If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.
A woman in her late forties might be on her second or third prescription for depression and still feel as if she is walking through wet cement. She may wonder whether therapy is worth adding, or whether it is a luxury she does not have time for between work, her kids and her father's appointments.
For many people, medication and therapy are not either-or choices. They do different jobs, and together they can cover more ground.
What therapy can offer
A good therapist gives her a regular, protected hour to say what she cannot say anywhere else. Therapy can help her:
- Notice patterns of thinking that make dark days darker
- Work through grief, divorce or the loss of a career she built
- Set limits with the people who lean on her
- Make sense of how perimenopause, sleep and mood are tangled together
- Practice ways to get through the worst hours
- Build and update a safety plan for times when suicidal thoughts return
Therapy is not just talking. Many approaches are structured and practical, with skills to try between sessions. Some women go weekly at first and less often as things ease, and that rhythm is something to work out with the therapist.
Finding a therapist who fits
Fit matters. She can ask a therapist how they work with depression and suicidal thoughts, how often they would meet, and whether they coordinate with her prescribing doctor. Some women prefer a therapist who understands midlife pressures, caregiving or life after divorce. It is fine to meet with more than one before choosing.
In Missouri, as in most places, options can include private practices, community mental health centers, employer assistance programs and video sessions for women whose schedules make office visits hard.
How therapy fits with other treatments
Therapy can sit alongside medication and, for some adults, alongside a treatment such as Spravato. Spravato (esketamine) is a nasal spray the FDA has approved, taken along with an oral antidepressant, to treat depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior. It is also approved for treatment-resistant depression. It is not a crisis treatment: it does not replace emergency care or a hospital stay when one is needed, and it has not been shown to prevent suicide or to reduce suicidal thoughts or behavior. It is given only in a certified clinic under a safety program called the Spravato REMS. The patient takes it there under supervision, stays at least two hours to be monitored, and does not drive until the next day after a full night of sleep. It is never dispensed for home use. Whether it fits is a clinician's decision after an evaluation.
A therapist can be part of that team, helping her talk through what she notices and keeping the rest of her care connected.
When the thoughts turn toward suicide
If she has thoughts of suicide, telling her therapist plainly is one of the most important things she can do. Therapists are trained to hear this and to help. Family and friends can watch for warning signs too: talk of being a burden or trapped, withdrawing, big sleep changes, giving things away, or a sudden calm after a long low stretch.
If you see those signs, ask her directly whether she is thinking about suicide. Asking does not put the idea in her head. During a hard stretch, safe storage of medications and any firearms, or keeping them out of the house for a while, is a sensible step.
Small steps add up
Recovery from depression is often built from many small steps: a prescription adjusted, a therapy session kept, a walk taken, a friend called. People do get better, even after long and discouraging stretches. Adding therapy is one more way to give herself support that matches what she is carrying.
If she is curious about options beyond what she is doing now, many clinics that offer this treatment start with an introductory talk at no charge. She can ask how an evaluation works and whether it seems worth it, and she can bring a partner, a friend, or a list of questions from her therapist.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.