

What will typically happen is that someone like your son will go into therapy for a bit, feel a bit better, and then feel like he's ready to stop therapy. This could be fine, but my guess is that he has plenty to talk about in a therapy relationship. He might or might not benefit from meds - certainly any competent therapist will consider it as an option.

Ideally, it'll be great if he can have a good feeling about *this* treatment episode, so he'll have the sense that there are people out there who can help him in the future, that he can get support when he's feeling needy.
posted by jasper411 at 8:44 AM on March 9, 2006

Also, as far as therapy goes, don't be afraid of antidepressants, they can be a lifesaver for many. Depression isn't just "feeling blue" - it does actual physical/chemical damage to the brain, and isn't always something that you can tough out or talk through on your own. There's no shame in that. If you want a harrowing and inspriational (and sometimes quite entertaining and funny) story, read this.
posted by mimi at 8:47 AM on March 9, 2006

Do you think you should talk to him about giving you his keys for awhile? Or at least have him specifically promise you that he won't drive into anything. I've heard a personal promise like that can be a strong deterrent.
posted by leapingsheep at 8:47 AM on March 9, 2006

What are his dreams for the future? What does he feel the point of living is?

a simpler approach than medicating the problem away may be to ask him tell you about why he rejects suicide.

If he is asking for family support, I wouldn't deny him, even if you ask him to see the therapist, too. Maybe a quiet family meeting is in order? Is that what he had asked for?
posted by eustatic at 8:55 AM on March 9, 2006

Yikes, this sounds like me... 22, anxiety, depression.

Ditto what others have said; you're doing very well. It's a very good sign that he felt comfortable talking to you about this; it means that you have already been doing a great job as a dad, and it also means that he isn't completely isolating himself or attempting to hide his state of mind.

I don't have much to add to what others have said, plus it sounds like you're going to do fine. Just be there to talk and make sure he follows through on therapy. It can be easy sometimes to lose the motivation to go or to just dismiss the effectiveness of therapy altogether (I initially came to this conclusion, but later realized that I simply wasn't at all comfortable with my first therapist).
posted by Stauf at 9:12 AM on March 9, 2006

Wow; whatever it is you did for the past eleven years seems to have worked. Calling you at 8 am when you're going into work because he needs your help and advice? That is incredibly difficult to do and it's clear that he trusts and loves you a lot. I would just do whatever you feel is right, because you seem to have this figured out.
posted by Optimus Chyme at 9:18 AM on March 9, 2006

Hoffman Institute
posted by vega5960 at 9:22 AM on March 9, 2006

Seconding leapingsheep. I was in the same place as your son myself and called my mother (a therapist) at work. Her questions were:
- Would you really do it?
- Can you promise me you won't do anything to hurt yourself until ...? (specifically, it was "until I get home".)

I think that it's important to set a short timeline for the personal promise - say "until the end of the day" or "until your doctor's appointment", not "until next month".

Also, my personal experience would warn against some of the advice in this thread. Being caring and helpful is key, but playing therapist and asking about his hopes and dreams won't help - you just can't have a productive therapeutic relationship with a family member. Don't be afraid of medication; as mimi says, depression is a physical illness, and rejecting medical help is foolish. To those who say "you did everything right" - I agree wholeheartedly, you've certainly done everything right so far, but you're not out of the woods yet. Keep up the excellent relationship you have with your son and get professional help for him. Things may still get worse before they get better, so don't let your guard down.
posted by pocams at 9:42 AM on March 9, 2006

Thank you for being so reasonable and understanding. It's frustrating to me that even now, when it's recognized how commonplace depression is that some parents react badly or fail to provide support.

I can't offer particular advice other than to keep supporting him. I think a lot of anxiety and frustration at that age can come from not really feeling that you have a particular place in the world -- it's hard to find goals or really create a life with a routine when your friends, classes, and family won't necessarily be the same from moment to moment. I'm speaking partially from personal experience, but also that of my friends.

The things he may be accomplishing in class might not seem to really tie into anything rewarding so it's hard to stay interested. Is he "self-medicating" alone or with friends? Do his friends share interests, and what are their long-term goals? When your peers aren't doing what you are, it's hard to recognize your own accomplishments.
posted by mikeh at 9:43 AM on March 9, 2006

Wow. He sounds just like me.

It took a lot of (emotional) self-abuse before I accepted medication. It was a godsend. There is no way in hell I'll ever go back to full-on depression: it's too painful to bear. I'll check myself into a looney bin before I get that far down. ANYTHING — even death — is better than being deeply clinically depressed.

So my advice: he needs to take the next step and go see a doctor and a counsellor. He needs to belly up to the meds, if that's what they recommend. He'll be delighted to discover a better self, though it'll take some time for him to accept the "new self" in place of the old one.

Good luck. He can email me if he wants support from a fellow victim of brain chemical imbalance!
posted by five fresh fish at 9:47 AM on March 9, 2006

Absolutely you are doing all of the right things. He is SO not alone in this...depression and anxiety are more common than many people think. And by depression/anxiety, I mean the biochemical kind instead of the situational kind.

This was me at 22. Except my parents did not want to discuss it. They had also suffered, as had their parents, and it was a big family secret that was never shared. THAT messed me up more than the depression itself.

Today, I am 39, have been on meds since 1992, am happily married with a new baby, and have a great life with a wonderful support network. If you had asked me, at 22, if I ever thought this was possible, I would have adamently replied, "No!"

Like five fresh fish, I have been clinically depressed and it was intensely, even physically, painful. It really can't be adequately described to someone who has not experienced it. When I was depressed, I could not remember ever feeling good. It was an experience of emotional amnesia that wiped out hope that things would ever be different because I could not remember what "better" was like. At all. During depressed times, it was helpful to engage in self care...massages, listening to music, lighting candles, taking hot baths, eating nutritious food. Unfortunately, depression takes away all of your motivation to engage in self care...even taking a shower is a tremendous effort. It actually felt painful to have the water beating down on my skin. Luckily, I had good friends around who gently guided me through the self care and it really helped.

I wish the best for you and your son.
posted by jeanmari at 10:23 AM on March 9, 2006

Contact the local hospital. They may hve a psychiatric inpatient facility with counselors that can talk to them. No, not rubber room kind of stuff, just an inpatient facility. And hopefully get him off of the drugs & booze. Eeek.
posted by drstein at 10:23 AM on March 9, 2006

I second and third all the compliments on how well you are handling this.

One small addition: when you are depressed, reaching out can be the very hardest thing to do. You can literally sit there just hoping and wishing someone would "reach in" to you. Now that you know what is going on, please try to reach in as your family moves through this. He may not always be able to reach out as he did here. Best of luck to you all.
posted by AuntLisa at 10:28 AM on March 9, 2006

From your very brief description, I'm willing to bet that cognitive therapy would help him a lot, if he is willing to explore it as an option.

He has taken the first and hardest step and, like everyone else is concurring, you're doing great. At this point your job is to help find out what avenues are open and help him make the choice to feel better.

Be aware also that suicidal thoughts may be red flag for mandatory reporting and you should understand the repercussions of this.
posted by plinth at 10:34 AM on March 9, 2006

On the other hand, it might not be worth worrying about. At least consider that. At about that age I used to carry around a bottle of poison. Several times a day I'd end up talking myself out of taking it. Also, in darkened rooms, and sitting alone, I've held a loaded gun to my head a few times. I drank a lot. Seriously a lot.

Sounds pretty messed up huh? But that's just me.

I was never close to killing myself. Not really. Just depressed and struggling to make sense of things. But I do think that having others force me into some sort of counseling would have made things worse rather than better.

I'm not saying that seeing someone isn't the right thing to do. Just that everyone is different. I just needed to sit alone in the dark for a few years and be weird. These days I'm happily married with a wonderful job and plenty of friends. My depression was just part of growing up in the modern world.

This may be bad advice, but I offer it in good faith.
posted by y6y6y6 at 10:37 AM on March 9, 2006

You, personally, did real well, from what it sounds like at this point. Listening to your son, letting him know that he's loved and not judged negatively, and guiding him toward sources of help are the best thing you can do. (When I found myself in similar circumstances at age 22, I brought it to a parent, who seemed to feel that I was blaming her--which I wasn't--and reacted very defensively and negatively. I didn't do anything else about recurring--and worsening--depressive episodes until nearly ten years later.)

From the experience of the ten-years-later--either before you go to the counselor or very shortly thereafter, I suggest talking to your son a bit about what he'd like to accomplish. I was in therapy for two years before figuring out that I was with the wrong therapist, since I didn't respond well to a cheerleader ("you're OK the way you are!") and wanted a coach ("OK, how can we develop a clear structure and goals for making yourself better?"). I haven't gone back to therapy since I seem to be doing OK with meds and a sympathetic husband, but if I ever did I would specifically seek a cognitive-behavioral therapist.

I realize that at this stage, your son probably isn't thinking about too much beyond not wanting to drive a car into a tree, so if he can't consider this kind of question and figure out the best type of professional to help him, that may be something you and your wife can investigate (the internet is very helpful). Don't deluge or overwhelm him with information, of course (he may feel too much pressure to get better, and it sounds like similar "pressure" is part of what's troubling him!), but just let him know that you're willing to do some of the "background" work for him if he needs you to.

Good wishes for both of you; he sounds like a sweet young man, and the fact that he did reach out is a very good thing.
posted by dlugoczaj at 10:38 AM on March 9, 2006

Since so many have suggested therapy already — and they're right, IMO — I'll just give a little more advice on that subject.

Finding a good therapist can be hard. There are a lot of mediocre ones out there. There are also a lot of very good ones who might not click with your son. (Let me give you an example: I'm most comfortable around chatty people. For a while, I was seeing an excellent therapist who made a point of speaking very little, and we got nowhere. I'm convinced he was good at what he does, but he wasn't any good for me.)

If your son is interested in therapy, he may need to meet several shrinks of various persuasions before he finds one who he can work with. Encourage him to stick with the process; but recognize that sticking with the process may mean ditching quite a few individual therapists, and don't be alarmed if he comes home from his first appointment saying "No, that one's not for me."

Also, in my experience, school counselors aren't worth much. I dealt with depression all through college, and in the process dropped out and transferred a few times, so I've seen the counseling services at several different schools and been unimpressed by all of them. The one at your son's school may be excellent, of course, in which case he should totally stick with them. But he may also find that all they're good for is a pamphlet on "stress management" or "study skills" and a prescription for antidepressants. Reassure him that there are shrinks out there who will show more commitment to helping him than that.

It's easy to get defeatist when you're depressed. Don't let his disappointment at one bad therapy appointment get in the way of a genuine interest in seeking help.
posted by nebulawindphone at 10:51 AM on March 9, 2006

What Pollomacho (Minus the deadbeat dad, and the pot & booze) and FFF(Minus the meds and counselling) said. I still go through dark times regularly but the worst is behind me, thanks to meditation(Which can be anything he wants it to be. For me, it's noodling on the guitar, writing songs, etc.) and knowing that if I need them, I have people who love me.

However, if he's cool with counselling, do it. It may not be the answer he's looking for(Maybe it's meds, maybe it's spirituality- YMMV), but it's the first step in finding what works for him.

...every day, he thinks about killing himself... He rejects it immediately...
That he knows suicide isn't a real solution is 100% thanks to you, and the love you've shown him.
Pat yourself on the back, you're doing an awesome job.
posted by Alvy Ampersand at 11:08 AM on March 9, 2006

Sometimes depression & add are tightly coupled--nicotine is one popular self-medication for add, so don't rule that out.
posted by lrivers at 11:11 AM on March 9, 2006

Since he seems comfortable talking to you and confiding in you, continuing talking to him. I have little doubt that when he rejects the thoughts of killing himself that he's thinking of you. Like other's have said, don't be try to be a therapist. Regularly talking about everyday things won't cure him outright, but it will give him an emotional foundation solid enough to make a stand at getting through this.
posted by bitpart at 11:35 AM on March 9, 2006

Please watch him. My mother committed suicide about 13 yrs ago, and followed a pattern I understand is very common. A real danger point is right AFTER the therapy, medication, or whatever starts. Prior to that a person may actually feel so little energy that they don't even have the energy to kill themselves. But, feeling just a little bit better they may be able to do the deed. Also, alcohol is involved in many many suicides - with your inhibitions relaxed you are more likely to do the deed.

I'm just telling you what I wish I'd known then. Right after therapy starts is the point when outsiders think they can relax but it is actually a very vulnerable time. Add alcohol to the equation and it's very easy to commit suicide. It's a permanant solution to a temporary problem, but when you are young and depressed you don't realize that. So it could be very valuable to him to have people around at that point so that one night of bad judgement doesn't take away the whole rest of his life.
posted by selfmedicating at 11:45 AM on March 9, 2006

Oh, and other questions to ask:

Do you have a plan for how you would kill yourself? (Having a plan is a bad sign, worse if they actually posess the means to carry it out.)

Is there anything that would prevent you from doing it, like religious convictions, family, etc? (This is important to know. If he says "I couldn't do it bc I couldn't leave my little sister alone in the world" or whatever, that is a good sign and something to build on.)

Some people have also found it valuable to create a contract where the depressed person promises not to commit suicide without talking to a specific person about it first.

Basically the idea is to figure out what their plan is and put some space between them and the act. It only takes a few minutes of bad judgement to kill yourself. If the gun is locked up or the car is inaccessible or there's somebody around, then the person may get through those few bad hours and go on to live the whole rest of their normal life. If the means to commit suicide are handy, then that moment of bad judgement is a life sentence.
posted by selfmedicating at 11:53 AM on March 9, 2006

Email's in the profile if you want to talk.
posted by selfmedicating at 11:54 AM on March 9, 2006

Add my voice to the others applauding your parenting. Long answers follow, I am not a doctor.

You are absolutely right to say that your son should not be trying to "tough it out", so good for you. Professional therapy may not be the best final solution, but it's an excellent first step.

What can you expect as your son enters therapy? Well, probably not much at first. Building a strong therapeutic relationship takes time, and the first therapist you see may not be the right one. While you should obviously allow for your son's confidentiality with his therapist, I encourage you to take an active interest in how the sessions are going. Like many others here, I was where your son is, and my first therapeutic experience was miserable. Unlike your son, I didn't have someone interested enough to explore other options with me, so I just sort of fell out of therapy for a few years and continued to decline. If the first therapist you see turns out to be a good fit, that's awesome. If it turns out otherwise, help your son seek alternatives, because a bad first experience can shatter a fragile belief that he can be helped. If that happens, he'll need you to nudge him along.

I also agree with the advice that you shouldn't be unnerved by the prospect of medication. If your son is self-medicating, chances are good that conventional anti-depressants will have a positive impact. I would caution you to be wary of therapists who lean on medication as the primary therapeutic tool, however. While most of the literature I've read has not found a conclusive link between combination talk-therapy and medication (and I haven't kept up with studies from the last couple years), anecdotally I was always turned off and disinclined to continue when I felt like my doctor was more interested in drugging me than helping me. If your son has similar sensibilities, even if he needs medication more than anything, try to make sure that he's getting some of what he thinks he needs also. Sometimes talk therapy is the sugar that helps the medicine go down.

Hang in there, and good luck.
posted by Errant at 11:55 AM on March 9, 2006

...every day, he thinks about killing himself... He rejects it immediately...

There's a chance he freaks himself out even more by saying "holy crap, how could I have thought of that? *reject, reject, reject*. I must really be messed up in the head. Oh no." His stress goes up, and this can contribute to his negativity.

So, I want to add that *I* think of killing myself pretty regularly - stepping in front of a car, falling off of a building, what could happen with sharp knives, etc. And *I* freak myself out about it sometimes. But. I had a conversation with my best friend a while ago where we discovered that we both do this. My ex boyfreind does it. My best friend's sister does it. It's normal.

Here's what happens in my head. I'm in a situation where I could potentially hurt myself very badly, and I envision the possibility of that. I recoil from it. I think it's a form of status-check, your brain saying "hey, remember that thing you could do? Don't! Be careful in this dangerous world. Dying would suck." If your son is doing that, I want to reassure you (and him!), that plenty of perfectly healthy, happy, stable, people have thoughts like that all the time and it's nothing to freak out about. Sure, he should make sure he never gets serious about it, but he should concentrate on other issues rather than freaking out over this one.

Funny thing is, after I realized that it was totally normal, the frequency, intensity, and associated anxiety of these thoughts all went down. Simply relaxing, not considering it a serious problem that needs fixing or else, can be huge.

This all only applies if 1) this sort of thing is what he means when he says he thinks about killing himself and 2) he's freaking out about it. I don't mean to imply that they shouldn't be looked at seriously, instead I'm trying to show that what your son is thinking of might not be destructive. That's something for your son to judge, though, and that after some careful reflection and guidance.

He should see a mental health professional. That said, I saw a counselor for a while and mentioned these thoughts, and she had no idea what I was talking about. Be aware that the counselor themselves might contribute to anxiety.
posted by lorrer at 11:56 AM on March 9, 2006 [1 favorite]

Taking him seriously without getting hysterical yourself was the most wonderful thing you could have done.

Things I wish I'd known much earlier:
* Therapy isn't punishment.
* Thoughs about suicide don't automatically make you a sick, dangerous freak.
* Meds aren't necessarily needed all the time for the rest of your life, depending on your reactio to therapy and extent of depression. With a therapist's supervision, some of us can use meds for a period of time to get over a hurdle, taper off, and recognize when another hurdle is looming.
* Depression does not have to define your entire existance. It's not your new name.
posted by desuetude at 12:45 PM on March 9, 2006

This all only applies if 1) this sort of thing is what he means when he says he thinks about killing himself and 2) he's freaking out about it. I don't mean to imply that they shouldn't be looked at seriously, instead I'm trying to show that what your son is thinking of might not be destructive. That's something for your son to judge, though, and that after some careful reflection and guidance.

Really well said, lorrer. I was thinking this too.
posted by desuetude at 12:46 PM on March 9, 2006

This is an amazing thread, and I'm glad so many people have contributed to it. AskMeFi rocks!

don't be afraid of antidepressants, they can be a lifesaver for many

I just wanted to repeat that, because it bears repeating. My meds are handled through the psychiatric branch of my local hospital, and it's the only thing my doctor does there. She has a far greater breadth and depth of experience than any general practitioner, and for the first time in ten years or so I'm finally feeling like myself. Not artificially happy, just...myself. It really is like the fog has lifted; the world no longer seems so contracted that the way I feel right now (that is, depressed) is the way it always was and always will be.

(Side note: even after working with someone who knows what they're doing, it was, and is, very difficult to get past the stigma that still surrounds psychiatric drugs. "Why can't I pull myself out of this, the drugs are just going to change me into someone else, this is taking the easy/lazy way out," etc. etc. etc. Don't listen to that voice; it's bullshit. Would you tell a diabetic or an organ recipient to tough out their illness? Hell no. And on preview, desuetude is quite right in that medication is often a temporary aid. I'm just saying that there's no shame if it isn't.)

Anyway, after awhile I asked if she could suggest the names of a few good counselors, which is how I found the therapist I'm working with now. It seems like a pretty ideal arrangement to me: they know each other well enough to keep this whole thing roughly coordinated, but the talk/drug conflict that Errant mentioned isn't an issue.

So far you've done everything right and then some--I wish my own stepparent had been so involved and loving. Kudos to you! The only other thing I might add is that depression tends to amplify personal inertia, so continuing to show an active interest in how your son is doing will be very helpful. Someone mentioned in a thread on the blue (maybe the one on brain-cell regeneration?) that they wished they had depression interventionists, who would just follow you around and tell you to fix yourself dinner, take your meds, do a load of laundry, etc. I'm completely on board with that.

(Email in the profile is good, just to throw my hat in the ring of Medicated Mefite Depressives.)
posted by Vervain at 12:55 PM on March 9, 2006

What he is having is called suicidal ideation and it is common in depressive illnesses and mood disorders. (I have it sometimes as I have bipolar type 2.)

One word of caution-antidepressants are a godsend BUT if they prescribe them for him watch him carefully-and have him monitor for himself-his mood state. If for some reason he has any genetic disposition for bipolar disorder, antidepressants can bring it out. If he gets super bouncy or super agitated, etc, it is important to let the doc know and have it evaluated. That having been said, it sounds like he has been selfmedicating anyway so it should not be a freaky step to consider meds at least for the short term.

My email is in profile too. And fwiw I think you are doing a magnificent job. He is blessed to have you in his life.
posted by konolia at 1:04 PM on March 9, 2006

don't be afraid of antidepressants, they can be a lifesaver for many

I just wanted to repeat that, because it bears repeating.

And I will repeat it again. There is no shame in taking a medication for an illness. Depression is an illness and one in *mumble* *mumble* people will suffer from it or something similar in their lifetime. (I think the UK statistics were 1 in 3 people will suffer some form of mental illness)

It seems to me your doing fine, he's a lucky man to have you.

I wouldn't worry too much about his "self medication" unless he is dependent on it.

The tragic thing about depression is that no one can persuade you that it will ever get better. It is a downward spiral and unless you can drag yourself out of it you just stay down.

Keep on what you are doing supporting him and find him a good doctor to prescribe him something. The spiral has to be broken.
posted by hardcode at 2:02 PM on March 9, 2006

I'm going to go out on a limb here and suggest some things that I wish I'd gotten when I was 22 and depressed and anxious, and things I've said to loved ones to encourage them to get help. This is all just my opinion.

He needs a therapist, yes, but as for you, don't hesitate to interfere, lead, and expect things of him, in essence, be fatherly, especially since his biological dad sounds like a source of problems. Don't argue with him or invalidate his gloomy/bad feelings, just offer him an alternative view. Depression will make him forget his good qualities and strengths, so look him in the eye and tell him he's wonderful and worthy and capable of having a great life. Tell him that you and his mother will do everything under heaven and earth to protect him. Make him promise that he won't hurt himself, and tell him that if he wants to, that regardless of the time or the circumstances, that he must call you (or his therapist, when that's possible) and you will drop everything to help him. Listen to everything he says and don't get defensive. Take him on walks, get him moving. If he can deal with it, ask him for a little structure, a weekly dinner with the folks or whatever. Go bowling. Something casual, even silly, but reliable.

Saying "lame breakdown" and wanting to "tough it out" seems pretty typical. Therapy might feel artificial or uncomfortable at first, so ask him to just put one foot in front of the other and see what happens. Don't force anything. You might be better off asking him what course of action he's 'willing' to take rather than expect him to be enthusiastic about anything. Depression doesn't allow for enthusiasm or decisiveness.

Depression feeds on itself. Depression induces a pervasive sense of futility. The very things that might help you climb out of it seem the most impossible to do. What's the point? It won't work. Nothing will work. You're numb at best. Exercise, eating better? You're joking, right? Do the things you enjoy with people you love? You don't remember what that means, and it all seems like too much effort, and nobody really wants your company/understands/likes you anyway. And this is who you are, this is how it will always be. You actually cannot imagine being happy and still being yourself.

I think this is why medication is so scary, and depression is so difficult for cerebral types who are used to relying on their brains as a source of strength and identity. Remind him that alcohol, drugs, lack of exercise and the depression itself all affect his brain chemistry already, so taking the right antidepressant could just restore him to a more natural balance and make him feel more like himself, only not miserable. He won't believe you, but tell him anyway. And that just because he's asked for help doesn't mean he's signed away his right to decide what's best for himself.

He's smart and wise for asking for help at 22; way ahead of most of us. Good luck, you sound like a great dad.
posted by tula at 2:44 PM on March 9, 2006 [1 favorite]

Wow. What jean mari said so eloquently. For me, depression was like that, except the times when it was black and gooey and harm-inducing. Those were what finally convinced me what I was experiencing wasn't normal, and that maybe I'd better change it before it killed me.
posted by five fresh fish at 2:53 PM on March 9, 2006

tula said it far better than I did
posted by hardcode at 3:04 PM on March 9, 2006

This is the original poster (and my new sock puppet).

Thanks everyone for the advice and encouragement. You guys are great. I talked with the school counselor today, and my son is going to see her tomorrow. I don't know her well enough to have an opinion of her competence, but we'll see.

It is especially encouraging that so many of you, posters I admire, have been through depression. It gives me confidence that my son will be OK.

The thing that kept coming back to me today is how could I not have known? We talk every day, and not just chatty small talk but about life and philosophy and the big questions. He lives under our roof. How could I have been blind to his suffering?

A few more details. He was about 5 when his dad took off. He felt a heavy burden being "the man of the house." He told me that for years and years, he would have the same nightmare of waking up, finding his little sister murdered and his mom being raped, and would wake up in a panic. As a kid he used to hit himself, hard and repeatedly, when he thought he had done something bad. He cried and cried as he told me these things. ("I used to hate mom's boyfriends," he told me. "Don't I know it!" I answered. We laughed and hugged.) Though he claims to be just drinking 2-3 drinks a day, he als said that when he is "really drinking," and out with his friends (once or twice a month, but a LOT more in the summer) he binge drinks, sneaking extra shots and so on when no one is looking.

Someone asked about his plans. He want to finish college, return to and hang out in the alternative friendly city where he went to high school, and eventually enter a graduate program and become a professor. He currently has the academic record that makes this a reasonable goal, even in his humanities field.

Thanks again all. He (or I) may be taking some of you up on your email offer.

Wife just drove up. Here comes another big conversation.
posted by LambChop at 3:29 PM on March 9, 2006

LambChop, I have nothing constructive to add, but I have to say that I really, really admire you. You're a credit to MeFi.
posted by languagehat at 3:33 PM on March 9, 2006

I think transferring schools to that city might help too, but then you wouldn't be able to check up as much. Good luck--we all go thru valleys, and many of us here have come out the other side ok.
posted by amberglow at 3:53 PM on March 9, 2006

To answer your followup question:

You weren't blind to his suffering. Your son sounds deeply intelligent, warm, and compassionate. Someone with those qualities who begins to suffer from depression will do almost anything to keep it a secret, because they are warm and compassionate and don't want to trouble other people with their confusion. Because he is also very smart, he knows how to keep things a secret. It's not like he had a master plan or anything; he's faced with extremely disturbing emotions and thoughts, and his initial, instinctive reaction is to cover it up, because it's not "normal". You weren't blind to his suffering, nor are you somehow a failure or a bad parent for not noticing before he told you. On the contrary, you're such a good parent that he could come to you and tell you when he couldn't keep it inside anymore, and you've done such a good job that he came to you first instead of hurting himself.

You should not and must not blame yourself for not interceding earlier or sussing out a problem. If your son didn't want you to know, you weren't going to know, period. So don't dwell on that. Take comfort instead in the fact that your son trusts you so much that he wants your help. When it became unmanageable, he didn't attack himself or go haywire; he summoned all of his remaining strength and came to you. You may not realize how impressive that is, for him and for you, but as far as I'm concerned you should count it as your greatest parenting success.

I'll add my name to the list of emails, if I can be of any help at all (email in profile). Good luck with the counselor.
posted by Errant at 3:53 PM on March 9, 2006

I've spent 13 years working a suicide hotline in a large city. When we get a caller, we don't hesitate to ask if they are considering suicide or if the thought has occurred to them. If so, we try to assess the probability that they will attempt.

The most important indicators are:
* Have they tried before? Previous attempts tend to remove inhibitions or stigma. Probably the most important because it means they have no fear of making the attempt.

* Do they have a well-thought plan and the means close at hand? Even if the plan is outlandish or complicated, details mean they've spent some time considering the attempt. A vague plan or something that entails acquiring items for the attempt means that they will have to perform acts that require energy and time.

* Is there someone close they can talk to? Between the lines here is the implication of someone being there to prevent them from suicide.

* Ambivalence: they've thought about it, but turn away from it. They see it as an option, but don't want to do it. Ambivalence means they're reaching out for help.

The depression curve resembles a U. When someone is on the high sides of the U, they are generally not in danger of suicide. When they are at the very bottom of the U, they are generally not in immediate danger because they will lack the energy for almost any act. The critical times are just before and just after that bottommost part. They have the energy and they are dangerously depressed. Other than clinical depression, the bottom part of the U will not last longer than about 2 weeks.

Remain supportive yet neutral. Empathize with him. However, don't take his side in any perceived conflicts. You can't be with him 24/7, so you have to provide him with the capability of being in control. Stress that he is in control and you are there to help. Don't use "make-feel" constructs since they imply a lack of control. ("How does that make you feel?" says he isn't in control. "What do you feel when that happens?" means he has a choice in how he feels.)

When you are talking to him, avoid the words "but" and "why". "But" negates everything you've just said ("You're doing great, but have you thought of trying this?") and can be replaced with "however", "yet", or even a non-vocalized semicolon. "Why" is simply confrontational. Instead of "Why did you do that?", say something like, "What lead up to that?" or "What were your reasons for doing that?" It sounds silly, I know. It works.

Don't belittle or shrug off any of his concerns. What seems small to you may not be small to him. Acknowledge them and make mental bookmarks about the things you can actually work on.

In any given conversation, guide him to focus on one concern at a time and discuss that issue. A shotgun approach will waste time and energy and leave you both frustrated. Develop a concrete plan of action for the issue. There may be times that you can't get him to focus or he will focus on an issue that he has no control over ("How do I make her love me?") Don't force the issue or demand he change focus. You will have to nudge him gently. Once he makes progress on things he can control, he will start recognizing the things he can't control.

I'm not going to blow smoke up your ass about you being a beautiful person or anything. You're not blessed, you're not an angel. As soon as you start believing that, you will start thinking you can fix him or think you're nobly infallible. You are not the central figure in this scenario, he is. When you start to think you're doing him a favor, you've removed control from him.

You will make mistakes. They are not your fault. Acknowledge them and keep going. You are not to blame for missing any signals nor for any actions he takes.

This is the website of the American Association of Suicidology. Look at the link About Suicide for information about the indicators of suicide. If you're in the US, call the AAS to find the number of a crisis center in your area. When you call the crisis center (and you should), don't be surprised that they are more focussed on you than on your son. If they're doing the job right, the caller is the client. Ask for information about suicide and depression. They will urge you to get your son to call. To be truthful, their suggestions to you and your son will be to seek counselling (they are a crisis line, not a therapy group). They are a resource for your son if you are unavailable in times of crisis, so give him their phone number and encourage him to call them if the need arises.

Sorry for the long post.
posted by forrest at 4:11 PM on March 9, 2006 [3 favorites]

Wow, all I can say is that you should take great pride in the job you have done with your son. The love and trust that your son has for you is the greatest compliment anyone can ever have, and it's obvious that you deserve it. That coming from a step-dad whose still trying to earn it from his own sons. I wish the best for you guys.
posted by snsranch at 5:05 PM on March 9, 2006

The thing that kept coming back to me today is how could I not have known? We talk every day, and not just chatty small talk but about life and philosophy and the big questions. He lives under our roof. How could I have been blind to his suffering?

Because he kept it in his private thoughts. Don't beat yourself up. I bet you have fears and doubts and regrets and thoughts that you keep private, yes? We all have lots of stuff in our heads that's not relevant unless it starts getting out of control.
posted by desuetude at 5:58 PM on March 9, 2006

You are a fantastic dad. Seriously. This, also, was me at 22. I wish I'd had someone like you to turn to when I started with the "lame breakdown" thing.

What you can do is remember that when you're depressed, everything is hard. Getting out of bed, getting dressed, etc. are struggles. It helps some to break things down into small enough pieces that the goals are actually attainable. Where you might once have expected him to manage, say, washing the dishes and vacuuming the floor, now you may have to scale it back and realize that running hot water and washing three dishes was all he could manage today, and even doing that much was a struggle.

You can't make him better, but you can let him know that he can get unconditional love and support from you. Although, given what you've already told us, I suspect he already knows that.
posted by stefanie at 6:17 PM on March 9, 2006

I just wanted to echo forrest. Though you sound like a really loving dad:

[Y]ou're not an angel. As soon as you start believing that, you will start thinking you can fix him or think you're nobly infallible. You are not the central figure in this scenario, he is. When you start to think you're doing him a favor, you've removed control from him.

It's okay that you didn't know. And if something should happen, God forbid, it won't be your fault.

Take care of yourself. I imagine this could be draining or overwhelming. Might want to be getting your own support group to help.
posted by salvia at 12:49 AM on March 10, 2006

Here's something very important, based on my experience:

The most difficult thing about dealing with my depression turned out to be accepting the "new me." I finally hit rock-bottom in my early thirties, IIRC, which means I'd been in and out of it for at least fifteen years, and had been 100% lost in it for at least five years before seeking help.

When I first started treatment I was quite uncomfortable with the changes. Not being depressed was such an alien feeling that I had some amount of crisis of self-identity. I literally "didn't feel like myself." It took a couple years to really come to grips with the fact medication does, in fact, let me be the real me.

One of the consequences of this difficulty in accepting the positive changes is that I tried discontinuing the meds several times. Each time I eventually slipped back into depression, and the first few times it was so familiar that I didn't recognize it for what it was. I had to hit bottom a couple times before I finally clued in. I expect to remain on anti-depressants for life now: I don't know if I'd live through another rock-bottom bounce, and I don't trust myself to catch myself in time.

Please be prepared to support your son in learning to like and accept and prefer the "new self" that he's going to be discovering. Help him understand that depression is a mask over reality, that it is not reality itself.

Also, once he's into therapy and meds, make sure to kick his ass into making lifestyle changes. My biggest fault in beating back depression is that I've yet to make changes to some of my worst habits, habits which only make it easier to slip back into a depressive state.
posted by five fresh fish at 10:53 AM on March 10, 2006

Original poster here again. My son talked with the school counselor on Friday and has an appointment tomorrow. The talk with my wife went OK, though I feel like she didn't quite want to face it. (Alternatively, perhaps it was far less of a shock to her, since she is more sensitive than I and may have intuited his state.) I had another separate talk with her to emphasize that the boy thinks of killing himself and has for years. Anyway, I think we are on the right track.

One concern I have is once we get him in therapy, be it chemical or talk or whatever, how do I behave towards him? I mean, love and support yeah, but what does that mean? "So son, how the drugs working? Many suicidal thoughts today?" I feel like everytime I ask him how his day is going, there is a huge subtext. I think my wife and I should probably visit the counselor as well to ask about this.

And if something should happen, God forbid, it won't be your fault.

Damn that is sobering!
posted by LambChop at 2:00 PM on March 12, 2006

you can joke about it--it'll help lighten it and make it seem less like it's some failing or that he's let anyone down or something.

i would, i think (but definitely only with him, and only in private)
posted by amberglow at 8:10 PM on March 12, 2006

Lambchop, sorry for that sobering comment... In retrospect, it's obviously not very appropriate or helpful.

Glad you posted again -- I was thinking about you and checked back hoping you'd left an update. Sounds like everything is going pretty well -- good luck!
posted by salvia at 8:44 PM on March 12, 2006

Couldn't emphasize enough what nebulawindphone said about being prepared to see and reject several therapists before finding the right one. Even people who are willing to give therapy a shot might call it quits after meeting and disliking a couple of them. It's important that he realizes that there are options and the choice is his, and that getting better means making sure he keeps looking for help until he finds the person who can give it to him.
posted by hermitosis at 9:13 PM on March 12, 2006

One concern I have is once we get him in therapy, be it chemical or talk or whatever, how do I behave towards him? I mean, love and support yeah, but what does that mean? "So son, how the drugs working? Many suicidal thoughts today?" I feel like everytime I ask him how his day is going, there is a huge subtext. I think my wife and I should probably visit the counselor as well to ask about this.

You've done great so can trust your instincts here. You remind him that you love him just the way he is. You can promise see him as your kid, not the therapy-patient under your roof. You can point out that if you're being 'weird' around him that he can point that out and you'll knock it off. You can gently joke about it. You can chastise him when he does something wrong and reward him when he does something awesome, just like normal.
posted by desuetude at 6:50 AM on March 13, 2006

OK, my son went to see one of the school counselors yesterday. He said it was very good, that it felt great to talk openly about this, finally, with someone. He felt he clicked with the counselor. We also discussed how he and I will talk about this in the future. I said that I didn't want to ride him about it, but didn't think we should act as if nothing happened either. We agreed to play it by ear.

Thanks again all, I do believe we are going to be alright. I will check in again. And if I need more help, well, I know where to find you.
posted by LambChop at 8:54 PM on March 14, 2006

As a former suicidal depressive, How I Stayed Alive When My Brain Was Trying To Kill Me made the difference in my life. Medication and counseling helped as well, but this book gave me hope, support I could handle on my terms and a swift kick in the pants, all of which I desperately needed.

You sound like a very supportive and loving parent. Your son is lucky to have you. Best of luck.
posted by hercatalyst at 10:07 PM on March 15, 2006

I think my wife and I should probably visit the counselor as well to ask about this.

Excellent call. Also, ask your son if he would be open to a session or two of family counseling. It would give you all an opportunity to ask/answer questions and express yourselves in a neutral environment.

It's also helpful to have what my dad called an "attack briefing." (Too much science fiction.) During ours, we clarified actions and responses we knew we might have eventually. i.e. "'How was your day today?' has no subtext. I just want to know how your day went." and "Don't worry when I'm quiet and reflective. Sometimes I just need to be quiet and reflective."

More than anything, do not be afraid to bring the subject up. If you want to talk about it or feel you need to discuss something, ask your son if it's a good time to talk. If it's not, schedule a later time that works for both of you.

I struggled with suicidal thoughts for ten years (I'm 25). Eventually (when I was no longer a teenager), my parents and I did the things listed above and we became a hell of a lot closer because of them.

Hope this helps.
posted by hercatalyst at 10:25 PM on March 15, 2006

Update: My son has been talking with the school counselor every week. At first, this was an enormous relief to him--just to be talking about it, I think, and realizing he was not as odd as he thought. But though talk therapy did make him fel better while he was in the office, it has not had any lasting effect. His classes are getting down to crunch time and he is paralyzed by apathy. (He is actually taking a class from me this semester.)

So after much reluctance today he is going to get a presciption for anti-depressants. I have been hoping he would decide to do this, but tried not to push him. The couselor says that finding the right medication can take time, which he finds discouraging. I keep telling him that the key to life is the direction you are traveling, not the speed.

He also quit drinking after our first conversation and has stuck to that. He says that he feels like he has no way of relieving frustration right now. We suggest excercise, and sometimes he works out, but not consistently. In the past, when he has lived elsewhere, he has gotten a lot out of yoga. But after studying yoga in India a few summers back he finds the yoga places in our little midwestern town way too backwards. I suggested he teach a yoga class, but he does not feel worthy.

We have kept communication open fairly well. On the days when he meets the counselor we talk about the meeting at dinner. He usually iniates the conversations.

I wonder about my other children, as I understand that depression runs in families. My stepdaughter is a few years younger than her brother and seems fine. But he seemed fine to me until a few weeks back. She is aware of her brother's struggles, and I should ask her if she has the same issues.

I also have a 6-year-old son. Sometimes (not often) when he gets angry and frustrated he cries and says he "doesn't deserve" whatever good thing is at issue. When he was four he would sometimes (not often) dig his fingernails into his face when he was frustrated. Normal kid stuff or early signs?

Parenting makes you so vulnerable.

Anyway, thanks again to all who responded here. A part of me still holds to the TV situation comedy view of the world--soon someone will say the magic word and we will go back to normal. But of course this is not going to happen. But at the same time I am convinced that my son is on a path to feeling better than he ever has.
posted by LambChop at 6:45 AM on April 18, 2006

Last Update Before this Closes:

My son ended up withdrawing from school the semester he had his breakdown. The drugs (Effexor) really helped break the spell. He spent the summer working in the town where he grew up, frittered away the fall there, and returned to our house just before Christmas. He is now back in school for his last semester.

He is off the drugs and keeps depression at bay with yoga and some mental exercises. He does sometimes have depressive episodes and is ready to go back on the medicine if need be. He seems happy most of the time and has plans for the future. He is going to be fine.

His 7-year-old brother is starting down the same road, but that is another post.

Thanks to all for the amazing support and advice.
posted by LambChop at 8:00 PM on March 1, 2007

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