My Brother: “is 21 and living with his family, he has never applied for a job, the family has moved to Germany about 6 years ago. He finished school two years ago” . He was never an outgoing person but he did have friends from his school days. Starting from last year he’s been undergoing ever more increasing depression. At first he was only feeling down sometimes, but now he doesn’t speak, even when directly spoken too. He doesn’t talk about his depression with anybody, actually he doesn’t talk with anybody at all nor does he leave the house at all. In the last few months he’s even developed a tick (he sometimes inhales very quickly and loudly as if he’s shocked). His lack of communication has made it impossible to get him professional help. He refuses any kind of professional care. My family and I are clueless on how to deal with this issue, how can we help someone who not only refuses professional help but also ignores almost all communication? (From Germany)

A:  The fact that you see your brother decompensating and that he has developed a tic may prompt the need for medical attention first. While he may not want to seek psychiatric help, your brother may be open to a physical exam. I think this might be the first step.

Your love and concern for your brother may be something that can help. Find a way to talk to him about the tic as something that should be checked out medically. You might even offer to go for your own check up at the same time with him. Support for him during this time might be very important.

In any case, a physician would be in a good position to make recommendations for a diagnosis, medication, or therapy.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral