Please help - calming a near-suicidal, highly distressed 16 yo daughter....

[cyclotherapy]

Hi.... Any advice you can give would be amazing... we have run out of ideas....

We have been with her 24/7 for the last 8 weeks - she's been put on Fluoxetine by CAMHS psychiatrist, but sadly without any impact though I know she is likely to up the dose when we see her next week. We keep all doors and windows locked, which DD finds reassuring.

This is the fourth time she has been like this since she was 9. Each time a bit different, each time "wearing off" after 4-12 weeks, although she would say nothing changes, the same dark highly-critical voices in her head, just she is able to manage them better and engage in life while they are in the shadows.

These last 8 weeks have been a mix of extreme distress and watching American sitcoms for hours on end.

bipolar?

No useful words. I can only send a handhold.

No advice but again, handhold, must be hard for all of you. You sound like you’re doing a great job

Handhold here, I've been the suicidal 16 yo daughter so I know in some way what your family are going through. What are you struggling with the most?

What is her life like? School, home, friends, sexually actively? Does she drink?

I was a mess at this age and you would've had to look at the entire picture to understand me.

When she is very distressed, she longs for us to comfort her - and becomes child-like in her distress, crying out for her Mummy and her Daddy and often "losing" us, asking why we are not there. At her most extreme she cowers in the corner like a frightened animal, unable to be approached - or beats her head and digs her nails into her flesh, drawing blood.

Things that can help are reassuring her that we are here, that it is okay, she is safe, nothing is more important than her mental health, we know we will find a solution (we just don't know when), that she is so brave and no one deserves such pain, sometimes images like emerging from dark confusing forests into the beautiful mountain tops where the air is clear and you can see forever.... and our dog, when he snuggles up to her and licks her, often can reach her when we can't

But beyond that - and she longs for us to talk, as if there is silence, she gets even more distressed as her internal voices get too loud, filling the space...we hesitate... finding it challenging to know what to talk about..... She finds it difficult if we talk about ourselves, wanting, understandably us just to focus on her... She is so distressed that anything rational is inappropriate - and indeed she is clear she wants a comforting Mummy and Daddy, rather than practical ones....

Does anyone else have ideas - or experiences - of what to do in these moments? We stumble through them... typically lasting 1.5-4 hours though at her most extreme we had a 12 hour marathon.....

We would love to be able to offer more comfort - and are aware if we repeat our existing repertoire too much, it is likely to lose its power to comfort and become just words..... We frequently look at each other having offered what scant comfort we can, stumbling to find words that will help her feel supported rather than abandoned.....

I do not believe we are the only ones - though we know our daughter is unusual in the extremity of her passion (and ability to function often in the real world, alongside this powerful emotion)..... I am hoping that anyone who has either comforted - or been comforted - might share ideas and thoughts that might help....

Thank you

Your poor DD. And I can't imagine how bloody terrifying it must be for you.

{{{hugs}}}

I had to say hello and I'm so sorry to hear how ill your dd is

I watch a lot of tv with mine when she's not well. Sometimes we do some baking, occasionally something arty.

Initial dose of a first AD is rarely the perfect dose, so yes you may need to up the dose. Is she able to be outside much, can you go for a little walk together?

Really hope she picks up soon and you find treatment and care that helps.

Have you tried doing a low key, fun fitness video together? It sounds like she needs some way to ground herself and ‘turn off’ her mind, and exercise is a great way to do that.

And big 🤗 too!

Sorry that sounds pretty feeble in light of you update. Are you aware of any issues that lead to these depressions? I also hope you have some good support in place for you. You sound really loving parents.

What about reading to her?

Firstly, well done so far on staying strong!!!
If you're saying it's wearing off could it be related to hormone changes, maybe look at the pill or various contraceptions to help stabalise, perhaps something like the mini pill that doesnt contain estrogen?
I know its online so havent got the whole whole story but have she tried better diets and getting fresh air, defo not hours of tv, enough to make anyone super anxious! Its not an absolute game changer, but defo relieves harsh symptoms, having fresh air and sunlight!
If she hasnt already tried then mindfulness is a game changer, it's even proven to help children with adhd, just to help people take stock of their thoughts and not get caught up in them, similar in a way to CBT where you train your brain.
I'd also really recommend talking to someone, both you and her, samaritans are fantastic but I'm sure your doctor can recommend the best person!
Good luck!!
Xxx

I know nothing about this, but if she needs the sound of your voice what about reading to her? Like she's a smaller child. What brought her comfort when she was a toddler? If she's regressing it might be worth going with that. As I say it was just a thought reading your OP. It sounds terrifying and I really hope you can look after yourselves as well.

I think dialectical behaviour therapy may be your best hope. Look up the skills training, in particular crisis survival and distress tolerance. You can buy the skills training manual. There are also workbook versions for teenagers eg Don’t let your emotions run your life. When your daughter is calm/more robust, work together to look through all the skills and shortlist some which she thinks might help. Then when the crisis takes hold, coach her to try them out. She might like to put together a crisis ‘kit’, or write herself some cue cards to remind herself of things to try.

You sound like lovely supportive parents who work hard to understand and support her.

Thank you for the handholds... it is so tough....

At school, she is relatively easily academic (though recently diagnosed as ADHD and the Elvanse really helps)... and good at making friends (though she doesn't believe this) - highly tuned into others and how they are ... very very funny with social observations - very kind, often too kind, and finds it tough to understand why anyone isn't - very stylish in her fashion sense, with a style that is her own, not mainstream but tuned in and important to her... and engaged in far too many activities, though not at the moment.... when it is this extreme she withdraws, when back at school and the voices are still loud she does a lot from dance and drama to cartoons and sport........and then only is 'at risk" during a couple of days of PMT each month...

physical comforts? a favourite blanket to curl up in, a hot water bottle, bubbly bath? favourite music? something she can bury herself in to pass the time - adult colouring books?

Oh gosh, how terribly difficult for you. What is she talented at?

Hi .... that was in response to an earlier post.... yes I think the sooner we can get her outside walking the dog the better... at the moment she is too scared but we are hoping soon - as is she - she is longing to....And what feels so weird is that even when she is in this really tough weeks, she does also talk about the future (studying at uni, sixth form, Reading festival, even just meeting up with friends)... then plunges back into the depths a few hours later...

And I agree re more out of her head activities like cooking or dance (we used to love doing the wii together last time she started coming out of one of these episodes)....

Though the toughest is when she is in one of the prolonged deeply-distressed stages for hours and we don't know what to say....

TV is a brilliant anaesthetic when she is unable to do anything else... and we do shamelessly use it, exhausted from the trauma and the worry....

Handhold and for you and your family, OP. I second the reading suggestion and other comforting/distracting things like comedies. I find Stephen Fry reading Harry Potter really reassuring. Also Fawlty Towers (appreciate she may be too young and cool for this, so maybe a 21st century equivalent) and yoga. It sounds so very hard for you all but you and your DH sound like you are doing all you can-I hope things improve soon.

If PMT is a trigger, might it be worth getting her on the pill and taking the packets back to back? No periods so no PMT.

Her life sounds lovely- are there not cracks anywhere?

You're amazing cyclotherapy. I've been that girl and not had the support that you give unconditionally. Your daughter will always remember what you are doing for her now.

I'm surprised they're treating what appears to be psychosis with fluoxetine. That doesn't feel like they're taking her symptoms seriously enough. It would be worth noting down a typical few days so they have in writing just how bad things are.

I'd also research into the effect of the pill (and mini pill) on mental health issues. It's common to use them to help PMT but they can cause as many problems as they solve. If she's sensitive to progesterone then a synthetic supplement (the mini pill) will make things even worse.

Sorry, no answers, but wanted to wish you and your daughter all the best in getting well.

Any trauma? Did anything happen to her around the age of 9? These kind of episodic crises can be caused by PTSD, especially the cowering in the corner and the regression. People who have suffered trauma often go through periods where they can cope with the feelings/memories/voices and when they can't.
Other posters are right that DBT (a therapy aimed at those with Borderline Personality Disorder and other people who struggle to manage severe emotional distress) focuses on emotion management and distress tolerance in particular. A key part of it is mindfulness and being "in the moment", being aware at the emotion is happening TO you but that you are NOT the feeling. When people are in crisis they can feel that they and their feelings are the same thing, so the bad feelings will never end. Mindfulness attempts to "put some air" in between the person and their emotions. I would try it with her, especially as she gets on with image meditation.
Other than that, be aware that ADs might not work for her. It sounds like she could do with some more psychological support. Is she getting therapy/counselling?

You sound like you're doing so much for her already.

I'm not sure I can suggest much but would echo the suggestion of contraception to steady her hormones. And maybe the radio, something like Classic FM if words in songs might be a problem?

Our eldest (11yo) has ADHD and his head can get stuck down some crazy rabbit holes at times. Cuddling up on the bed and just talking through it, going along every tangent can help with him, working through every little niggle and worry, though it can take hours. We still end up taking turns sleeping on his floor or snuggling into bed to reassure him at times.

With her taking the ADHD needs, do you find any times of day are worse than others? 4-5pm is our witching hour as they wear off, and then 9-10pm is the worry hour. We just have to work through it but recognise it and plan through it.

So many lovely messages - so many helpful suggestions: Thank you!

Firstly trauma - we do think this is a route we should explore more. She definitely had PTSD age 11 with three hospital ops and prolonged pain. She was ridiculously stoical and went to school almost throughout (in spite of my trying to persuade her to take time out), but the grin and bear it approach took a huge toll.... She ended up as an inpatient for 10 weeks. They did rule out psychosis then, as she did have several symptoms that suggested it might be possible.

So we are going to try EMDR. And I'm beginning to find out more about trauma, as we think there may have been developmental trauma - I was pretty ill in the first two years of her life, so not able to be with her as much as I would have liked.... and we know she was a super-alert baby (probably the ADHD?), very difficult to settle and needing little sleep... She also didn't hear properly, and now does having had three lots of grommets, but there was a stage when she was learning to lip-read without our realising it. She is also super-sensitive and has always felt personally responsible for everything - I remember her devastated face, aged 4, when she came home from school and said "Mummy, we are killing our planet".... and is now charity rep at her school, as well as semi-vegetarian (we won't let her go fully veggie until she is 18) and heavily into ecological issues.

We have tried a lot - with varying success:

• counselling and therapy - place to Be and CAMHS
• Family therapy - CAMHS - helpful but limited
• CBT - hopeless, very resistant
• ACT - useful in day to day when NOT in traumatic phase
• psychotherapy - too much ... spiralled into third episode age 13
• diet and supplements - and healing!