The Friendship Doctor

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Where Can My Depressed Friend Get Help?

Sometimes a depressed friend needs more help than any friend can provide.

QUESTION

Hi Irene,

I have a friend (for the past 20 years) who is extremely negative and depressed, impossible to deal with, irrational and who is completely draining me. Any and all suggestions I give to better her situation are repeatedly dismissed.

She “vents” angrily to me on a regular basis about how life is so unfair and how the world is playing a cruel joke on her. She has said many times recently that she’s “on the edge” and “about to lose it” or “at her wits end.” Many of these (mostly one sided) conversations end with me feeling frustrated or angry or in tears.

She is, I believe, clinically depressed. She is 44 and is suffering from chronic pain due to fibromyalgia and scoliosis along with depression. In the past, doctors have prescribed antidepressants but they make her gain weight. She refuses to take them because of this, saying that if she gains another pound she will kill herself. She is also in debt and doing credit card counseling. I see clearly that she repeats the same mistakes over and over again and is always disappointed that nothing works out for her.

She is desperately lonely but has had many men interested in her and every time, she ends up dumping them and then is back to being lonely again.

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I have read about many similar issues on your blog and you usually recommend that they seek treatment for depression.

My question is: How does someone who can’t afford treatment get help? There seems to be a disconnect for my friend in this area. She has a job that provides health insurance but cannot afford to pay for the doctor visits or medications.

Is there any help for someone in this situation? Do we have to wait for her to actually “go crazy” to the point of losing her job and apartment for her to get any help?

Signed, Vera

ANSWER

Hi Vera,

It is very common for people who are depressed either to deny their problems and/or to resist seeking treatment. That can make it tough on the family and friends who care about them. Often the sense of hopelessness and lack of energy you describe in your friend is associated with depression itself. No matter what you say or do, it’s impossible to talk the person out of it or lift their spirits.

Since your friend is likely being treated for her chronic pain, the first step should be for her to speak to her primary care doctor, rheumatologist, or pain management specialist to assess whether her pain is being adequately treated, and whether her depression may be related to any of the medications she is currently taking to manage her health problems. You might encourage your friend to allow you to accompany her on this visit both to help her remember to ask the right questions and to act as a second set of ears to listen to the doctor’s recommendations.

At this appointment, your friend needs to be honest and let her doctor know how she is feeling. He/she may be able to confirm whether or not she is clinically depressed and if so, prescribe antidepressant medication. Even if she didn’t have luck taking an antidepressant in the past, newer drugs have come on the market and not all antidepressants are associated with weight gain.

If the doctor isn’t comfortable prescribing an antidepressant or other psychotropic medications, or thinks she needs other health and social supports as well, he/she might be able to refer her to a local mental health program, either run by government or a voluntary agency that serves people on a sliding cost scale based on their means. A social worker or case manager may be available on staff to assist her with her problems on an ongoing basis.

If your friend is unwilling to go the route of speaking to her physician, there are two organizations in the U.S. that might be able to provide your friend with information and support. The National Alliance on Mental Illness (NAMI) is a grassroots organization with more than 1000 local affiliates across the nation that provide support for individuals with mental disorders and for their families and friends.

Admittedly, the mental health system is under-resourced, confusing, and can be daunting to maneuver, especially for someone who is depressed. For these reasons, it can be very helpful for your friend to link up with people who know the resources in your local community. Most NAMI offices have helplines to assist you in finding care. Ideally, it would be great if your friend could make this call on her own; if not, you may want to call and find out the information for her. Many of the people manning the phones have family members who experienced similar problems.

The Depression and Bipolar Support Alliance is another nonprofit that offers advice for people with mood disorders, including local peer support groups, to help people connect with appropriate care.

Clearly, it sounds like with all her problems, your friend needs far more help that you can provide as a friend. The best thing you can do is encourage her to get professional help.

If your friend sounds like she may be a risk to herself, a free 24-hour National Suicide Prevention Lifeline (funded by the U.S. Department of Health and Human Services) is available to people in crisis (or their loved ones) at 1-800-273-TALK (8255). Calls are routed to local crisis centers. In the UK or Ireland, Samaritans offers confidential support at 08457 90 90 90.

I hope this is helpful. Check in and let us know how things go.

Best, Irene

Other relevant posts on The Friendship Blog:

Irene S. Levine, Ph.D., is a psychologist and professor of psychiatry at the NYU School of Medicine. Her latest book is Best Friends Forever: Surviving a Breakup With Your Best Friend.

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