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  • Recent Inury - Depression and Suicidal Thoughts

    Depression and Suicidal Thoughts


    Hey Everyone,


    My boyfriend has been in rehab for about a month now (T7 ASIA B) and before rehab was in the ICU for a month before that. Until this week things were going fairly well, he was upbeat and although things were tough, he was able to stay positive and in good spirits. This week everything has flipped around and he's really been a mess. I think this is largely because he's starting to become more confident that he'll not be walking again and can't seem to see a life as a para.


    The thing is that he CAN see a life as a para (ie he understands that he will be independent and that he can have a life), but he's having trouble visualizing himself in a happy life. There are a lot of different things going through his mind, but he is largely lucid with his reasoning and understands his situation fairly well. He's starting to have suicidal thoughts, and although they are just thoughts, he's started to generate a bit of a timeline (ie if I'm not happy by this time...maybe Switzerland is the answer). Although I think a lot of that is mental masturbation, I do think he will eventually make it out of this with a happy life, I am concerned about what we can do for him right now.


    Anyone have any ideas? Insight? Obvious things I'm missing out on?


    I know this is a long road and that we're still in early days, but I'm at a loss of what I can do for him besides be there to listen, to cry with, to talk, etc. It is horrible because when we are talking I find myself validating a lot of what he is saying (which is essentially validating his misery and suicidality).


    He's had some trouble with his antidepressants (pharmacy ran out over the weekend) and his clinical psychologist (personally I think he needs a therapist). We're working on both fronts to sort out stuff in those areas, but otherwise what can I do?

    There are A LOT of other issues that we have to deal with (relationship, international visa troubles), but this is the most pressing at the moment...

  • #2
    Welcome! Yes... When my hubby was in rehab at Craig in 2005 (T11 Asia A) he was ok until about 3-4 weeks after his accident. A couple of things triggered the depression: One was watching a fellow patient actually stand up out of her wheelchair in the cafeteria and the other was being in the rehab unit during July 4th... We liked to say that the chickens came home to roost. We asked for a psychiatric consult and he was put into therapy and put on medication which he is still taking to this day.
    I guess that all I can say, as a spouse if that you just have to be as supportive as possible and as positive as possible. Every day in rehab is a true challenge and especially for the patient...and as time goes by,,,, believe it or not it does get better...

    Hang in there and keep coming back to this place... the support is here...

    Sieg

    Comment


    • #3
      If there is any way that he can have some peer counselling it might be great. It is one thing to hear from nurses and therapists how independent his life can be and how many options are still open to him, but when it comes from someone at his level or higher who has been doing the whole wheelchair thing for quite some time it can have an amazing effect. Some hospitals have peer counselling available, or lacking that there may be a Spinal Cord Injury group that meets somewhere occasionally. Someone with a T7 injury has almost the whole world open to them in terms of opportunities if they are willing to seize them, but it is also natural that he is grappling with his very real losses right now and needs to grieve a bit, but if the suicidality becomes too intense make sure he has professional help available from social work, psychotherapists, or a shrink.

      Comment


      • #4
        I agree. Is he in a rehab center that specializes in SCI? If so, they should have a peer counseling program. They may also offer groups, and he should attend.

        I am glad he is taking the antidepressant, although it should like he may need some adjustment in his dose or change in which one he is taking? How long has he been taking it? It can take 2-3 weeks to start kicking in for some. I can't believe the hospital let themselves run out! How irresponsible!

        A clinical psychologist is a therapist. If he is having a problem forming a therapeutic relationship with this one, ask to have the psychologist changed to a different one. Often you have to shop around to find a good match.

        Is he sleeping? Participating in his therapy program? Socializing with others in the dining room and during recreation activities? Going on therapeutic recreation outings? Does he have decent pain management?

        It sounds like you have been an important source of support for him. That is great, but you also need to take care of yourself. You may also benefit from some counseling at this point...both to help yourself and to learn more how to help him.

        Please keep coming back, and get him on-line here too.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


        • #5
          Originally posted by SCI-Nurse View Post
          I agree. Is he in a rehab center that specializes in SCI? If so, they should have a peer counseling program. They may also offer groups, and he should attend.
          He is in "the" premier SCI center here in the UK (the same one with the famous rugby dude...). The medical care he is receiving is quite good, but the other stuff I'm not so sure about. He's had some peer counseling, but he isn't responding well to it. He thinks that his problems are different from everyone else (which i suppose is true for everyone). Really, I don't know if the peer support could be tailored to him as our situation is so unique (i'm sure I'll post it on here in the next day or two). This really is my biggest concern, whenever he talks to someone who has been there he doesn't connect with them.

          I am glad he is taking the antidepressant, although it should like he may need some adjustment in his dose or change in which one he is taking? How long has he been taking it?
          I'm pretty sure they started him on it in the ICU more than a month ago. He's deffo been on the same one for long enough for it to kick in. I don't know if the missed doses could cause such a change, though I suppose it makes sense.

          A clinical psychologist is a therapist. If he is having a problem forming a therapeutic relationship with this one, ask to have the psychologist changed to a different one. Often you have to shop around to find a good match.
          This guy is NOT doing therapy. He seems only interested in the SCI side of things and not in a therapy sort of way. It sounds like he's telling the bf where he should be psychologically, but not actually working on it. We're starting to get him moved to a new therapist - though the clinical psychologist said, "we all work the same way here, it won't make a difference" - shocking.

          Is he sleeping? Participating in his therapy program? Socializing with others in the dining room and during recreation activities? Going on therapeutic recreation outings? Does he have decent pain management?
          Yes (though he recently moved to a 6 bed ward full of snorers).
          Yes (though he is struggling)
          Somewhat
          There haven't been any yet.
          Pain isn't a huge problem anymore.

          It sounds like you have been an important source of support for him. That is great, but you also need to take care of yourself. You may also benefit from some counseling at this point...both to help yourself and to learn more how to help him.
          Yeah, i know. I'm trying to take care of myself.

          Please keep coming back, and get him on-line here too.
          Will do. He's a bit hesitant to get on sites like this, but I'll work on him.
          Last edited by caredboarder; 03-13-2009, 06:44 AM.

          Comment


          • #6
            Long time psych nurse here.

            A month is definitely long enough for an antidepressant to kick in, unless he is on one of the really old tricyclic ones, like amitriptyline, which I doubt. If it is an SSRI (fluoxetine, sertraline, paroxetine, citroprolam, for example), or SRNI (venloxafine, duloxetine) or buproprion, all those would have had sufficient time to kick in, and two or three days without should not have made an appreciable difference.

            As KLD said, he may need a different antidepressant. Finding the right one can often be a matter of trial and error, it is nigh impossible to predict which one will work for any particular person. That being said, he has been through a life-changing event, and while an antidepressant can certainly help by tempering the response, they don't change the underlying circumstances and they won't prevent the grieving of his life as he knew it that he needs to experience. In my own experience, it is a time of ups and downs, and the downs will keep cropping up for a long time to come, several years, although with time, the downs were less intense and shorter lived. Yes, there is life after SCI, and it can be wonderful, but it will be different. Nobody likes change, and this is a big one. He is going to need time. This is something he will need to work through himself. A good therapist can help alot though, if he can find one. I guess the best thing you can do is just be there for him, be willing to listen, and let him know that you are willing to stick by his side through all of this. There isn't much more you can do, but doing this much can mean all the world to him. I had been married for 15 years, and my husband wasn't able, he couldn't handle it, and bailed ship on me, so I guess you could say it would have meant the world to me anyways. Although, it seems people often have a bad habit of often not appreciating what they have........ until they don't have it.

            It sounds like you are already doing all the right things. Listening, validating him. You can't fix him. Emotionally or physically. Nobody can. All that you can do is to give him a soft shoulder to lean on. And as already suggested, take good care of yourself, because if you aren't in good shape yourself, you can't be of use to anybody else either. Don't forget that this time is very stressful on you, too, and it will be okay, and necessary, for you to take time out and get some support for yourself.

            Comment


            • #7
              Originally posted by dunwawry View Post
              That being said, he has been through a life-changing event, and while an antidepressant can certainly help by tempering the response, they don't change the underlying circumstances and they won't prevent the grieving of his life as he knew it that he needs to experience. In my own experience, it is a time of ups and downs, and the downs will keep cropping up for a long time to come, several years, although with time, the downs were less intense and shorter lived. Yes, there is life after SCI, and it can be wonderful, but it will be different. Nobody likes change, and this is a big one. He is going to need time. This is something he will need to work through himself. A good therapist can help alot though, if he can find one. I guess the best thing you can do is just be there for him, be willing to listen, and let him know that you are willing to stick by his side through all of this. There isn't much more you can do, but doing this much can mean all the world to him..
              This needs to be understood.
              I'd be more worried if he wasn't going through some depression.
              It's just part of it.
              It should ease off...
              He is lucky to have someone to care.
              J
              Doh!

              Comment


              • #8
                Yes he is very lucky to have you and will need much support. I am not sure I can add much more than the great advise you'll receive here. It does take time and will go through many stages of emotions. I went to a rehab that did not give me phyc therapy at all (crappy rehab, right?) and had to figure it out mostly on my own. I've been injured 29yrs (quad) and life truly is what you make of it, in a chair or not. I've been married 20yrs and 2 kids to boot. My life is different, but in may ways the same. Ups and downs and still trying to figure it out, but thats living I guess. Pls take care and best of luck...

                Comment


                • #9
                  The level of my injury is T7 and is complete.
                  My rehab was over 3 years ago. I was depressed.
                  Being in the gym and exercising made me feel better.
                  Being in an institution is not fun.
                  The food gets old.
                  The snoring and other interuptions at night don't make for sleeping well.
                  I wanted to be out of the rehab and sitting outside in the sun in a quiet natural place.
                  They gave me things to read about SCI and recreation etc. At first I didn't want to read them.
                  The experience of suddenly being in rehab with SCI was very intense.
                  At night, I found myself counting to 100 or 200. It was a way to still my mind.
                  My mother showed up very often. I wish she'd showed up less. Having her there was sometimes an interruption of the "rehab experience". The routine of rehab can be helpful. It's a time of preparing for a new kind of life on the outside.
                  Caredboarder, I know it's hard on you, too.
                  Rich

                  Comment


                  • #10
                    The first 3 years, SCI's have an astonishing (to me) rate of suicide, more so in paras, I think.

                    Go figure.

                    So as ever, never take suicide talk lightly. If he sets a time limit of 5 years, I think that's ok. Lots do that, but it fades, or they extend it when the time comes. 2 years or 3 years is too soon. Hard as it is to believe, many of us are only regaining our strength at that time.

                    Rehab is hard. Going home is harder, imo. It's all REALLY hard. And I've survived 8 1/2 years, many of them fairly good ones, all fairly intense ones. Most likely, he will too. Good luck.
                    Blog:
                    Does This Wheelchair Make My Ass Look Fat?

                    Comment


                    • #11
                      L1

                      I was hurt 072707 and I still have thoughts ever now and then. I remember telling the doctor going into surgery if I'm not going to be able to walk don't bother operating on me. He has to stay positive and I know thats alot harder to say then do. He still as a para has alot more then others on this site. I still have all use of upper body and I assume so does he. Everting else will take time, I agree with the gym as well I go 4 to 5 times a week. He has to get his mind right before hecan even think about making any gains with therapy. Best of Luck Any questions feel free to PM me.
                      What ever doesn't kill you makes you stronger

                      Comment


                      • #12
                        I'm an incomplete Cauda Equina 2005 and almost did it Aug 07 due to chronic intractible nerve pain and spastic pain. I'm lucky I guess because I can walk but the pain is still excruciating. I was on heavy duty pain meds which fueled the crazies and depression. Wife found me the next day with a loaded and cocked 45.

                        Wife Church and friends kept me this side of the line during my "night of trial" and the next day I got serious intervention by my shrink, neurosurgeon, neurologist, clergy family and friends who essentially wouldn't leave me alone.

                        I had 3 more surgeries and have reworked meds a dorsal spinal stim and it is just enough to keep me on this side.

                        fwiw, if the pain went back to where it was, I'd likely do it. A personal quality of life issue. But I am lucky for the help I got.

                        The morphine I was on was extremely depressing and disorienting for me and oving to other meds helped with the crazies.

                        It may be worth trying different meds? My anti-depressants could not cover what the morphine was doing.

                        Pay attention, there are no empty threats. I wish you well and will pray for you both.

                        Kindly,

                        Bill
                        Kindly,

                        The Ketamine Kitty

                        All the tears, all the pain, all the rage through the night (apolgies to the rewrite) RR

                        Next time I die make sure I'm gone,
                        don't leave 'em nothing to work on JT

                        And I ain't nothin but a dream JM

                        Comment


                        • #13
                          This is a natural series in the whole recovery process. You must both understand that the process witll have ups and downs with many crises occurring during the phases of recovery. There are days where you are going to bottom out, but you can rebound. I am a T6 and also a social worker and although I do understand that med management is important and often necessary, often a therapist patient relationship can have a lot to do on the recovery. You may have to experiment with multiple therapists (be it psychologist, counselor, social worker etc) until you find one who you seem to work well with. It's not always the meds that are the answer. Providing support for the drastic emotional rollercoaster is imperative. Feel free to contact me if you have any questions or want to chat more.
                          Ride It Like You Stole It!

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                          • #14
                            Hey Everyone,

                            Thanks a ton for the advice, I really appreciate it. Everything you've all said is correct. He probably does need a new therapist, which we're working on. Also, we know these bad days are to be expected. I think what suprised me is how sudden and steep this downturn was. When any sort of self-harm gets mentioned - even as an aside, I know to take it seriously.

                            The BF is doing MUCH better right now. He had a great weekend with friends and family and we got him down to the pub for a beer garden drink on the first truly warm day of the year. I don't doubt that we're going to make it through this part (rehab), but again it is the long-term stuff that is scary.

                            I'm going to get him on here soon enough, we'll explain our story and then we'll REALLY have some fun discussions on here.

                            Comment


                            • #15
                              I'll take the road to Forch (Switzerland) as soon as I sold my house and could pay the total amount, a lot of money partially payed to have all the thing goes right despite italian law, cause I can live along daily pain, on wheelchair, SCI trouble but I can't live without sex anymore. I know it's hard but, by me, this is the best way. I'm tired wait the superdoctors talk only about stupid things, life is life if you can love. even the trees are more happy than me and many of us too. please apologise my english again and this hard post but this is the true, too much time, I smoke only along my pain, I can't sleep anymore, I can't see tv, women, happy people anymore, this moment are 2 days I can't eat nothing, I've drink a coke only, I love you all and I hope this letter comprehensive

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