Plan Ahead for a Crisis

What do you do when nothing works?  This is one of the biggest dilemmas in medicine.  In a group I was leading (on the hospital psych inpatient unit) the other day on leisure, a couple of patients said they had lost interest in everything, others said they just had no motivation to do anything.  These are typical feelings with depression.  A few months ago, a patient said she knew she could and should pick up the phone and call someone when she is thinking about suicide, but at that point, that was not what she wanted to do.
There are no foolproof answers to these situations. Motivation and interest can't be conjured up if they aren't there, and if someone really feels they are better off dead, why would they call someone to stop them?  Research has shown that usually a combination of medication and talk therapy works best to treat most depression.  When people get to the point of the patients described above, medication is the first line of attack. When they start to feel better, they can better make use of other options.  It takes alot of strength to pull out of real depression without medicine.
The groups I teach are a sort of talk therapy, but I don't see patients on an ongoing basis.  Each group I lead is separate, the patients choose to come or not, and only while they are inpatients on the psych units at our hospital.  With these constraints, I try to make each group have an impact on how the patients think about themselves and/or their illness.
One of the things I talk to my patients about is having a plan in place before a crisis.  Keep phone numbers handy  or on speed dial for close friends or relatives who are supportive, their doctor/therapist/counselor/case manager/sponsor, and the crisis and suicide hotlines.  When a person is depressed, thinking clearly can be very difficult.  Having a clear plan ready can save their life.
I talk to them about getting familiar with their symptoms so they can learn to catch things before they get to the crisis level.   Experiment with a variety of coping techniques to learn what is most helpful in different circumstances, and have the materials readily accessible.  We brainstorm coping techniques they have tried or heard about, including relaxation techniques, distraction, reframing, etc.
These ideas are helpful not only for depression, but for physical illness and pain, as well.  Think about yourself- What triggers a flare for you?  How do you know you are going downhill?  What has helped you in the past?  By planning ahead, you may be able to prevent a crisis, or at least minimize its impact.