Ask An Expert / Suicide and Self-Harm

My daughter has been treated for depression, but it doesn’t seem to be working. What can we do?

Be a good listener, but also be ready to help

Stephanie Dowd, PsyD
Stephanie Dowd, PsyD

Clinical Psychologist, Mood Disorders Center

Child Mind Institute

My daughter is a college sophomore. She has been treated for depression with Lexapro and Abilify, and therapy. She had been cutting but has stopped that. She is home for the summer but is miserable. She is working part time, but has no friends. She is very creative and is a lovely person, energetic and fun. However, lately she has just been argumentative and rude. She was an extremely gifted athlete, but an injury 5 years ago caused her to stop competing. Since then she has gained 40 pounds and does not want to even go for walks or bike rides.We are at a loss as to what to do. Therapy and medication do not seem to be working. I feel like I am walking on eggshells because anything I say can be misinterpreted. I love her dearly and do not want to lose her. What else can be done?

This sounds like a very difficult and troubling situation for you. You want to help your daughter in every way possible, and she’s not letting you. It can also be frustrating when you see your daughter not helping herself. We hear from many parents who feel the same way you do.

While you can’t change your daughter — she has to want to change first — there are some things you can do to help support her and guide her along the way.

First, you can work on strengthening your relationship with her. Try to build empathy by putting yourself in her shoes. For example, she might be feeling discouraged because therapy and medication haven’t been making that much of a difference for her, and that might make her feel that it’s pointless to make an effort to do other things, such as taking a walk or going for a bike ride. Communicate that you understand her being discouraged.

Make an effort to listen without being judgmental even if you disagree with her choices. Don’t try to solve her problems unless she asks for your advice. Acknowledge that her injury was hard on her and that going through college with depression is tough. When you’re talking to her it might seem as though you’re highlighting the negative, but in fact you’re letting her know that you see her, you’re listening, and you’re trying to understand—not fix her. People don’t like to be fixed.

Try also to give her opportunities to do things without being critical. Instead of saying, “Honey, you should really get up and do something. How about calling an old friend?” you might say, “I’m going out to do an errand. Let me know if you want to come with me, and maybe we can get lunch together.”

Meanwhile, make sure you’re noticing the positive things she does. She’s working part-time, she completed a year of college, and she’s taking her medication. These are all great things. Parents sometimes don’t realize that when they express concern, it can sound critical rather than helpful.

Likewise, you don’t need to mention that you’re disappointed she doesn’t have many friends or she’s not exercising. She probably feels disappointed too, and doesn’t need to be reminded of what’s not going well in her life. Remember, she doesn’t want to feel this way. If she could snap her fingers and feel better, she would.

You also want to remember to give her space. Young adults want independence, and it’s important for you to respect that. For example, you could say, “I have some ideas of what could help you feel better. Let me know if you’d like to talk about them.”

It’s also a good idea to ask your daughter why she thinks treatment isn’t working. What wasn’t helpful or what didn’t she like about therapy? What did she like? Maybe you can work together to find a therapist who does more of those good things that she likes. If you do consider changing therapists, it’s important to discuss this with her current therapist before the decision to change is made. Many times, the therapy and/or the therapeutic relationship can be improved.

If you do change therapists, make sure she has a voice in her own treatment. Tell her she can interview two or three therapists and choose the one that she feels most comfortable with, and thinks will help the most. It’s extremely important to find a therapist who is a good fit.

It’s also important to have the right fit with the kind of treatment you’re getting. There are several specific kinds of behavioral therapy that have been shown to be very successful with teenagers, including dialectical behavioral therapy (DBT), which has been found to be effective with kids who have a history of self-harm. You might also want to consider meeting with a new psychiatrist for a second opinion on medication treatment. Again, it’s a good idea to let your daughter’s psychiatrist know you’d like to get a second opinion first.

Lastly, it’s important to make sure that you’re taking care of yourself. It can be emotionally and physically exhausting to deal with children who are struggling with depression. Know that you are not alone and get support for yourself. Set aside time for yourself, and investigate parent resources and support groups. The books Stop Walking on Eggshells, by P.T. Mason and R. Kreger, and Helping Teens Who Cut, by Michael Hollander, might be helpful.