My husband has suicidal tendencies…

I think my husband has serious depression issues — bordering on suicidal tendencies. Off and on, for years, he has mentioned that things would be better if he wasn’t around. When confronted with hard issues he tells me he routinely hopes he’ll get hit and killed by a semi on his way to/from work. In his own words “wishing I was dead all the time is because I can’t find any point of sticking around and lots of reasons to not”.
He refuses to think about the idea of medication. He was on amitriptyline for just over a year and since it didn’t help he hates drugs, doctors, and thinks pharmaceutical companies are a sham. Again, in his own words “I’m sure part of it is chemical, but there is no way I’m taking pills. I’m not willing to give my money to drug companies” When asked if “you’d rather die a horrible death than take a chemical that is supposed to be in your body but isn’t” his answer is yes.
What can I do? His only reasons (given at various times in our 10+ year marriage) are: “I can’t think of a way to do it that wouldn’t leave you destitute, I’m too chicken, I would mess even that up and end up seriously wounded and be a drain on you for the rest of your life.”
There are so many other issues right now, with our marriage and with him, but I’m afraid that one day I will wake up to find he actually went through with it.

I am sorry that you are finding yourself in such a difficult position. I agree that your husband has “serious depression issues.” Once suicidal ideation sets in, one is definitely in the throes of severe depression. As you make perfectly clear, depression is not just an individual disease – it affects the entire family system. As I was reading your experience, I got the sense that you must feel like you’re being held hostage by this situation. I wrote a previous post answering questions to a wife whose husband was suicidal. You might find reading through this useful.

It is unfortunate that your husband is being resistant to medical treatment, since he would have the highest amount of success if he were to combine medical and psychological treatment. The problem with treating depression is that it needs to be addressed on a multifaceted level. Medications work over time (several weeks are needed to see initial results), making sure you are at the correct dose (many doctors -especially primary care phycisians- start dosage low which will not work for severely depressed individuals), and sometimes having to be on more than one medication at a time. Since this process is lengthy and at times frustrating, it is easy to give up and assume this venue “doesn’t work.” I would encourage anyone who is dealing with severe depression to ask for a referral to a specialist – a psychiatrist – who is better equipped to come up with a combination of treatment methods that can elicit a higher rate of success at a quicker pace. One treatment I haven’t yet mentioned, but that is highly effective with resistant depression, is ECT (Electroconvulsive Therapy). Although considered controversial by some, it is not a highly invasive procedure (compared to surgery for instance) and has a track record of high positive results. Any medical treatment should be coupled with psychotherapy (individual and family) so that all in the system can be equipped with the proper tools, skills and education to understand and progress.

As you cannot force your husband to seek treatment, here are some suggestions to face this resistance:

• Empower yourself through self-care and the realization that whether or not your husband decides to take his life is not your responsibility. I know this may sound crass, but until you take this step you will continue in the hostage role.
• Be willing to listen, stay calm and be consistent with the following comeback: “I can’t imagine how difficult it must be to live with this chronic disease. I am just amazed with your strength and perseverance to continue to move forward. At the same time, I know we need professional help – help that includes therapy and medical treatment. I realize you may not be willing to get help at this point, but I know this is what we need. I’m asking you to be willing to go with me and let’s tackle this together. I’m asking you to help me lead this family in a positive direction. You don’t need to do this alone.” Say this type of statement over and over and over and over again. Keep it short, simple yet constant. When he makes irrational statements, just calmly and gently dispute them (i.e. “I know you are frustrated. And I disagree that antidepressants are a sham. I know they help many people. We just need to find the right treatment combination for you.”). Then as much as you can, go on with your day-to-day life. Don’t allow the depression to take over every aspect of your lives and relationship. Ignore it as much as possible – don’t draw attention to it when not necessary.
• Getting overly emotional and dramatic can intensify the experience. This does not mean you shouldn’t show emotion or try to hide emotions that you are legitimately feeling. It’s perfectly appropriate for you to show tears, sadness, frustration or worry and to calmly state how the depression affects you. “It is very sad for me to hear you talk like this. It leaves me feeling powerless and without knowing how to help you. This problem is beyond my ability.” The key is staying calm and truthful as you express your emotion.
• Respectfully and kindly let your husband know that you are going to seek treatment with or without him. Go get professional help yourself. Get it for your children as well (if you have any). Always invite him to participate and respectfully ignore any squacking he may throw at you as you do. If he says he doesn’t want to spend money on this – you respond calmly that you understand, but you do. You do not need to do this alone! Setting the example of self-care will help him and you simultaneously.
• Explain to him that there are consequences to suicidal behavior. If you feel he is in danger to himself you will call the authorities to make sure his life is preserved.

Some bullet points I’m copying from my previous post:

• You need to know that you have the right to call authorities if you feel like your husband is suicidal and get him admitted to the hospital. You can do this by calling 911, by calling his therapist and/or his physicians. You can also call the suicide prevention hotline and always ask their advice 1-800-273-TALK.
• It is important to understand that these mental health diagnoses are diseases, and serious ones – much like diabetes, congenital heart failure, etc. Therefore, even with much faith and righteous gospel living, it may not be that symptoms will magically disappear or that the disease will be cured. However, most diseases (even chronic depression and OCD) are manageable and can benefit through preventative and health-conscious efforts. You may both need to work around how you change your expectations on how to live in conjunction with these diseases, rather than trying to completely rid yourselves of them.
• I encourage you to be very verbal regarding what you see as your husband’s strengths and the confidence you have in him to manage these struggles he faces. Be very verbal of your need for him to live and the needs of his children for him to live. Be verbal in your declaration that together, you can survive whatever it is he faces. That you signed up to be with him in sickness and in health – and that you expect the same from him. Be willing to listen and empathize, while at the same time gently challenging towards wellness and life.
• It is part of your stewardship to love, support and be a helpmeet to your husband. However, you are not responsible for his disease, for his actions or for his feelings. Ultimately, these lie with him and his own personal stewardship. If he does indeed follow through with the tragic decision to take his life, this decision will be on him. Hopefully it will not come to this.

I hope this is helpful information. Please feel free to write back with further questions if needed. I wish you and your husband the very best.

Electroconvulsive Therapy (ECT): An Effective Treatment for Depression