Treating treatment-resistant depression.

With all love and respect, this isn't what http://en.wikipedia.org/wiki/Treatment-resistant_depression means. Depression almost always lies about how it's never, ever going to get better and that there's nothing one can possibly do to make it go away so one might as well not even bother. While there's no doubt in my mind that he believes what he's saying, you should go ahead and hold tight to the idea that it can get better, because he's hardly even begun to explore his resources.

He needs in-patient treatment. He needs to be in a hospital setting where he can be on suicide watch until the crisis is over and he's stable enough to begin treatment. This is like a heart attack - your job is not to perform surgery but to get him into a hospital so he can have surgery. If the underlying problem is depression, then therapy and meds and helpful life changes (like getting meaningful work, exercise etc) are the only solutions we have for now. It could be that this is a different condition or a response to a crisis of other sorts. I've been in your position, and I have to say the hospitalization feels scary and official but is a big relief for family and friends. You will probably have to argue to get them in because beds are often limited, but it's the most helpful thing you can do, be his advocate for treatment, not trying to provide the treatment yourself.

I agree with everyone saying he needs to go to the hospital, because this is exactly the kind of thing in-patient treatment is for. It's not a punishment or prison, it's a *help* to stabilize him. I know it's frightening, but him dying of depression instead of going to the hospital for help is much more frightening. He's right about the worst case scenario -- that it won't help. But he's wrong about the probability of the worst case scenario happening -- it's much, much lower than 100%. It sounds like he actually doesn't have treatment-resistant depression, either, which is depression that doesn't respond to (multiple) anti-depressants. He just has *severe* depression, that he needs help with. He refuses to be put on medication because he says it will make him a zombie I had an ex who would say this whenever I brought up medication. He'd also been on medication when he was much younger. Most psychotropic medications, and definitely most anti-depressants, work differently on kids and teens (or, the label says anyway, people under 25) than they do on adults. What your bf experienced when he went on medication when he was younger isn't necessarily what he would experience now. He also might need to give a few different medications a shot before finding one that works for him. I had to go through a couple that gave me nothing but side effects before finding one that actually worked. Taking a pill in the morning is honestly the easiest treatment there is for depression, though -- there are others that he could/should do in conjunction, but taking a pill (instead of just suffering the pain he's suffering now!) is really not that onerous, as far as treatments go. Also, if he's suffering from severe depression and is suicidal, he might not even remember what having emotions is *like.* Depression isn't an emotion. It's more like a black hole that your emotions vanish into. Depression is *much* more likely to make someone into a "zombie" than anti-depressants are, imo. Personally, I was shocked when I finally got onto an antidepressant that worked (which was not the first or second antidepressant I tried) and I could actually *feel* things again. First just anger, than sadness, too, and eventually lots of good things! Like love, delight, curiosity...even *anger* was delicious at first, though. The world just felt so much brighter and more alive. Even a low-grade depression can suck the feelings out of you. He should try flipping his thinking -- it's not necessarily medication keeping him from feeling positive emotions (or honestly, emotions at all), it's likely depression that's keeping him from that. And if anti-depressants do make him feel like a "zombie," he can always go off of them again. Trying them out isn't a contract written in blood. Anyway, this isn't to say that medication will definitely work and it's probably not going to work all by itself in any case, but imo it's bullheaded not to at least give it a try. They're not sugarpills, but anti-depressants aren't *that* dangerous, and they're not addictive. and just serves to let doctors off the hook because it makes you "technically better" I feel belittled and honestly frightened when doctors jump to explain all of a person's problems as stemming from a mental illness or mood disorder, because mental and physical health are so intricately intertwined, and because I don't want doctors to miss something physiological and serious just because they refuse to take me seriously, and because it just feels like such a brush-off to be told "it's all in your head." So I kind of know what your bf is talking about when he says he feels that medication "serves to let doctors off the hook." Does your bf think anything *else* is wrong? He definitely needs treatment ASAP for his suicide attempt and related depression *in any case.* But what else is worrying him, does he think that some other problem is getting blown off? You can help him get help for those things, too -- eventually. The depression is the #1 priority right now, because it's threatening to be lethal. But once it's been dealt with, then you guys can move on to the #2 priority, whatever that might be -- if he even wants to make a list of things he wants to change or that are bothering him, that's OK. But try not to make any big decisions (either of you) right now, because the mental state each of you is in right now is likely to change and is likely not your "normal" state anyway. Also, when he says "serves to let doctors off the hook," is he scared of not being taken care of, and does he feel like he needs more care than he's getting? If so, then he's right to be scared, because he *does* need more help than he's getting -- as shown by the suicide attempt. That's not *your* fault, you're doing the best you possibly can, it sounds like. But you're not a medical professional and this is beyond your pay grade as his gf. He needs to be taken care of by professionals who know how to treat this and are set up to treat this. You can't cure illnesses on your own, much as you might want to -- but luckily, that's why people created Health Care Systems and why there's an NHS. If he does feel alone and like he's being left to twist in the wind and nobody is able to help him, then he should know that the place he'll get the *most* help and the *most* care and care specially suited to people in his situation, is in an in-patient facility. And again, I know it's frightening, but it really is his best shot at getting better. In the meantime, or if something happens that means he can't go into in-patient treatment, I second elephantsvanish that routine and physical health is of the *utmost* importance. The bare minimum, imo, is: 1. bedtime and wakeup at regular times. 2. nutritious food and at regular mealtimes -- three squares a day 3. bathe and do at least basic cleaning up every day 4. leave the house at least once every day. 5. If at all possible, exercise (even walking is great. Outside is better than in a gym in any case). Even if he does go into in-patient treatment, once he's out, he'll need the support of a routine, still. It's a good thing to keep to until he's really "all better" (and just in general). Routine and structure is a way of making life easier and less stressful, by making it less chaotic -- so while he's such a mess inside, and under so much stress, it's important than the world outside be as orderly as possible. It's very good that he's staying with you right now. Try to get him to follow your lead. If he's just going through the motions *that's OK.* He can feel however he feels, but he *has* to get through every day and he has to be as minimally self-destructive as possible, which is where the routine can help, too. He also needs to figure out how to take time off of work. He obviously can't go in, but he may be able to get signed off for health reasons instead of having to quit. I'll let others speak to that, though, because I don't know the system for that in the UK (or really anywhere, frankly!).

UK hospital doctor here (not a psych). Take him to A&E, tell them what you told us. He will be seen and assessed by psychiatry there and then. He might be admitted, he might be managed as an outpatient (my money would be on admission if he is sti suicidal and is refusing medication) but either way he will have been seen and assessed. A&Es are generally not that busy in the mornings, so go in now. You'll probably wait an hour or two, and a full paych assessment takes about an hour to complete. Go to the hospital in his borough, it will be easier for them to plug him back into a community team on discharge.

Hi all, I am the OP of this question (and blockquoting myself to make this easier for later readers to find). Thank you for all of your responses. I really appreciate your words and thoughts for us. I woke up this morning at 4AM after some weird-ass dreams and couldn't get back to sleep, so I called the NHS 111 helpline and spoke to a lovely nurse who walked me through how I was feeling and what the situation was like. He gave me some language to use and helped to steady my resolve a little. He couldn't provide specific help or crisis management because apparently that would require actually talking to my boyfriend, who was upstairs asleep. This morning my boyfriend and I talked a bit and I got him to agree to see his GP with me tomorrow (we couldn't see them today because he has an important work thing he needs to be at -- I know, I know, but everything is so fragile right now I didn't want to push it). So I'm going to call tomorrow morning and see if they can give us an emergency appointment. If not, I am going to take him to the nearest A&E (thankfully there are two within 15 minutes of our respective homes) and see if he can be assessed that way. Right now his instinct is to rail against my advice because he's been so poorly treated in the past, but he has acknowledged that this is unreasonable and that I am making sense. His mood is generally OK, but swinging a lot between normal "up"ness and laughing at dumb jokes on Twitter and then talking about how the universe doesn't want him in it and that things will never get better. He hasn't spoken about specifically ending his life again. He does seem to think that he's only "a little bit sad" and therefore it's nothing to worry about. I have talked to some other friends who know him and have also dealt with mental health issues, and they are also providing support.

Have you spoken with someone at a hospital about this? In some jurisdictions in the US at least, I believe you can get someone hospitalized if they are a threat to themself. I would see if a recent suicide attempt gives the authorities any leeway here.

Agreed with the answerers above. Calling a crisis line is appropriate for depression or passive suicidal ideation (i.e. "I wish I were dead" with no actual plan to hurt oneself, or having transient thoughts of hurting oneself but being assured that one would never carry out these plans because of whatever reasons). Calling a crisis line is not meant for people who have actually attempted suicide or have active suicidal thoughts/a plan to hurt themselves - such people will be referred directly to the emergency department as they need to be immediately evaluated by a mental health professional and likely to be hospitalized. DO NOT WAIT FOR HIM TO ATTEMPT SUICIDE AGAIN. He could be successful this time, and then how will you be able to help him? Get him to an emergency mental health evaluation immediately.

Yes, jumping on the bandwagon of "get him hospitalized at all costs, right now." Also - hopefully once he's in a slightly better place you can help him understand that not all medications work the same for everyone. Some people can get rid of a headache with tylenol, others need ibuprofen. Some people treat allergies with claritin, others with allegra, and still others with zyrtec. Once he can internalize that his past experience with medication "making him a zombie" isn't indicative of all drug treatments, maybe he'll be willing to try something new. Same with therapy.

Update: we managed to get an emergency appointment to see my boyfriend's GP yesterday (otherwise we would have had to wait over a week). She seemed concerned and referred him to the borough's mental health crisis team. For those of you in the US, MH crisis teams are set up by the local NHS service as a front-line alternative to hospitalisation. They liaise directly with the person in crisis and recommend them to various services including therapists, social workers and psychologists, but they can't themselves prescribe medication. They are also critically overworked, underfunded and understaffed and it is a fucking travesty at every level, but that particular political rant can wait for another time. Luckily the crisis team are situated not far from my boyfriend's place, so we could spend the few hours between appointments chilling out and watching a couple episodes of The Wire to distract ourselves. So that was good. The nurse from the crisis team was lovely, albeit a little tactless and clearly stressed. She got my boyfriend to describe his level of risk and did an assessment of his mental state and previous experiences with healthcare. He is no longer actively suicidal but did admit that he has been having suicidal thoughts (though not ideation) for a while. His biggest problem is that he has no hope for his future and doesn't see anything working out. He said that he is willing to experiment with medication, but the nurse advised that it would be difficult for him if he is starting from a place of not wanting to be medicated, given how long it would take to find the right drug, the side-effects etc. She said that she doesn't think a hospital stay would benefit him and is instead trying to speed up his existing referral to a counselor (which usually takes 6 weeks at least, see above comment re: the shitty state of the NHS mental health services). His GP is also going to call him today to check up on him, which I hope means she is taking a dedicated interest in his well-being. So yeah, right now we are in a holding pattern. My boyfriend is mostly up-and-down in mood, positive and happy during the day and then crashing hard at night. He's staying with me right now and I'm doing my best to trust him when he's on his own, but it's tough. I will be looking at finding therapy for myself but I can't afford the expense at the moment.