I have a friend who is having a lot of trouble with depression that has come about as a result of a brain injury-related chronic movement disorder. He used to be very motivated to overcome his illness, but lately, he has just given up hope. He just sits around playing video games and eating prepackaged junk food because he doesn’t have the motivation to even cook for himself. His girlfriend is having trouble seeing him so hopeless, and has been asking me for advice on how to help him find his self-worth again. I offered what I know, but my experience comes entirely from psychosis. The only time I ever had to deal with depression was during the few months I was on Depakote.
So far, I have found a chronic illness support forum he can join, and I can offer to take him to the vocational rehab program in my city. My therapist has also been trying to get me to join a brain injury support group that she runs, and maybe I can bring him along with me.
For those of you who have struggled with depression or negative symptoms, what are some other small steps he can take to improve his quality of life? He already takes an anti-depressant, but would some of the vitamins that help us also help him? What would be the best way to make these suggestions to him? I tend to be a very enthusiastic person, and I don’t want to come across too over the top and make him push back against these ideas without even considering them. I also don’t want to seem unrealistic, if my suggestions are too lofty for his current emotional state.
People who are down in the dumps can be pretty resistant to suggestions and offers of help. Don’t be too forceful, but be persistent. He needs to be gotten out of his current funk before he becomes too set in it.
I have also wondered what is the difference between those two.
Based on my experience, here’s what I can tell: low self esteem or more precisely, self disgusted and self despising feeling that has little or none funding in person’s life circumstances.
So, the first thing that should be done is to combat those negative self perception not so by trying to assure person of his worth but to suggest concrete actions that could be done and that will give him the sense of self worth and significance.
Get him to whatever therapy where he will be able to talk. Go with the argument that every individual needs that kind of stuff when the mind gets exhausted and lose its defence mechanisms. Even psychotherapists do therapy. It is ok to not be ok. We all need time out. Something like that.
Second is, perhaps, to work on getting the right antidepressant. I tried like a four of them before wellbutrin. And even with wellbutrin and zoloft I have my breakdowns every so. But I get up and keep going faster than it was in the past.
And get rid of junk food. Bad body image affects and worsens depression.
No, he doesn’t have any psychotic issues at all. He got a bad concussion and now he has a movement disorder. He’s just depressed, because he’s so focused on the list of things he can no longer do. I get it. That’s a normal part of the grieving process when you develop a disability. But it’s been almost two years now and he still hasn’t started trying to figure out what he still can do. I kind of want to tell him to stop waiting for someone to find a cure, because it’s not going to happen. Now he needs to just try to make the best of the shitty situation he was handed.
I think if he got in that kind of state, where he finds the comfort in his helplessness, and it slowly becomes his natural state - which is very very bad - only the professional could make him to see where he is and where he could be.
He goes to therapy, but his therapist just pisses him off because she is convinced his movement disorder is a psychological problem, rather than a neurological one. To be honest, I think that may be the case as well, but he isn’t ready to hear that. So far, whenever anyone suggests any steps he can make to improve his life, he just pushes them away and says they don’t understand what he’s going through. I’m pretty much the only person who has ever gotten him to take any steps at all, because he knows he can’t use that line on me. But I don’t want to push him too hard too fast. So you guys think the best first step would be trying to get him to go to the support group or a new therapist?
Maybe changing therapists is not a good idea, is hard enough to find a good therapist. Especially those who are willing to tell us what we don’t want to hear but need anyway. Building trust with a new therapist is hard.
Okay. To be honest, I am a bit nervous about going to the support group too, and it might be good to have a familiar face there. I won’t push him about vocational rehab just yet. Baby steps.
Cymbalta. He takes it primarily off-label to treat his muscle spasms, but also as an antidepressant. It’s hard, because he and his girlfriend are both afraid of trying new meds after a bad experience with one. We try not to talk about medication together, because they know my stance, I know theirs, and neither of us makes any sense to the other.
Well cj.if they are both afraid to make changes, there is only little you can do.
And hanging out with the depressed and untreated person can be really painful. Painful like having a bad constipation.
Yeah, that’s definitely true. That’s why, if I’m totally honest with myself, I’ve been kind of avoiding him for a while. But I don’t think I’ll burn myself out just offering to take him to the group. He does want to make changes in his life. He’s just so lost right now that he doesn’t know where to start. He needs a way to stop focusing on what he can no longer do, and start focusing on what he still has.
At the hospital, they acted like depression and negative symptoms were the same thing and kept referring to my negative symptoms as depression. So idk about the difference.
IF he is truly negative-symptom sz, he may (or may not; there are just no guarantees right now for NSS) benefit from going on Abilify and/or a low-dose anti-D in combination with an anti-P that is working for him. (But =not= one that isn’t.) But with any TBI, this is iffy. Because medicating the TBI can itself induce symptoms that look almost exactly like NSS (see below).
If he is essentially (because it’s usually more relative than absolute) clinically depressed along with a TBI, but does not have genetically induced sz, he needs to be very carefully scanned and referred to a team of experts. The sad truth with TBI is that high-dose anti-Ps are so often needed that what appear to be negative symptoms of sz are induced as sfx of having to control the impulsivities cause by the TBI. I have dealt with cases like this. They are often heartbreaking. (Sigh.)
IF he is cognitively depressed as a result of a thought disorder – and the symptoms induced by the TBI are relatively minor – he will need one or more of the psychotherapies listed at the bottom of this post. Possibly in addition to a more stimulating / less dopamine-channel-blocking anti-P like Abilify arapiprasole or a low-dose anti-D in combination whatever anti-P he’s taking that is working at least fairly well.
All this said, I have seen some patients with fairly severe TBIs make a lot of headway into their NSS or clinical depression. And others who are relatively to almost entirely treatment resistant.