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#1 of 15 Old 08-08-2006, 11:36 PM - Thread Starter
 
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My 15-yo stepdaughter is having a very hard time with depression, and I'm wondering if anyone here can give some advice.

A little background: she has been raised primarily by her mother in another country, and her mother has had a serious alcohol problem for the duration of my sd's life. She has now lived with us for about two years (with a break of six months, when she went back to live with her mother), but is now back for good with us (or at least until she goes to college). There's a lot to say about her relationship with her mom, but there's not space to go into it here. I think the main fall-out is that she suffers from low self-esteem, difficulty forming and keeping friendships, inablity to communicate her feelings... lots of things that make sense, given how hellish her life with her mom has been.
My husband and I have suspected that she was depressed for some time (we started bringing her to a therapist back in March), but it was hard to talk about it with her. Then a few weeks ago, she came out and told us that she had been cutting herself for the last year and a half, and wanted to get anti-depressants from a doctor to try and feel better.
This started a big discussion between her, my husband, and me, where we talked about so many issues that she hadn't been able to talk about up till then. It felt like such a relief to finally get a lot of things out in the open, and to know what she is actually feeling inside. Things have seemed much better for the past two weeks, and she says she went 21 days without cutting herself.
She also started the anti-dep's a week and a half ago, and the therapist she was seeing has agreed to start seeing her more frequently (from once every two weeks to once a week).
Things took a big turn for the worst in the last two days. She's been cutting herself more severely, has been downright abusive (verbally) toward my 4-year-old daughter, won't come out of her room, doesn't want to eat, etc. The social worker she saw to start on a course of anti-depressants recommended "escalating" our response, by putting her in a three-week in-patient program, because my sd says she doesn't want to stop hurting herself. She is very resistant to the in-patient program idea, saying she knows it won't help to just sit around and talk all the time.
I feel so helpless. I know that it is going to take a lot of time for her to start feeling better about herself, to be able to start healing, and she will go through lots of down, dark times, as she's experiencing right now. But it's so scary. I don't want her to hurt herself. And I don't want her doing long-term emotional damage to my daughter either.
I guess I'm wondering if some of the people who have posted on here about the difficulties they battle with depression now, as adults, went through things like this, when they were teens. What do you wish your parents had done differently? What can I do, beyond trying to exhibit unconditional love, support, and listen when she tries to talk? How can I convey that I totally understand her being angry, frustrated, sad, etc., while still making it clear that it's not okay to take it out on a young child who can't possibly understand why she's being attacked?
Sorry this is so long. Any advice is welcome.
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#2 of 15 Old 08-08-2006, 11:59 PM
 
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I'm so sorry your stepdaughter is going through all of that. As a teenager, I was extremely depressed and displayed many of the same symptoms as your girl. I never cut myself, but I did engage in other risky behaviors, which I'd rather not discuss here. I attempted suicide twice and eventually ended up in an inpatient 3-day crisis intervention program when I was 19 because it wasn't safe for me not to be. I went voluntarily.

As far as anti-depressants go, you have to be really careful to research whichever ones are prescribed as some, such as Zoloft, can actually INCREASE suicidal ideation in adolescents due to their unique chemical makeup and raging hormones.

I completely understand your fears with regard to your younger child and I think it might be helpful to talk it out as rationally as possible with your step-daughter without being confrontational or saying anything that will further harm her self-esteem. I think it's possible that a combination of meds and bringing issues to surface in therapy are causing the escalation in her behavior. Unfortunately, sometimes the old addage is true: things get worse before they get better.

However, if her cutting is becoming more severe, an inpatient facility may be the best thing for her right now. Perhaps trying a crisis intervention program for suicidal intention/ideation wouldn't be a bad idea. You can't be with her all the time and she may either intentionally or unintentionally cut herself too deep. It really sounds like she's completely unstable right now and a short-term intervention program may save her life. I'd also suggest contacting her therapist immediately and letting him or her know that her behavior is escalating and in what way. They may be the absolute BEST person to give you advice with regard to the situation and how you should handle it.

I wish I was actually a counselor as I plan to be when I finish school. If I was, I may be able to offer better advice. I wish you all the best. I hope your stepdaughter is able to begin healing and go on to lead a healthy life. Again, I'm so sorry you're going through all of this.
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#3 of 15 Old 08-10-2006, 10:33 AM
 
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I'm of the same mind as Krystal.

I started suffering from depression at 15 and so wish that my mom had been as helpful as you and your DH are being with your SD. Although I didn't cut, I had a lot of suicidal thoughts and was very withdrawn. As someone whose BTDT, I think an in-patient program might be best for her at this point. I know she's very resistant to that idea which is totally natural. But she probably doesn't fully understand the seriousness of her situation and needs your guidance, with the help of her therapist and doc.

Is a 3-week program necessary? Is there something shorter? Perhaps your SD could talk with her support team about what going into a hospital means. (Daily schedule, etc.) I'm sure its a scary prospect for her b/c its a big unknown.

Regardless, IMO she needs intensive help. In the long-run, she (and you and DH) might find that hospitalization helps her get back on a path to feeling better.

Best to you, mama Keep us posted.
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#4 of 15 Old 08-10-2006, 11:58 PM - Thread Starter
 
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Thanks so much for your replies. The latest is that she will be starting a three-week outpatient program when we come back from vacation in 10 days. The program is apparently a three-hour thing each day, which I think is excellent. She can get intensive assistance, without the stress of being completely removed from home. The fact that she's willing to do it is a great thing, too.
On a bright note, she went out to dinner with me and her sister (the 4-yo) tonight, and we had a really nice time. She even initiated it! This was after a few very dark days where she really didn't want to come out of her room, and had been cutting herself more severely.
I'm trying to take each day as it comes, and know that there are still plenty of difficult times ahead, but what joy to have her want to spend time with us!
Thanks again for the support.
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#5 of 15 Old 08-20-2006, 11:33 PM
 
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I found this site to be useful for some mental health problems, i hope you find it useful too
www.aboutmh.com
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#6 of 15 Old 08-20-2006, 11:45 PM
 
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ITA on zoloft causing escalating suicidal ideation. IME it can also contribute to escalating self injury (got the scars to show it). Therapy is very frightening as well.

I think the outpatient program is a great step. I would really avoid in-patient unless she is aboard or is actively suicidal. Even then, it may do long-term harm unless it is a *very* good hospital, which is very hard to find. And maybe even then.

It is possible to still hurt oneself inpatient. Trust me on this.

It is possible for inpatient to make things worse and likely for inpatient to simply not do much of anything.

Please don't let her or her family be lulled intot he idea that medication will help. Medication *may* help the underlying depression, or it may not. Medication may (as you're experienced) worsen the self-harm. This may temporary or last as long a s the medication. I wa snot able to stop self-harming until I got off the medication. That is both anecdotal and corelational only, since of course other things were going on as well, so take it for what it is worth.

Pleae, pleae make sure the therpaist she is seeing is good with self-injury. Many, many fine therapists are terrible at treating this. Trust me on this too. some are good. You gotta find the good ones.
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#7 of 15 Old 08-21-2006, 11:37 PM - Thread Starter
 
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Thanks again for the feedback. In response to a few of the previous posts, I feel like I should clarify our approach to the question of medication. I share everyone's nervousness about anti-depressants such as Zoloft--believe me. I was initially opposed to the idea of her going on them, because there is such a serious risk of teens developing greater suicidal tendencies while taking this stuff. And none of us (her, her dad, or me) think that the medication will make her depression "go away," or that we can relax and figure things will take care of themselves. She has fifteen years worth of trauma to try to deal with, not to mention all the changes that have taken place over the past six months that she is now grappling with. It's painfully clear that there is no "magic bullet"--therapy, medication, hugs, whatever, could make some difference, but they might not, as the previous poster wrote.
But the more I thought about the question of medication, the more I thought it might at least be worth a try. Given that her mom has perhaps "self-medicated" with alchohol for decades, it seems possible that she has some sort of chemical imbalance that my stepdaughter may have as well, which medication could help. And I've talked with friends who have grappled with depression who have said that anti-depressants helped give them the smallest edge to be able to start taking care of themselves (through exercise, eating better, etc), which helped them to eventually feel better. So it seems like it's at least worth trying, if it's in conjunction with everything else we're trying to do to help her. Plus the doctor who presribed the medication (it's actually Selexa) sees her weekly, to try and assess what effect the drugs are having. It's quite scary, but if it can help, what a good thing that could be, no?
On a different note, we have just come back from vacation, which I think helped somewhat. It was good for her to have a change of scenery, to be outside more, among more people, etc. But boy, was she hard to take! Her dad and I keep trying to remember that she acts so nasty and mean and obnoxious because she feels lousy about herself, but it can be hard to maintain perspective sometimes. I really hope this difficult behavior can change.
She will be starting the out-patient program in the next few days. Let's hope it helps.
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#8 of 15 Old 08-25-2006, 05:16 AM
 
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Quote:
Originally Posted by tie-dyed
I think the outpatient program is a great step. I would really avoid in-patient unless she is aboard or is actively suicidal. Even then, it may do long-term harm unless it is a *very* good hospital, which is very hard to find. And maybe even then.

It is possible to still hurt oneself inpatient. Trust me on this.

It is possible for inpatient to make things worse and likely for inpatient to simply not do much of anything.

Please don't let her or her family be lulled intot he idea that medication will help. Medication *may* help the underlying depression, or it may not. Medication may (as you're experienced) worsen the self-harm. This may temporary or last as long a s the medication. I wa snot able to stop self-harming until I got off the medication. That is both anecdotal and corelational only, since of course other things were going on as well, so take it for what it is worth.

Pleae, pleae make sure the therpaist she is seeing is good with self-injury. Many, many fine therapists are terrible at treating this. Trust me on this too. some are good. You gotta find the good ones.
:

I fought serious depression from the time I was 14, but managed to still make it look to most people like I was ok. I was put into hospital at age 19 after being referred to a psychiatrist by a social worker, and being in hospital led me to totally giving up on trying to function.

I agree hospital is necessary when a safe place is needed - and I also agree that it is possible to self harm in hospital. I do recommend avoiding the hospital cycle if possible though... it tends to involve addition of more meds, and a lot of times can involve downright abusive experiences. :

It sounds to me like you & your dh are doing everything you possibly can to help & support her & given time to process everything I think your SD will start to improve. It's true that things get worse before they get better... prior to admitting what was going on your SD was probably living in denial, and when reality smacks you in the face & you can't ignore it anymore, that in & of itself is depressing.

I hope that the program is helpful for your SD. It sounds like a good stepping stone to getting her the help she needs without taking away any independence or sense of autonomy.
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#9 of 15 Old 09-09-2006, 04:08 PM
 
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Quote:
Originally Posted by atristin
She is very resistant to the in-patient program idea, saying she knows it won't help to just sit around and talk all the time.
I feel so helpless. I know that it is going to take a lot of time for her to start feeling better about herself, to be able to start healing, and she will go through lots of down, dark times, as she's experiencing right now.
A general rule of thumb in treating depression is that you don't want to try to tackle the underlying "issues" until your SD is feeling more stable. Focus on creating a safe environment, dealing with chemical imbalances or mood swings, and getting through the day.

If she's lived with depression this long, pulling back the layers can be extremely traumatic. Finding new ways to cope takes time. Even if the new medication she is taking is right for her, it takes the body and mind some time to adjust.

It may be weeks, or months, before it's time to hash out the issues you've been discussing with her.

When I read your first post, I was going to recommend you try an out-patient program rather than an inpatient program. I hope that works out for her.

She might want to find a depression support group for teenagers/young adults. I was involved in a group like that at one point. Sometimes it's easier to talk in that type of group setting rather than to talk with a therapist.
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#10 of 15 Old 09-20-2006, 09:55 PM
 
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if you would like more info on depression, have a look at
http://www.aboutmh.com/depression.html
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#11 of 15 Old 09-21-2006, 01:09 AM
 
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....

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#12 of 15 Old 09-25-2006, 12:04 AM - Thread Starter
 
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Sighhhh, mamas...
More bad news, I'm afraid. I haven't posted in a while, because things were seeming to stablize somewhat. My sd started school again, and has been getting really good grades, as always. She also seemed a little happier for a little while.
But she refused the outpatient program, because it would have meant missing the last period of school for a while. She was continuing to go to her therapist, so we didn't push it.
But things have been getting rockier in recent weeks. She's been getting nastier and nastier to everyone around her again--from her little sister to her best friend to her dad. And she has been sketchy about the antideps--letting them sit on the kitchen table when her dad gives them to her in the morning, but then swearing that she took them when they disappeared a little while later. We kept saying that she could of course go off them if she wanted--her choice--but that she had to do it with a doctor's help, because going off suddenly might make her feel really awful. She saw a doctor last Friday, and they agreed that she would stay on them for another month and then they would reassess.
In the meantime, she said she was done with therapy, didn't want to keep doing it, and there was nothing wrong with her. Yes, she was still cutting, but that's "just who she is" and she's not going to stop. We had been trying to get her to a different therapist (through some recommendations from my new therapist, who I've been seeing for guidance), but hadn't succeeded.
So this morning, we sat down and had a long talk, to figure out what to do about the meds, since she still didn't seem to be taking them, and the therapy. We said we were committed to finding a therapist, program, and/or group that could help, but that doing nothing was not an option. Not negotiatiable. We tried to stress that her behavior and her coping mechanisms are not her fault, that they come from serious trauma in her background, that she is a good, caring, smart, beautiful person in her core. But we wanted to be clear that we can't go back to doing nothing.
She was really quiet throughout, and the discussion didn't really resolve much. But afterward, she went upstairs to lie down, and her best friend called. She told us that my sd had not been taking her meds for weeks, and that she stockpiles them, and then takes a whole lot all at once. My sd had done this last night, with 12 pills, and she had done it a few weeks ago as well. We had noticed that my sd had been shivering throughout our coversation, and she complained of not being able to sleep during the night. She has had a cold lately, so I thought that's what the shivering was; and I thought she had gotten more consistent with the meds since Friday, hence the insomnia.
Guess I was wrong!
It's unclear exactly why she took the pills. She says she didn't want to kill herself, and that seems true. It seems more like she was just feeling really, really bad last night, after a fight with her best friend, and a rough week, and took the pills out of despair and self-loathing. But I don't want to be naive. Maybe she really is becoming fully suicidal.
At any rate, her dad let her know that he knew what was going on, and took her to the emergency room. Health-wise, she didn't suffer too many effects. But they did an all-out "suicide watch" type thing with her: put her in a room where she couldn't hurt herself, brought in the psychiatrist, the social worker, various other folks. The social worker is supposed to talk more with her tomorrow, and I guess they're going to decide on a course of action: she can do a hospital inpatient thing (least likely), an outpatient program, a ten-day retreat, or therapy with a different therapist and/or group discussions. The outpatient program seems like the best idea by far, and it's at a place that everyone raves about. But she's saying she won't go because she would have to miss the last two hours of school. She HATES doing anything against her will, but that has kept us from being more interventionist up till now, so I'm inclined to push more for this.
I guess I'm not asking for advice outright, but I wanted to update everyone who has been so helpful and insightful so far. Certainly, any comments or further advice is very welcome.
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#13 of 15 Old 09-25-2006, 12:30 AM
 
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I have very little advice, but a lot of sympathy for you and for her and for everyone involved.

Taking pills in unhealthy but not immediately life-threatening ways is probably not an indicator or active suicidality. When I was in a position similar to hers, I started taking all sorts of pills in an attempt to somehow make things "right," mostly by doing something harmful to me that wouldn't attract a lot of attention. I used to take fifteen or twenty tabs of ibuprofen at a time and mix them with alcohol, or take a week's worth of anxiety meds. The antidepressants are more dangerous in the short-term, but unlikely to kill her, and she knows this.

Please, please make sure that the hospital she is in is safe. I eventually (mostly) stopped self-injuring (had a relapse in August) and learned to manage my depression and anxiety pretty well with no meds (most of the time), but honestly, most of my problems today come from PTSD from the hospital "experience."
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#14 of 15 Old 09-25-2006, 03:00 PM - Thread Starter
 
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Thanks for the reply, Tie-Dyed. I think what you're describing is very much what she was doing--she has since said that she was just feeling so "out there," and so full of anger with herself, that she took the pills to try and make herself feel right, as you describe. It's so sad that she is going through this.
Just to clarify, though: she was released from the ER many hours after she got there, so she's not in the hospital. We're trying to figure out what the next steps should be, but the things you and other people have posted on here about your traumatic experiences with hospitalization have made me pretty adamant about keeping her out of a hospital in-patient program. So thank you for sharing your experiences--they are a significant factor in my own considerations about what to do to help my sd.
I'm sorry you had a relapse in August, by the way. That must have been difficult for you.
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#15 of 15 Old 09-25-2006, 03:46 PM
 
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Yeah, I noted that she only spent the night in the ER. ERs can be bad places though, in fact I realized little while ago that my last two relapses into self-injury were in part prompted by visits to ERs for other reasons--PTSD. But this is not about me...everyone reacts differently.

I think you should read _A Bright Red Scream_ by Marilee Strong. Good book on self-injury the best I've come across.
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