Hello, my name isXXXXX and I'm a Licensed Marriage and Family Therapist in California. I believe I can help you.
Can you tell me if your son has a longstanding history of depression or other mood disorder?
I would say he has been depressed since age 15 but would never acknowledge it.
So he's never been in treatment for his depression then?
just the last 6 weeks but he refuses to take the rx the psychiatrist prescribed and thinks the counselor he went to is an idiot
What did the psychiatrist prescribe for him?
Is he on any other medications?
Good. Here are some initial thoughts:First, you or your son need to talk to his counselor about the type of therapy he or she practices.The most effective treatment for depression is cognitive-behavioral (CBT) psychotherapy. Alone or combined with medication it has a roughly 80% success rate in the literature. The counselor your son has been seeing may or may not be trained and experienced in providing cognitive-behavioral therapy. If he or she isn't, your son may be feeling the sessions are useless as they are "just talking" and he's not getting tools and techniques to deal with his depression now. In CBT, he would be getting tools to use immediately to combat his depression. If his counselor is not a CBT therapist, your son needs to find one who practices it.
Second, I'm wondering if his medication is the appropriate one. He needs to speak with the psychiatrist about his increasing depression. Six weeks into a medication regimen one would think he would start to experience improvement.
Third, there are some good books out there which your son could use now. One of them is called Feeling Good: The New Mood Therapy by Dr. David Burns. It is readily available at major booksellers. Feeling Good and its accompanying workbook walks one through self-directed CBT for depression. I think your son, and you, could find it very helpful.
Does your son live with you or at school?
in an apt with 1 friend near school
Also he has not tried the medication--he absolutely refuses to. Any ideas on how I could change his mind?
You could certainly encourage him to take the medication, but I wouldn't push it too hard. Often, people with depression have a significant amount of anxiety and are reticent to take medication. Further, if the medication doesn't help or makes his symptoms worse, as it sometimes does, he might never try it again. My recommendation is that he enter cognitive-behavioral therapy and that you let him know that if he follows through with therapy, you won't push him on the medication.
If the therapy isn't successful, which you will have a sense of its progress after about 5 or 6 sessions, then it would be time for him to consider adding medication to therapy.
Has your son ever verbalized suicidal thoughts or plans?
He told me he has thought about killing himself many times but never told me about any plans
When did he last tell you this?
3 weeks ago
It would be a good idea, of course, to check in with him daily, if you don't already. I always recommend taking any suicidal thoughts seriously. In the future, if he verbalizes plans, I would take him to the nearest emergency room for an evaluation. It is part of depression that one thinks about death or suicide frequently.
I try to talk to him daily but often he won't return calls. I think he is spending most of his time in bed. He is being very unrealistic and pretending that he is willing to try what the counselor suggests but never does any of it. I know he wants to feel better but is not doing anything to improve his situation. Is there anything I can do to motivate him?
I think the best thing you can do is to keep the line of communication with him open. Ultimately, no therapy will be effective unless he is motivated to do the work. You need to help him capitalize on his motivation to get better, so find every opportunity you can to underscore the importance of getting well.
My husband wants to cut him off financially to motivate him and thinks this would get him to work on getting well. What do you think?
I think that it would be wiser to give him a deadline, say a month or two, before cutting him off financially. A sudden financial cutoff might be too much stress at once.
In general, do you think him working or going to school would be better in his situation?
I think school might be his best option, unless he can find a job relatively easily. You don't want to set him up for failure in any case.
You have given me some good suggestions. Thanks for your help.
Thank you and I hope this has been helpful. You may always contact me directly through Just Answer. Please remember to click the Accept button.