Can anything help my seriously depressed autistic teen?

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I'm desperate to help him. He's become more and more depressed throughout his teen years. Hes been in a constant cycle of wellbeing support from NHS, college and private health care. He likes to talk about the causes of his depression but nothing takes the feelings away. He was prescribed Mirtazapine earlier this year but it had no positive effect, and as his dose increased he got worse so had to be taken off them. Hes generally struggling with life, becoming more independent, not being like other teens, not fitting in or having friends. His mood is so low he barely talks about anything other than how bad he feels. We spend hours talking things through with him and it is so upsetting. Even when good things happen in his life he cannot enjoy anything any more. I dont see how he can continue like this, he will never be able to live a normal life or get a job if he cannot clear the depression in his head.
I would love to hear advice from anyone who has had similar family circumstances where something has created a positive change for their loved one.

What therapy has he had? DBT tends to work better for autistic people, rather than CBT or traditional talking therapy. I’m sure I saw some workbooks online (can’t remember where now, I’m sorry) that he could use at home - they were very much aimed at autistic teens/young people and used DBT techniques, might be worth looking for those?

Hi, this must be very hard for you. My DD has autism but although not depression has a friend who really suffers badly with it. He does have friends though and my DD does her best to support him. When he is very low he doesn’t see much of his friends. One of the biggest turning points was getting a dog, the dog is not that young and used to belong to an elderly neighbour, being responsible for and genuinely loving this dog really helps. Getting out day for a walk etc in the fresh air.

Vitamin D. Check his bloods at GP for deficiency, also possible folate deficiency

Fresh air is also good and daylight in the morning but vitamin D isn't available from Sept to March in northern latitudes from sunshine.

One small positive thing every day could be going to postbox or reading an amusing or thoughtful poem or taking a hot shower with a colourful bath towel wearing a Xmas jumper. Try not to let him think about all the demands and problems but think about small things around him. Observation is a kind of beneficial mindfulness whereas rumination is not

Ds also found singing extraordinarily helpful. First in the shower or along to music then in a group setting. He was already a singer but it helped when depression hit in his teens. Also walking. Just walking no special route. He sometimes just walked for a few miles for it's own sake.
TV and film and talking about what he had watched...although that can be a bit of a downward spiral lying in bed watching screens.
Ds used to walk to the cinema. That was a good balance screen plus walk.

This was backup to CBT. No medication

A very very depressed son of a friend started a very simple 2 hour hospitality job that he couldnt fail at. And it was in the evening...he always felt better after midday so that suited him more than an early start. Depression is often worse first thing in the morning when cortisol levels are high and can cause anxiety in some.

Pets

music

finding things he enjoyed and encouraging him to do those.

Why was he started in mirtazapine when this is a second line drug?

My dd started fluoxetine which did nothing. Then she went on Sertraline which has been transforming. Each dose rise she gets less and less anxious and much happier. Maybe change drugs. We tried everything, the only thing which really had an impact was anti depressants. She smiles every morning now.

Have they been assessed for adhd? ADHD meds also really helped her.

Maybe it wasnt CBT...certainly it was talking therapy but aimed at reducing intrusive thoughts and rumination, panic attacks

There’s a book by Stella O’Malley called What Your Teen Is Trying To Tell You - it’s much broader than this but I think I recall there being a bit about getting teens out of their head and into their body at times like these. (If it’s not that book it’ll be Jonathan Haidt’s Anxious Generation book).

Talking about the problems all the time is just ruminating on them.

Can you get him outside? Get him moving? If not an organised team sport, then out walking. Even better if, as @Nettleskeinssays, outside in daylight, ideally in the morning.

Bright (outdoor) morning light will help regulate his circadian clock, which will help him sleep better. And if you’re out being and doing you can’t be so easily ruminating.

Try climbing, trail running, walks to find birds. Does he have any particular interests that could be hooked to being outside.

Martial arts (look at different groups, some attract a more neurodiverse group than others), fencing, nerf events? The gym (oh weights do more for the mind than they do for the body). Music & dancing (where did all the under 18 club nights go?).

Whatever you can get him to engage with will be hard at first. And then you’ll spend a lot of time reminding him how much he enjoyed it last time because getting out/changing tasks/situations is hard. But stick with it. Eventually you’ll find something that works. (Fair warning, this bit might take months or more).

Singing is magical, group singing even more so! (Which is why there is singing in church and at sports matches. Singing together at a concert is almost a religious experience experience). What a great idea!

My son switched from flournizine to setraline and setraline helped much more.

Then when the setraline kicked in, he did equine therapy which helped loads in combination

@Octavia64suggested pets - have you tried horses? Another magical (if expensive) transformative things. Definitely one to try. Go and groom and muck out if he doesn’t want to ride.

Also, counselling for YOU. The burden is very great and I think it becomes an additional source of tension if he worries about you worrying. And you are worrying, I know I did.

It helped me to let go of some assumptions i has made re job qualifications friends and reframe them differently.

Also once you allow him to be responsible for his own happiness ironically it will be easier for him to feel that freedom, children teens adults want nothing more than to please their parents even when they are at their most selfish so you giving him back that power to please himself might bear some fruit.

I know that sounds a bit woo but it worked for us. Still not perfect but job friends direction independence

I definitely recommend asking for DBT therapy. Changed my life!

There are loads of treatments. My autistic daughter has tried most! If one doesn't work they should offer another. Keep going xx

Sertraline, cats and bouldering worked for mine.

Oh so sorry to hear this. Def would second suggestions to look again at meds and a pet although I know this is such a commitment, we have lost our gorgeous dog who was life changing for DD, just processing this now but will prob get a new one quickly

This is good advice, and it is in the Stella O’Malley book.

Model taking responsibility for your own happiness to him. Make sure he sees his parents taking responsibility for their health and happiness by going out, being active, seeing friends. Make participating in life look like something he can and should do. Invite him along at times, or suggest similar things he could do.

It'll definitely help you to deal with him, and might very well help him to help himself.

(Also other things he might enjoy: local wildlife/conservation volunteer groups? Local heritage/history groups? There’s something out there for everyone)

my son joined the gym and on the days he goes he is definitely a bit better

It sounds like his feelings have become his obsessive special interest. Do you think it might be possible to cultivate a different interest?

I'm so sorry my headspace has been so messed up this week that I forgot I'd made this post. I'm incredibly grateful for the responses, they are so useful and relatable.
As a bit of extra information, he is now transitioning to Sertraline, which I have high hopes for as that seems to be the main medication that people report makes a difference.
He is very strict, based on previous advice, about taking long daily walks. He runs on occasion and that noticably lifts his mood. He enjoy listening and playing music. He is a gym member but aeems to be losing enthusiasm for going unfortunately.
I've not heard of DBT but that is something I will definitely explore and it sounds very hopeful.
@GooseyGandalf you might be onto something there, obsessive special interests have always been a thing.

Does he like animals? The right rescue dog could be absolutely transformative.

You sound like a lovely caring mum. I really hope the sertraline helps.

There are so many families struggling with this. We should start a support group

It does take us longer to work our way out of depression. We ruminate about everything and when something doesn’t make sense we go in circles trying to find a way to make it make sense. This is why we often talk over and over about the same traumas, triggers, feelings etc.

when I was younger the only thing that helped me get rid of the depression (and it was really bad with harming and suicidal ideations) was to change my life completely and live it the way I wanted not necessarily how society wanted me to. I was 7years out of my teens then so it’s not as easy to do when still living at home… but I do believe drastic changes can help (alongside all the conventional treatments). What I will say is autistic people can respond more sensitively to things like anti depressants and normal clinical doses can be too much for some people. There have been studies on subclinical
dosing but it’s still quite a new field. I was left unable to feel anything and ADs and even now I’d rather feel sadness than nothing. That prolonged my misery.

It’s complex and I totally sympathise with you both.

I think this is where our modern life of endless support and chats actually makes things worse. I actually think if we woke up tomorrow in a nuclear apocalypse (yes it would be horrific BUT) it would be amazing how how many depressed people would rise from their beds and fight to stay alive, because necessity is a great motivator which is hugely lacking now.