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.

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:

• When a close friend is depressed
• Drained by a profoundly depressed friend

The post Where Can My Depressed Friend Get Help? appeared first on The Friendship Blog.

QUESTION

Hi,

I need some advice on a very tricky situation. My friend, whom I met online and have known for a couple of years, has been depressed and suicidal for the past year. I also have had chronic depression from since I was young and have also been suicidal so I thought I could relate to her feelings of being a failure and thinking that life is going nowhere.

The problem is she doesn’t actively seek help on her own and doesn’t like seeing a psychiatrist. She often tells me about her suicidal feelings and gets mad at me and her other friends for supposedly ignoring her and making her feel miserable because we don’t pay enough attention to her.

It has come to the point that I feel like our relationship is toxic. Every time I speak to her she gets mad. And when I don’t talk to her every week like she expects me to, she gets upset, too. It really feels like no matter what I do it’s never enough. She is negative in every aspect of conversation and any time I try to bring up something optimistic it gets knocked down or I get some sort of smart remark in return.

It’s also frustrating when my friend guilt trips me into paying more attention to her or tries to make me feel bad for not doing enough for her.  I’ll even get something like the suicide card sometimes and it makes me feel trapped.

I’ve spoken to her mom about this and have even invited her to my home even though we were only online friends. I make sure to contact her every once in awhile to see how she’s doing but if the timeframe gets too long, she accuses me of avoiding her. It’s come to the point where I feel like I’m being taken advantage of or played with even though she may not mean it.

As I mentioned before I also have my own depression to deal with, I’ve been seeing a psychiatrist for years and it’s really hard for me to even get my own life together let alone take on what my friend is dealing with. The thing is though I’m afraid if I distance myself or set a boundary she’ll attempt to commit suicide in which case I wouldn’t be able to handle the guilt of maybe not helping enough or not caring enough. How can I distance myself enough to still be her friend but also allow myself the space and breathing room to focus on my own life?

Signed, Rosa

ANSWER

Hi Rosa,

While you and your friend share a history of depression, that shared experience alone is not enough to cement a healthy friendship.

As you well know, it is extraordinarily difficult to be close friends with someone who is severely depressed. If your friend always sees things in a negative light and has no hope for the future, being with her can begin to feel like a real downer. Given that you are prone to depression yourself, you are correct in trying to gain some distance from this relationship.

Ruminating about depression isn’t good for either of you. Your friend also sounds manipulative and may have other psychiatric diagnoses. You need to be honest and tell your friend you’ve realized this relationship isn’t good for your own mental health, and that until she seeks treatment, you need to step back. When you speak, focus your conversation on your needs, not hers.

If you feel you want to maintain this relationship, you need to set firm boundaries that feel comfortable for you. For example, you can tell your friend you can only communicate online once or twice a month. Alternatively I can also understand you deciding to break off the friendship or place it on a back burner for now.

Sadly, you are correct in being concerned about your friend. A person who talks about suicide is at increased risk. This is something that your friend may do whether or not you remain friends. You have done the right thing in alerting her family and urging her to seek treatment but you can’t take on the responsibility of making yourself her virtual life preserver.

Hope this helps.

Best, Irene

Some prior posts on The Friendship Blog that discuss friendship and depression:

• Psych 101: When a close friend is depressed
• Depression, loneliness and friendship
• Is it friendship anxiety or depression?
• Drained by a profoundly depressed friend

The post Dealing with a depressed friend when you are depressed appeared first on The Friendship Blog.

QUESTION 

Dear Dr. Levine,

I was close friends with a woman for several years. Six months ago, she abruptly ended the friendship. Two months prior to the end of the friendship, I was going through cancer radiation treatments and could not devote the time and energy to her that she seemed to need to feel satisfied with the friendship.

A few weeks before my treatment began, she suddenly claimed she was having severe, recurrent flashbacks/memories of an abusive period in her childhood. I tried my best to be patient with her whenever she wished to discuss her psychological state, but it was very difficult for me to be attentive because of my own physical condition.

At one point, she asked me to stop talking to her about my cancer treatments because she was in a fragile emotional state and was not in a position to be supportive to me at all. I was very disappointed but continued to do what I could to try and support her anyway since her mental state did, in fact, seem to be deteriorating.

In the weeks that followed, our conversations become very strained. I felt I couldn’t talk to her about my treatment, and whenever I tried to talk with her about what she was going through, she didn’t seem to want to discuss it.

Our last conversation was very upsetting. She told me that it was impossible for me to understand her severe emotional upset in any way and that I might as well not even try.

Additionally, she told me that I was ‘”lucky’ to have cancer since once my treatments were over, I could heal and move on but her abusive memories were something that no time could ever heal. I was deeply offended by her remarks and when I attempted to discuss those feelings with her, she told me I was self-absorbed, hung up the phone, and cut off contact with me, except for a single text she wrote saying that the way I spoke to her when I was frustrated about my treatments and/or my life reminded her of a past abuser and caused her to have even more negative flashbacks.

Since that time, I have heard through our mutual friends that she thought I was very selfish and cruel for expecting her to be supportive while I was going through treatments because she herself was so sick.

I confess I am not sure what to think about it. The relationship is so strained that we have not even been able to say hello to one another in public. I have considered writing to her or calling her to gain closure, or as a gesture of goodwill but I do not want to open any old wounds unnecessarily if the friendship is not worth saving.

What are the boundaries when both friends are struggling and have nothing to give to one another? Isn’t friendship supposed to be in sickness and in health? Is it best to just move on from this? Were my expectations in fact too high? Were hers? I would genuinely appreciate any advice you could give me on the subject.

Thanks,  Sheryl

ANSWER

Dear Sheryl,

A diagnosis of a serious or life-threatening illness is likely to make anyone feel vulnerable and it’s normal to turn to others for support. Surely, your diagnosis and treatment must have been a very challenging period in your life.

Your friend seems to have been dealing with some serious emotional problems at the same time as you were struggling to cope with your own illness and its treatment. It had to be disappointing that your friend was emotionally unavailable, and couldn’t be more empathetic and supportive when you needed her. Her comments comparing her illness to yours and telling you that you were “lucky” were very insensitive but it sounds like she was under terrible stress.

The timing of all of this was unfortunate in terms of your inability to be there for each other. If you weren’t experiencing health problems, you may have been more patient and understanding of your friend. Conversely, if your friend wasn’t experiencing traumatic flashbacks, she may have been more understanding and supportive of you.

Since this friendship was a meaningful one to you before this disappointment, my suggestion would be to send your friend a short note. Say something like, “I’m so sorry we were unable to be there for each other but I realize we were both experiencing enormous stress and turmoil in our lives. I’m feeling stronger now and I hope you are feeling better, too. Our friendship has meant a lot to me in the past and I hope that we will be able to reconnect in the future.”

This will give you some sense of closure because you will be doing the right thing in terms of being supportive of someone you care about. You will have also conveyed your disappointment about the past—yet you’ll be leaving the door open in case your friend is able to think about what happened more clearly now as you do. Even if she doesn’t respond in kind, it will allow you to greet her cordially, having your feelings out in the open, and this should also allow you to feel more comfortable among mutual friends.

I hope your recovery is progressing nicely and wish you the best of health.

Warm regards, Irene

Here are a few prior posts on this blog about coping with cancer:

• Another reason why cancer sucks
• Diagnosed with cancer and feeling depressed: Don’t isolate yourself
• Cancer is a Bitch: An interview with Gail Konop Baker
• On Healthy Women: Why friendships are so important

The post Friendship: In Sickness and In Health appeared first on The Friendship Blog.

QUESTION 

Hi Irene,

I’ve recently been coming to terms with some deeply buried grief, and also struggling
with self-injury problems as well. My "best friend" of 19 years has
hardly been there for me and only seems to come around when he needs me. He
makes it very clear that he does not care about my emotional troubles, and I
find it truly frustrating to try and be there for him when he is never there for me.

I try to be supportive of him and he knows
that whenever he calls, texts, or emails me, I will answer. On the other hand,
it’s rare that I can get a hold of him and even rarer that he’ll answer in a
timely fashion, despite his "open" schedule.

As I’ve been going through therapy, I’ve often asked myself if my friendship
with him is worth it. Sure, he has his moments when he can say something nice,
but those times are far and few, and the time in between those golden moments
is filled with unanswered calls and snide remarks, put-downs, and just plain old disregard for my emotions. He makes me feel guilty
for trying to ask that he be supportive of me in my recovery! It deeply hurts
me that even my struggles with self-harm don’t even phase him.

He is my only friend at the moment, and it
makes me fearful to think of leaving him, even though the cons of staying with
him outweigh the pros. What should I do?

Signed, Trish

ANSWER

Hi Trish,

Since you are in treatment, I hope you are
discussing this problem with your therapist who knows you far better than I.
Since my knowledge of your situation is limited, I can only speak in
generalities.

You haven’t mentioned whether this friendship has always felt one-sided. If it has been this way for some length
of time, it has to be frustrating and disappointing to feel so unsupported by
someone you care about and depend upon—especially when that individual is your
only friend.

On the other hand, it would be difficult for
any friend, even a very good one, to know how to respond to self-injury. Perhaps,
you are expecting too much of him.

One suggestion: Your friend may be capable of
becoming a better friend if you depend on him for companionship, and depend (at least primarily) on
your therapist to discuss emotional issues related to your recovery.

Also, since you feel like your friend isn’t as
supportive as you would like and is caustic at times, it would be worthwhile to
seek out other friends as well. It sounds like you may be overly dependent on one
individual who isn’t capable or willing to meet your needs.

Hope this helps.

My best, Irene

The post Asking too much of a friend appeared first on The Friendship Blog.

Keep in mind the researchers weren’t talking either about the garden variety of befriending (a term that has become common parlance among Facebook or Twitter users) or about a mild case of the blues. For the purposes of their study, the team of primary care researchers at the University of Manchester, Manchester, UK defined “befriending” as social support that was “initiated, supported and monitored by an agency” expressly for one or more parties to benefit. It was, by definition, a treatment for depression or emotional distress that was “non-judgmental, mutual and purposeful.”

The meta-analysis (a systematic statistical analysis) looked at more than 24 studies that covered a wide range of depressed populations, including caregivers of individuals with dementia, adolescents, lonely widows, men with prostate cancer, and pregnant women. The frequency of befriending varied among the studies as well as the ways in which the befriending took place. Some contacts were made face-to-face, others were by telephone, and some were a combination of both. Befriending was delivered both by trained and untrained volunteers.

The researchers found that the befriending intervention was less effective than cognitive-behavioral therapy (CBT) in adolescents with depression and in medication-resistant individuals with schizophrenia. It was also less effective than nurse cognitive-behavioral problem-solving in caregivers of people with dementia. It was similar in effectiveness to a nurse education and self-efficacy intervention in older adults recovering from myocardial infarction, to local community support groups for new inner-city mothers, and to systemic family therapy in depressed adolescents.

Based on their data, the researchers were unable to conclude that “befriending” is an effective, evidence-based treatment. Instead, they suggested that more rigorous study was needed to compare “befriending” head-to-head with standard treatments (such as CBT and medication), and that individual preferences should be considered in determining what works, for whom, and under what circumstances. This study relied on meta-analytic techniques to look at the friendship question but it would be worthwhile for researchers to design more large studies that look closely at whether and how friendships can alter the course and outcomes of various types of depression.

The conventional wisdom is that the presence of social supports can serve as a buffer against depression. Sounds logical enough: Friendships offer an outlet for people to express their emotions, to put things into perspective, to feel less alone, to reduce stress, and to encourage someone who’s feeling distressed to seek out professional help when needed. But people with severe depression often have a hard time reaching out to anyone and it is often equally difficult for friends, even very good ones, to know what to do to help them recover. There’s a lot more to learn.

Source:

Effects of befriending on depressive symptoms and distress: Systematic review and meta-analysis

Nicola Mead, PhD, Helen Lester, MB, ChB, MD, FRCGP, Carolyn Chew-Graham, MB, ChB, MD, FRCGP and Linda Gask, PhD, FRCPsych, NIHR School for Primary Care Research, University of Manchester
Peter Bower, PhD, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

The British Journal of Psychiatry (2010) 196: 96-101. doi: 10.1192/bjp.bp.109.064089

—————————————————-

How to Help a Friend or Relative Who is Depressed (From the NIMH)

If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

To help a friend or relative:

• Offer emotional support, understanding, patience and encouragement.
• Engage your friend or relative in conversation and listen carefully.
• Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your friend’s or relative’s therapist or doctor.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don’t push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will lift.

Facts about Major Depression

According to the National Institute of Mental Health (NIMH), major depression is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once pleasurable activities. An episode may occur only once in a person’s lifetime, but more often, it recurs throughout a person’s life. , It is estimated to affect 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.

Also on The Friendship Blog

• Why Listening Matters: Friends Who Listen May Protect Our Cognitive Abilities

Updated 8/21

The post Is “Befriending” A Treatment For Depression? appeared first on The Friendship Blog.

QUESTION

Dear Irene,

I’ve gone through multiple friend break-ups and it seems to be a recurring theme for me. I never want these friendships to end but they always fall apart because I ask too much of them.

I always have a feeling of insecurity with friends to the point where I need so much reassurance that the friend becomes exhausted. I think this tendency may spring from my ongoing depression—but how can I overcome this extreme friendship anxiety?

And how can I go about repairing friendships that have been weakened or cut off because of this? Too frequently I’ve had friendships that have started well, escalated towards very intense then petered out for the reason above. I don’t want this to happen anymore, what can I do?

Signed, Anonymous

ANSWER

Dear Anonymous,

If you feel depressed and it is complicating your friendships, you need to get to the root cause of your problem: depression. When someone is depressed, it can take a lot of energy to focus on other people.

The good news: You seem to have a knack for making friends and you’ve recognized that you eventually ask too much of them. Try to keep this in mind and see your friends in small doses so it isn’t overwhelming for them or for you. At the same time, speak to a mental health professional (perhaps, you’re already seeing one) and ask for help. Depression is a treatable illness.

Thanks so much for posting and I hope this was helpful.

Best,
Irene

The post Is it “friendship anxiety”…or depression appeared first on The Friendship Blog.

Dear Irene,

My friend started on anti-depressants about 6 months ago, and has been drinking a lot lately. Drinking while on medication is usually not a good idea. It’s gotten to the point where she goes out every weekend, gets so drunk she pukes, and makes a total fool of herself. She ‘blacks out’ and forgets nearly half the night. She’ll be all over guys, some of them complete strangers, spilling her drink, and losing her phone, too. It used to be fun going out with her, but now she gets drunk so early in the night that I feel like I have to babysit her.

A few weeks ago, she got into a car with some guys that we knew. She wanted me to go with them but I declined. I had work the next day, and had a feeling that I wasn’t going to get to where I needed to be by noon. I insisted that she come with me, but she didn’t want to get out of their car.

The next day, I found out from her roommate that my friend had said something wrong to the driver of the car, and he kicked her out, 3 miles from her house, at 3AM, in the country. She lost her phone, and had to walk to find a phone to call a friend.

I felt badly for her, but I thought it served her right for being so ridiculous. I thought that it would get her to tone it down, but she’s just getting worse. This weekend, she puked in the street. It really makes me upset, because she’s such a strong independent woman. I’ve never seen her act like this before. It’s like she’s trying to destroy herself, and I don’t want to see my best friend get arrested, raped, or worse.

I just don’t know what to do in this situation. I’ve told her to stop, but she won’t. I’ve talked to another one of our close friends, who has known her longer than I have, and she doesn’t know what to do either. We tried getting her to do other things, but she just isn’t interested. Her roommate started being rude to her just so she would leave. She was tired of my friend coming home at 4am all the time, and waking her up.

Is there something I could tell her? Or should I just leave it alone, and wait for her to wise up on her own?

Signed,
Kayla

ANSWER

Kayla,

You are right to be concerned about your friend’s well-being. It sounds like she is engaging in a number of very risky behaviors.

It’s always a problem when someone needs but doesn’t want help. At this point, it sounds like your friend’s behavior is out of her control and she should be diagnosed and treated by a professional. A few thoughts:

•    Can you talk to her when she’s sober and see if she is willing to call or go back to the person who prescribed her anti-depressants?

•    Can you contact one of her family members and let them know what’s going on?

•    Can you provide her with contact information for Alcoholics Anonymous in your area and see if she is willing to attend a meeting?

If none of these are possible, you may want to assemble her friends as a group to let her know how concerned you all are. You didn’t mention whether she is able to work and has a source of income.

She is fortunate to have a friend like you. Encourage her to talk to you and gain her trust. Continue to express your concerns for her well-being and maybe you’ll be able to catch her at a moment when she’ll respond.
Of course, if she seems to be in danger or she is homeless, you should consider calling 911.

My best,

Irene

The post A friend who drinks too much appeared first on The Friendship Blog.