You’ve done your best to help your partner manage her ­ongoing severe depression—encouraging her to enjoy activities…supporting her treatment…taking her to therapy appointments…and just being there for her. But nothing seems to be working. You sense that her depression is getting worse and are wondering what to do. Here are clues to look for to guide your next steps—from internationally known clinical psychologist Judy Kuriansky, PhD…

Signs of worsening depression: Look for exacerbation, or worsening, of symptoms or manifestations of depression. In women, signs often are increased sadness, withdrawal and decreased care about her appearance. Signs in men more often are anger and irritability. Signs of an escalation can be either big…or small. Example: Perhaps your partner was planning to work from home three days a week but then drops onto the couch several times a day…or she used to put on makeup every day but now does so barely once a week.

What you can do: Let your partner know that you notice these changes and that you’re concerned that her condition is worsening. Be prepared for her to deny it or get angry with you. Don’t be afraid that you will rock the boat and make things worse…in fact, you have to rock the boat because things are worse and won’t magically get better. Be honest about what you are seeing, and give details—there’s no point in beating around the bush. Ask your loved one to make an immediate appointment with her doctor or therapist…or offer to do it for her. Perhaps suggest that you will go with her for a joint session—to discuss possible changes in treatment, such as a new medication or a more intensive or new approach in therapy.

Signs of suicidal thinking: While some people might talk openly about harming themselves or about the world being better off without them or even start acting recklessly, your partner might hide his plans from you.
One counterintuitive sign that should spur you to immediate action: If your severely depressed partner seems radically better practically overnight—perhaps going from being inactive or despondent to calm and peaceful…or suddenly no longer is fighting with you or complaining about a lack of sleep…or even seems surprisingly cheerful. He may appear or act better because he has resolved to made a plan to end his life.

What you can do: Question him about his change in mood or behavior. Yes, that could mean confronting him and saying you don’t believe that a miracle happened or that treatment suddenly kicked in. Be blunt—ask him if he is thinking about suicide. You can use words like, “Your sudden shift in mood makes me very worried that you are planning to end it all by killing yourself. I’ve heard this happens for people who are severely depressed.” Be prepared for him to lie and deny it…but counter that by saying you are still worried and question whether that’s true.

People at the brink actually want someone to call them on it, even though they will object and deny it. You have to act to save your loved one’s life, and you may have only limited time to respond. A good analogy is if you saw someone drowning—the further that person sinks, the more imperative it is that you jump in to save him. You wouldn’t just stand there and watch him go under.
Next, ask him to go to an individual or group therapy session as soon as possible, even if you have to schedule the appointment. In the meantime, scour your home for any means that could be used for suicide—medications, guns, poisonous materials including cleaning products. Also, stay with him round the clock—he might make the attempt the moment he is left alone.

Even though therapy is confidential, call his therapist or doctor to share your concerns. In a life-threatening emergency, call the 988 Suicide and Crisis Lifeline at 988 (press one if your partner is a veteran) to get advice and support…or if his action is imminent, call 911.

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