Severe Depression and Delusions: A Call for Urgent Help

Please help me diagnose the symptoms, as it is a matter of life and death?

Hello, Dr.
Su.
My sister has been suffering from depression for over three years.
She has been receiving regular medical treatment and medication, and her condition is classified as severe depression.
The doctor has suggested hospitalization for psychiatric care, but she has not gone.
She visits the doctor once a week and continues to take medication.
She often expresses thoughts of wanting to die and has made comments about being prepared to die.

A notable aspect of her personality is her strong belief in Buddhism; she reads many Buddhist texts and frequently discusses concepts of heaven and hell.
She often cries in front of deities, primarily due to emotional distress from relationships that she feels are not taken seriously.
She believes she is the kindest person in the world, yet feels that others treat her poorly, thinking that people are inherently bad.
Her strong superstitions lead her to claim that she communicates with Guanyin (the Goddess of Mercy) and that the Bodhisattva will take her away.

She often says that she believes she was an ancient person in a past life.
Recently, she expressed a desire to visit the memorial temple of Liang Shanbo and Zhu Yingtai in mainland China, and she wants to see Liang Shanbo's grave.
She feels that in one of her past lives, she was Zhu Yingtai.
She even bought a qipao online, saying she is ready and hopes that people will remember her when she is gone.

I understand that this story may seem absurd, but it is genuinely happening to me.
I hope the doctor can help me determine whether my sister is suffering from depression, delusional disorder, or something else.
If it is not depression, we need to quickly change her outpatient treatment to address the correct issue.
Please, doctor, this could be a matter of life and death.
Thank you.

A Ying, 30~39 year old female. Ask Date: 2016/03/10

Dr. Su Zongwei reply Psychiatry

This is no longer just simple depression; please discuss the actual situation with his physician to ensure appropriate treatment.

Reply Date: 2016/03/10

More Info

I'm truly sorry to hear about your sister's struggles with severe depression and her concerning thoughts and behaviors. It sounds like she is going through an incredibly difficult time, and it's understandable that you are worried about her well-being. Based on the information you've provided, it appears that your sister is experiencing symptoms of severe depression, which may be compounded by delusional thoughts or beliefs.
Severe depression, also known as major depressive disorder (MDD), can manifest in various ways, including persistent feelings of sadness, hopelessness, and a lack of interest in activities that were once enjoyable. In your sister's case, her expressions of wanting to die and her preparation for it are particularly alarming and indicate a potential risk for self-harm or suicide. The fact that she has been expressing these thoughts regularly and has a history of severe depression suggests that she may need more intensive treatment than what she is currently receiving.

The delusional aspects of her thoughts, such as believing she has a special connection with a deity or that she was a historical figure, could indicate a more complex mental health issue. While these beliefs may stem from her deep spiritual convictions, they could also be symptomatic of a psychotic feature associated with her depression. This is not uncommon, as severe depression can sometimes lead to psychotic symptoms, including delusions and hallucinations.

Given the seriousness of her situation, it is crucial to take immediate action. Here are some steps you can consider:
1. Seek Immediate Help: If your sister is expressing suicidal thoughts or intentions, it is vital to seek immediate help. This could involve contacting a mental health crisis hotline, taking her to the emergency room, or contacting her psychiatrist or therapist for urgent intervention.

2. Consider Hospitalization: Given her severe symptoms and the risk of self-harm, hospitalization may be necessary. A psychiatric hospital can provide a safe environment where she can receive comprehensive care, including medication management and therapy. It is essential to communicate to her that this is for her safety and well-being.

3. Engage Her Healthcare Providers: If she has a psychiatrist or therapist, it is crucial to communicate your concerns to them. They can assess her current treatment plan and make necessary adjustments. If she is resistant to changing her treatment or seeking hospitalization, you may need to advocate for her and express the urgency of her situation.

4. Supportive Environment: While navigating this challenging time, it is essential to create a supportive environment for your sister. Encourage open communication and let her know that you are there for her. However, be cautious about engaging in discussions that may reinforce her delusional beliefs. Instead, focus on her feelings and experiences without validating the delusions.

5. Educate Yourself: Understanding more about depression and its potential complications can empower you to support your sister better. Resources from mental health organizations can provide valuable information about symptoms, treatment options, and how to approach conversations about mental health.

6. Take Care of Yourself: Supporting someone with severe mental health issues can be emotionally taxing. Ensure that you are also taking care of your mental health and seeking support for yourself, whether through friends, family, or professional counseling.

In conclusion, your sister's situation is serious, and it is crucial to act promptly. Encourage her to seek help, and if she is unwilling, you may need to take steps to ensure her safety. Remember, severe depression is treatable, and with the right support and intervention, there is hope for recovery.

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