Where do you draw the line between depression and laziness?

In My Humble Opinion
1

My brother is a 20yr old college student. He flunked out of a local college because he quit attending classes in favor of sleeping all day and doing whatever all night. He was diagnosed with having clinical depression and is on his second flavor of antidepressants. Now he’s living with the folks, working and attending community college. He claims the meds are starting to kick in (he’s been on this variety for 2.5 months now).

On the face of things, it sounds like things are turning around, and maybe they are. Our mother, however, complains that the only reason he is making any progress is because she’s around to nag him constantly to do things like wake up, go to work, go to class, go to bed, get the meds refilled, etc. When she does not do this, he tends to forget to go to work, fail to attend classes, and stay up all night.

I told her to stop doing these things and let him be responsible for himself. He’s a big boy and old enough to live with the consequences of his actions or lack thereof. The problem as I see it is that there are no consequences. Flunk out of school? Live with mom and dad. Lose your job? Whatever. They gave him a car, pay his car insurance and gas, and expect no payment for him to live with them.
I say tough love is way overdue, but my mom is reluctant because of the depression. She doesn’t want to come down on him too hard because she’s afraid of what he might do.

I realize that depression makes the whole “get out of bed and get on with life” thing difficult if not impossible. It appears to my parents, however, that he isn’t even trying to get better. So my question is when do you say, “You’ve had enough time and help to deal with this illness, it’s time to start behaving like a responsible adult!”? It seems that his friends are all in competition to see who can be the most miserable. They’re all taking antidepressants, or into cutting, or posting morose poetry to their Live Journals.
How do you know when it stops being the illness and starts being sponging? When does being supportive become enabling?
(My first OP! I figure I’ll give this whole guest membership thing a run for its money. Still up in the air about permanent membership.)

2

I am not a doctor or any sort of medical professional. I have been clinically depressed since childhood, though.

Two and a half months is just not enough time to show a lot of improvement. Right now he’s trying to overcome the habits of a lifetime. He really does need someone to manage him. He and Mom and possibly you should work to set up small goals, things like going to bed at a reasonable hour every night at first, that he can do by himself.

If your brother had just had surgery to correct a crippled leg, would you expect him to go out and run a marathon tomorrow? He needs time to condition, to exercise his leg/mind, before he can walk normally/live a somewhat normal life. It’s entirely possible that he will always need extra help. A “tough love” approach might very well set him further back than he ever was.

3

I agree with Lynn. Two and a half months is not very long, and the claim that the meds are “starting to kick in” is probably quite true. Most antidepressant drugs take quite a while to take effect, and a mind that has been living in darkness doesn’t snap into daylight instantaneously.

I have grappled with depression for most of my life. Folks who’ve never really been there may think that I am just shirking my responsibilities, at a time when I am literally fighting to stay alive.

Remember these lines from a Stevie Smith poem?

I was much further out than you thought
And not waving but drowning

Sometimes that’s what it can feel like for a seriously depressed person surrounded by “normal” people.

4

The research shows that antidepressants plus therapy is the more effective combination. Antidepressants give you a window in which to learn some new behaviors, and provide a contrasting mood so that when you’re depressed you have a basis for evaluating that and being more proactive.

5

Another unfortunate possibility is that the first brand of antidepressant may not work. It took me ‘forever’ to find one that countered the drug-induced depression I had from corticosteroids, and the dosage may need adjustment as well. Most drugs I ran through had a 6 to 8 week lag time.

Is there depression in the family tree? Has he always been ‘lazy’ or is this recent? Is he taking care of himself: showers, getting out now and then?

A good psychiatrist may be the answer, not all of them have the skills or experience to do the job efficiently. There is a great deal of trial and error involved.

6

You need to know that depression sucks all the life out of you. Imagine being just too weary to do anything. Can’t? Well thank your lucky stars. It’s not something that you can snap out of even if you want to.

In a way, it’s almost too bad that ailments of the mind don’t show physically. If depressed people literally turned blue, you’d be able to see a visual to let you know something is not ok.

7

Another depression sufferer, here.

Two and a half months is nothing, and it does seem that he can function with some prodding. Usually, it seems to me that by the time someone gets to the point where an outside intervention has occurred, they’re so far into depression that they can’t recall how to be motivated.

One of the worst, and most insidious, aspects of depression is how it saps any sense of accomplishment from a sufferer. That feeds back into the lassitude the disease brings, leaving a thought process along these lines:

“Yesterday sucked. Had to get up. Showered, shaved, and all that. Even got to class and did some work there. And it’s all for nothing. If I get up today, I’ll have to do all that again, and it’s all going to suck again. All for nothing.”

When I’m well, I can take satisfaction from the simplest job, even if I hated doing it, simply by knowing it’s done (even if only for a day) and hopefully done well. When one is in the middle of depression it can be impossible to even accept that something has been done well, regardless of any outside opinions. Did he ace a test? It was just a fluke. Did he look good going out? They’re just buttering him up for something.

Seriously, look at all the things you do each day that are repetitive things. Do you take pleasure in looking good? Your brother may not be able to feel that. Do you take pleasure in simply removing the stink of the previous day? Your brother may not even feel that. It’s even possible that he doesn’t even feel any pleasure while eating. When I’m at my most depressed that’s the only pleasure or satisfaction I can feel. And many people don’t even get that, in a full depressed fugue.

I’m sure that there a lot of things you do as part of a daily routine that you don’t believe you enjoy. But, I think that you might want to take a closer look at just how much simple satisfaction you gain from them. It’s not the only reason to do things, I know, but it’s a far more powerful motivator than most healthy people want to admit.

I doubt he fell into this state in just a few months. And I doubt he’ll get out of it without an equally long effort.

8

Another one to chime in on meds and finding the right one. I, oddly, just realized something yesterday.

I’ve been on meds forever. Several years ago, I would have days where I just could not get up and go to work, although I’d been taking my meds for months/years and thought they were working.

However, for the last two years I’ve been on a different med, and I never have that feeling anymore. I can’t remember the last time when I wasn’t truly physically ill that I couldn’t face going into work. It just occured to me that I never have those feelings anymore. They just dissolved since I switched to Lexapro.

My point is that I thought I was on a med that was effective (and mostly it was) and just accepted those “mental health days” as normal, a part of my nature. Turns out they’re not, and a different/better med has taken them away entirely. I used to easily miss 4-6 days a year because I couldn’t do it.

For a lot of people, you have to adjust your meds (sometimes a lot) by dosage, by type, by different drug in the same class. And remember, if he’s been depressed for a long time, he may see his depressed self/behavior as normal and not realize there’s all kinds of life out there when you find a med that truly, truly works.

Yes, a depressed person does want to have to do the work in therapy and consistently take their meds. But it can take awhile to come into the light from the darkness and have your life turn around.

9

I agree with both sides of the fence on this one. While I realize depression can be all-encompassing, I also think it’s good medicine to be forced and prodded and encouraged to stay in the swing of things, no matter how sucky it feels to do your daily life. Depression feeds on itself. I feel sorry for those who have to face it alone. It’s a good thing he has someone there to help him stay on track. In time, with any luck he’ll be able to self-motivate. Until then, mom or a therapist will help him see the value of forcing himself to stay active.

10

You said he was “doing whatever all night”. I think a lot would depend on what exactly he is doing then. Is he able to go out and do fun stuff at night with the depression only keeping him from going to school in the day?

11

Thanks for all the replies so far!

To answer some questions - he was on Effexor last fall, courtesy of the campus health center. It didn’t help him at all. When he came home for Christmas break, he began seeing mental health specialists who switched him to Lexapro. He says he thinks it’s kicking in. He feels like he can at least cope with life, even if “life” isn’t getting better. This gives me hope. I don’t know if the current health care is includes counseling, or if they’re just prescribing the Lexapro. He was seing a counselor at school, but I don’t know if he’s seeing one now. I hope so.

I should clarify what I mean by “tough love.” I think my mother should stop nagging him and babying him and complaining about having to nag and baby him, and give him a chance to achieve things like waking up by himself. She complains that she has to tell him to get up three times (and never had to do that through high school). If I knew someone was going to tell me three times to wake up every morning, I’d probably sleep in until warning number three, too. While he was more of a self starter in high school, she’s always had to prod him to do pretty much everything. This dependant relationship between the two of them is nothing new. How can a person learn to manage their own life when there’s always someone there ready to remind them fifteen times to do everything?

As far as going out and doing whatever, it appears that he has plenty of energy to go out clubbing until 3 a.m. on the weekends, or make a 45 mile sushi run. (and he’s got plenty of funds to do so because he’s got a no strings attached gas card and free car from the parents) He claims insomina as the reason for staying up until 5 a.m. on weeknights IMing friends and writing webpages. I’ve never had to deal with the beast of insomnia and I don’t envy him. However, those are the times when he accidentally goes back to sleep after Mom leaves for work and ends up missing work until 11:00.

While this has been on my mind for a while, what really made me think about it was the thread on living at home into adulthood. (that, and a lunch yesterday that consisted mainly of my mother lamenting his lack of initiative) I know depression is an illness (my husband is also dealing with it, but that’s another story). But there is a difference between saying, “I couldn’t get out of bed today because of the depression and I was not coping well with life.” and saying, “I don’t feel like going to work today. Don’t expect me to - I’m depressed!” When someone can’t make it to class because it’s too hard, but it’s not to hard to go out partying all night, is it depression, or is depression a convenient excuse?
When people have physical injuries that require physical therapy, they can either work hard to try to regain their strength, or they can sit around and mope that their leg hurts and therapy is too hard and why is everyone so mean to them.

I think being at home is best for my brother right now. I’m glad he’s getting medical help. I don’t think this is something that popped up overnight, and I don’t expect it to go away overnight. I feel stuck in the middle between my mother and brother right now. She complains about having to nag him to do everything, he complains about her constant brow beating. I’m trying to convince my mother to back off a little and let him do for himself and see if he’s ready. To let him live with the consequences of his actions while still being there to support him. To quit feeling like she is the one who has to run his life since he is failing to do so. Mostly I’ve been trying to be a listening ear to both of them and letting them vent. I know there are two sides to every story, particularly since my mother and I didn’t get along until I moved out. My brother has brought up the possibility of coming to live with me, so I chew all these things around in my mind and wonder if that would be better or worse for him. I will always be there for him, but I want to be there in the best possible way. I want to help him, but I refuse to be a crutch.

I guess that’s the crux of the question - when does help become a crutch? When are people taking advantage of their illness?

12

Since he’s not bed-bound, and he’s able to party all night, I’d say his inability to get up in the morning is largely due to being hung over. It would have helped if you would have shared that in the OP. He’s getting away with it because your mom doesn’t want to relinquish all control over him. This is more her problem than his, despite his diagnosis.

13

Well, I did mention in the OP that he stays up all night. It’s not always partying, but sometimes it is. And I’m not saying he’s a total mooch, but I think in some ways he is. So how do you know when it’s mooching and when it’s an illness? Depressed people can be irresponsible mooches, too.

14

If he is drinking, (not absolutly nessisarliy the case if he is going clubbing, but certainly likely) then he is also interferring with his meds to some degree or another. The occasional drink might be OK a few times a year (depending on doctors advice, etc) but on a regular basis? Probably not a good idea. A (real)crutch is a good thing, if it is needed. If you have a broke leg and insist on going slam dancing, however…

That said, I know that depression can and does cloud judgement. Sometimes people do activities that are mindless to try to feel alive of dissociate from the emotional pain. Waking up when depressed (or when medicated, depending on the meds) can be near impossible. It sounds like he may not be, as Doctor Eve would say fully “participating in his own recovery” (Sordid Lives reference)
Depression is easy to wallow in, and easy to enable, and sometimes it’s hard to see the lines. Your Mom may be willing to go to great lengths to wake him up because she is afraid that if he loosed his job, whe will have to support him even more.

15

My feeling is that depression is a more legitimate excuse when it keeps you from doing things that you enjoy as well as things that you don’t enjoy.

Can’t go to work? Well, if you don’t enjoy it and/or don’t feel the repurcussions, that might not be a big deal.

Can’t get together with friends because you have a big hole in your center that feels horrible? Well, that might be more painful.

The problem is, I’m sure there will be at least one person who can chime in with a legitimate, although different, take on it based on their own experience. That’s why it’s difficult to say without knowing his personal baseline.

16

Well, many depressed people suffer from insomnia, so that is what I assumed by being up all night. Is he expected to pay your mother something each week? He needs to maintain as much responsibility as he can. It’s your mom’s responsibility to require that he contribute financially, as well. Less party money will help him in the long run, as per med conflicts, as mentioned upthread.

17

I am going against most of what has been said here. I have (and have had for much of my life) many of the symptoms of depression; but have never been diagnosed–being that I against medication for these sorts of disorders after having witnessed the “results” of many people I’ve known. There are many days, especially the ones where I don’t keep myself ridiculously busy, where I can’t even be bothered to do things I enjoy, even if I’ve been looking forward to them.

That said, I NEVER miss a day of work and I NEVER miss a day at the gym unless it was planned ahead of time (vacation, or recovery period); I may be late, even REALLY late, but I never miss a day. Why… because I think you’re right, Solfy. When I had all of that kind of crutch support, it was impossible to have enough will power to do anything… I often missed classes, my grades suffered, etc. It is only by sheer force of will and superimposing it as a necessary obligation, not any bit of self-motivation, that I maintain myself as busy and get these things done.

Now, obviously, my solution is to the extreme, but my point is that I never would have learned to cope with it if I’d not been made to face the consequences. I understand that parents want to protect their children, especially in cases like this, but I think you’re right, it’s doing more harm than good. She doesn’t need to go cold turkey, but she can start by not giving him only one wake-up call instead of three and, of course, telling him ahead of time.

18

Dit-fucking-to. If you have the strength to get out of bed and accomplish one obligation, even if you have to really push yourself, you are doing yourself a huge service. I realize that some people literally cannot get out of bed. Those people should be in a hospital. But for low- to mid-grade depression, you really need to give it everything you’ve got.

19

That’s how I described depression-it took away my ability to enjoy ANYTHING. It wasn’t just sadness. It was just a big grey nothing. My favorite foods didn’t taste as good, my favorite songs sounded blah, I never laughed at jokes, or anything.

20

Another thing that should be considered is bipolar disorder, previously termed manic-depressive. A person can go from a high when they can (and will) do anything to a low where they are immobilized. It’s especially a dangerous time when going from the low to the high; people often are not only suicidal at that point but are motivated to actually do so.

The issue of alcohol is very important, and the patient should be discussing this with his doctor. My experience is that a single drink of wine or a cocktail at dinner one night, or a tiny sip of something, is o.k. for me most of the time. But not two days in a row. Wine with dinner 3 days in a row and the “grays” start to return. Other people I know have reported similar occurrences. Obviously YMMV.

Another option to consider is family therapy. The patient’s therapist, psychologist, or psychiatrist may be able to conduct session(s) involving the patient and relatives to help all come to agreement on reasonable approaches to improve things. For some folks, being forced to “take responsibility” or “tough love” may be just the thing. For others, it could drive them right over the edge. Just as the meds don’t work the same for everyone, neither do the various coping mechanisms and other interventions.

It would be really, really nice if we could cure depression, bipolar disorder and the like with a simple course of some medicine the way we cure a simple sinus infection. Or if we could vaccinate against it.