My best friend is severely depressed. She’s not suicidal, but she has been in the past. She been in treatment and even hospitalized for it in the past. Right now, though, she is suffering a through a major depressive episode with no means of obtaining treatment.
She’s out of work and can’t find a job. She has private medical insurance, but with absolutely no mental health coverage. She’s 22, and as of last April, at least, still a dependant of her parents, who make too much for her to get government support or benefit from the sliding scale at a local clinic, but not enough to pay for her treatment themselves.
She has no friends who live close by, no job, and very little to feel hopeful about. As long as she’s depressed, it’s very difficult for her accomplish anything (though she’s done quite well applying to jobs, to no avail), and with no accomplishments, she sinks deeper into depression.
She knows that she desperately needs to be in therapy and on medication, but with all our brainstorming, we haven’t been able to come up with any solutions. I even suggested selling her plasma and using the money for therapy, but she’s too anemic! No one will insure her for mental health after her hospitalizition, and school councilors won’t see her since she dropped out of college. Ministers and pastoral councilors tell her she needs treatment they aren’t qualified to give.
Does anyone have any advice? I really care about her, but I’m damned if I can see a way out for her.
PS–If you hold spiritual beliefs of any kind, praters and meditations on her behalf will be greatly appreciated.
If she has health insurance, but no mental health coverage, I’d recommend that she go to her regular doctor and see if he’ll prescribe antidepressants anyway. I’ve done this before under the same circumstances. Some doctors will do a great job under these circumstances, but other won’t. Also, her doctor needs to check her out to make sure she doesn’t have some kind of non-psychiatric problem like a thyroid disorder.
Also, I would try calling a lot of shrinks and see if she can find a discount shrink. This has also worked for me in the past. I get reasonably good psychiatric care for $50 a month, not including medication. If her parents make too much for her to get help from the government, they ought to be able to come up with $70-100 per month on a temporary basis to keep her from killing herself.
If her insurance won’t cover the astronomical prices for something like Prozac, she should try some of the older tricyclic antidepressants, which can cost as little as $20 a month. They work great, but tend to have more and different side effects than the newer ones. The side effects are still better than killing yourself.
And remember that a lot of doctors take credit cards, which are easy to get these days. While it’s financially unwise to use credit cards this way, it sure as hell beats constant suffering and suicide. And, unfortunately, if she gets to be suicidal and shows up in an emergency room, her treatment will end up costing much more than the preventative treatment she needs.
Lastly, tell her I was in a situation quite a bit like hers in my early twenties, and now in my mid thirties I’m happy and successful, so there is plenty of hope for her. It’s important for her to remember that her situation is temporary, no matter how hopeless she feels.
Depending upon where she lives, she should contact area universities with graduate programs in psychology, counseling, clinical social work, or medicine (psychiatry). Usually they offer low-to-no-cost therapy as part of professional training. (The students receive expert clinical supervision.) Another option would be for her to contact the local United Way or county mental health agency and ask for help/referrals. ALso, although it’s not generally known, some therapists provide limited pro bono work and almost all moderately-sized cities have grant-funded mental health centers for the indigent.
Ultimately, however, your friend has to be her own agent of change–she has to be resourceful and determined enough to help herself out of this situation. This is a difficult proposition for the chronically depressed. Throw in a personality disorder or tendency toward dependence upon others, and the problem becomes more challenging. Yes, you may be able to help her with some contact numbers, but ultimately she has to want to get better–not just say so–and then be motivated enough to go the extra mile to seek long-term help. There are solutions, if she’s willing to work hard to find them. Unfortunately, many depressed individuals are low on motivation and swat down solutions without really trying. The good news is that many, many people have recovered–and so can she.
My SO is a psychotherapist and has done work for the local Catholic Charities organization here in town. The services are provided on a pay as you can, if you can basis. The United Way should be able to help here, as can the local department of social services. Best of luck to you and her.
Bob Scene is right. Her primary care physician can prescribe anti-depressant medication. All primary care physicians are trained in how to screen for this sort of thing, and they see it all the time. I realize that there is some debate in the medical community about how appropriate this is (since psychiatrists are the true specialists in this area and are best qualified to choose medications and monitor their effectiveness) but under these circumstances, there’s no reason to fret about that. Those medications, since they are described by a doctor she’s seeing under her health plan, should be covered under insurance (though of course, that depends on what her prescription plan is). Or perhaps some samples could be made available. The doctor might also be able to steer your friend to low-cost mental health services.
Is this common, that health insurance doesn’t cover mental health treatment?!
Regardless of what your friend does, get her outside. Sunlight seems to be beneficial for treating depression, and the physical activity that accompanies it can’t hurt. It’s worked for me to the point where I have not needed medication for fifteen years.
I first had that recommended to me by a physician and accepted by a psychologist, but that’s no substitute for specific advice from a doctor.
My girlfriend is uninsured. She also suffers from depression, and no private insurance will touch her for anything even approaching affordable rates.
Why does insurance have to be tied to employment in this country?
Your friend may be depressed enough to find getting a job which offers decent benefits impossible. This is a catch 22 that may ultimately lead to her death and surely has lead to avoidable deaths in other cases already.
I dont mean to interject some political statement here, but obviously this situation your friend is in is the result of an astoundingly inefficient and above all else shamelessly immoral system which is set up only to benefit for-profit insurance companies. It is a system that is not found in any other industrialized country. The health insurance system in this country is thoroughly intrenched, and the only way it will be changed is if LARGE numbers of people DEMAND that it be changed.
The aforementioned grad program at a local university. These students are not only up on all the latest therapeutic methods, they also really seem to care (They haven’t been in the system long enough to burn out.) I found my former therapist in a program like this, and he helped me immeasurably. And it might be good for her, having someone closer to her own age that can relate to some of the situations she’s in.
Filing a mental health petition (this is what was formerly referred to as "being committed.) If she’s bad enough to require hospitalization, this might be the way to go. If she’s 22, and not in school, it might be possible to get her independent status from her parents. You file the mental health petition, a judge reviews it, and if she’s deemed a danger to herself, they might hospitalize her in a state hospital (while I’m sure the conditions vary from location to location, I think state mental facilities are far better than they used to be.)
http://www.nami.org There’s a lot of information on this site, and some of it might pertain to her case. They have a hotline that might be able to refer her to free/reduced cost mental healthcare in her area.
I know it’s so incredibly frustrating to suffer from depression and not to be able to get the help you realize you need. The fact that she realizes she needs help is a very positive sign, though. It really needs to be treated as a chronic physical disease, from her lifelong perspective. It’s likely to go into remission, but it’s always something she should be vigilant about. I definitely think people in the US need to treat mental health the same as a physical problem… no clinic would turn away a diabetic that desperately needed insulin, but they will turn away a depressed patient that needs an antidepressant that could turn out to be just as lifesaving. Bleah.
I have seen similar cases (mid-twenties, unable to find work, chronically depressed) where the individual self-medicates to his/her detrement. This is done most commonly with marijuana, but other recreational drugs also seem to keep depression at bay. Of course, it just makes matters worse. Not to judge your friend in any way, but if that is the case with her the first thing is to stop self-medicating. The next logical step, as Sofa King said, is sunlight and fresh air. I also cannot stress enough how wonderful grad. students in psych and particularly clinical social work are. Personally, I would not make this a question of how to get anti-depressants without insurance, but rather a question of how to get your friend better. Having said that, she may suffer from a severe enough depression, in which case a professional will know when and if to prescribe. My thoughts are with your friend. Perhaps just showing her this thread would help her to know that people do get through it.
Comming in kind of late in this. Here are a couple of recommendations.
>Going to your Primary Care Physician is a thought and even a consideration, but your friend will have to know there will only be Chemical help through this method. And in My opinion Chemical help may be good in the short term but she is going to need some kind of counseling as well.
> Also Chemical means of treatment can only go so far, and with the latest pharmaseuticals taking upwards of two weeks to activate the atainable behaviors, I would go with a more short/long term therapy of Medication to start under a strict behavior-therapy regiment, and a declination of the medication after her baseline is established. Which means once the therapist establishes where your friend should be, they can work with a short term stint of meds and a therapy that will be structured for her.
> I have only breifly read the above relpys, but there is no hospital that will reject a patient who commits themselves. You can go for 9/14/even 30 day stints, with behavior therapy, medication and the afore mentioned SUNLIGHT–> very helpful. This is a consideration, and it is a pay as you get it deal. And is federally mandated. Is she in the USA?
As for your role, stay there with her and let her know you are there for her. It sounds like you are a good friend, whom genuinely cares. Also bring her a Gardenia, they have anti-depressant aromas, and can often produce a smile
I suppose sunlight, herbs, gardenia fragrance and crystals all have their places, but for individuals suffering from major depression, the interventions of choice are psychotrophic meds, talk therapy, and regular exercise.
My apologies to Bob and Crankyasanoldman, but the downside with the primary care physician route is that many such physicians are pressed for time, poorly trained in psychiatry, and not predisposed toward talk therapy. Of the dozens of potential meds at their disposal, most PCP’s are intimately acquainted with maybe a half dozen. Ignorance, infrequent contact, and superficial, rushed conversations do not make for a solid foundation for effective long-term treatment–especially re: major depression and a poor support system. That said, your friend should get a complete physical.
One also needs to be careful about “committing” oneself to the psychiatric unit of a hospital. Anyone even remotely familiar with contemporary inpatient settings knows that the staff’s primary objective is to: (a) stabilize the patient and (b)promptly discharge him/her for (hopefully appropriate) follow-up in a community setting. Psychotherapy within an inpatient setting in America today is nil; the foci are on symptom relief and discharge planning. (BTW, Discharge is generally faster and treatment less competent for uninsured patients.) A second limitation: when one voluntarily “commits” oneself, insurance carriers will be even more predisposed to rejecting her in the future. This is a major red flag. An outpatient setting, as I described earlier, will accomplish far more without the drama.
In your profile, you claim you are an environmental psychologist. Fine. I know dozens of psychologists/psychiatrists and all are literate. Your frequent misspellings are one thing–I made a couple myself
–but what credible clinical evidence can you provide for the therapeutic efficacy (for the “anti-depressant aromas”) of gardenia(s) in the treatment of major depression? Also, what is a “strict behavior-therapy regiment”? Why rule out cognitive approaches? If a gardenia can indeed “produce a smile,” what relevance has that in the treatment of major depression?
Excuse me ‘tsunamisurfer’, but I must beg your pardon. This thread was written in the span of about 5 minutes. If my frequent misspellings annoy you I appologise for not being a perfect speller. I wrote this thread to possibly aid someone in need that happens to be utilizing this board for answers. I did not have time to cite I happen to be a little busy at work today and this thread caught my eye when I randomly checked in.
Also, my profile is not a ‘claim’ nor a lie. Please do not insinuate that it is, that would be insulting and an adequate slight to my integrity.
The GARDENIA reference was NEVER EVER said to be a cure for Major Depression. It would merely be a kind gesture from one friend to another. As for the aroma, have you ever smelled a gardenia? They smell quite nice, thus the anti-depressant properties would be that of a pleasent smell.
Environmental Psycholody is the study of Humans and their habitat and work place basically. Completely different from clinical Psychology. I worked in the clinical setting for two years, I am very familiar with inpatient care. For some it can be a stepping stone for others just another knoch in a belt of illness.
Please do not insult anothers suggestions for aiding one in need. It is an unnecessary hijack that gets away from this serious thread. I stand by my recommendations and anyone else who recommended a healthy future for this young woman.
Alan Smithee please excuse this un-needed interruption…
Well now, this makes me crabby. I don’t the sarcasm is called for. The OP didn’t ask what the ideal treatment for depression is. The OP asked what someone with extremely limited resources, and no coverage for psychiatric care, could do about depression. Under those circumstances, I think people did a damned good job offering thoughtful suggestions that are a start given the limitations of the situation. I didn’t fall off the turnip truck yesterday; I realize that seeing a GP isn’t ideal and I could have made that more explicit (although I think my caveat was enough). When seeing a GP is all you can do in terms of getting paid professional care, then I’m not going to recommend she cut off her nose to spite her face. Nor am I going to sneer at a suggestion to try to cheer herself in more pedestrian ways.
Many thanks to everyone for offering some wonderful and caring advise. I don’t have time right now to reply every post, but I want you to know that I appreciate the time and thought you are giving this. I’ve learned several new ideas that I hadn’t thought of myself, especially of tricyclics and Masters Degree programs.
I’ve been through treatment for Major Depression myself, so I know what she’s going through, as many of you obviously do, as well. It’s painful to see the forms of treatment that were (after many years) so successful for me cut off from her. Right now, she doesn’t seem to have the hope or motivation to find what she needs, and that’s even harder, because I know so well all of the mental blocks she puts up before any suggestion, and it’s hard to be encouraging without pushing too hard. I will try to get her to read this thread, and hopefully she will realize how much support there is for her.
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*Originally posted by CrankyAsAnOldMan *
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Tut, tut, Ms. Cranky-Crabby. Who said she is limited to a GP? Don’t set up strawmen. Again, read my first entry. An individual suffering from major depression, past suicidal ideation, and who has a meager support system and has withdrawn from activities of daily living clearly is not an ideal candidate for what you call “pedestrian” approaches (e.g., fresh flowers, sunlight, or infrequent GP monitoring and lack of talk therapy).
Attempts at “cheering up” severely depressed persons in “pedestrian ways” shows a profound misunderstanding of the power of this disorder. Sarcasm is thus earned.
BTW, how is it that “General Questions” has devolved into IMHO? Are the moderators asleep at the switch?
Good to hear from you, Alan. Prey, how is it that you, having undergone treament for major depression yourself, have never heard of tricyclics (or SSRI’s)? What kind of treatment was it? I cannot imagine a therapist never mentioning psychotropic meds to you, unless this happened 30+ years ago.
tsunamisurfer, are you seriously tell thing this person that you do not believe them? Why not offer some kind of assistance. instead of asking if they seriously have never mentioned psychotropic meds. And actually if you were completely current, meds are not exactly the wave of the future. Are you a psychotherapist? therapist? social worker?
I would venture that under these circumstances I would try to offer the young woman advise, not disbelief. Scroll up, check it out, look at all the helpful advise to your constant malevolence.
