Worried About Your Sister From Hundreds of Miles Away

Distance makes it harder to see when a sister in her forties is sinking. Here is how to read the signs over the phone and help from out of state.

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.

When a sister lives a few states away, you learn her life through phone calls, group texts and the occasional holiday. You know her voice well enough to hear when something is off. What is harder is knowing what to do about it from so far away.

Sisters in their late thirties to early fifties are often stretched thin. One may be caring for a parent in St. Louis while the other lives in another time zone. One may be going through a divorce, a layoff, or the sleepless months of perimenopause. Depression can slip in quietly, and sometimes it comes with thoughts of suicide.

Signs you can catch from far away

Calls get shorter, or she stops answering and texts back hours later with one word.
She sounds flat, or tired in a way that never seems to lift.
She mentions not sleeping, not eating or not leaving the house.
She talks about being a burden or says things like "what's the point."
Her kids or mutual friends mention that she does not seem like herself.

Trust your read. You have known her longer than almost anyone.

Ask her directly, even on the phone

Distance can make people more careful, but this is a time for plain words. Choose a call when she has a few minutes and some privacy, and tell her what you have noticed. Then ask: "Are you having thoughts of suicide?"

Asking does not put the idea in her head. It tells her she can be honest with you. If she says yes, stay on the line and ask if she is safe right now. If she is in immediate danger, call 911 and give them her address, or ask someone close by to go to her. If she is not in immediate danger, encourage her to call or text 988 while you are still on the phone, or offer to call together.

If she says no, believe her for now and keep calling. Tell her she can bring it up with you any time, day or night.

Build a local circle

You cannot be in her kitchen, but someone can. With her permission when possible, connect with people near her: her partner, a close friend, a neighbor, a grown child, someone from her church. Swap phone numbers. Agree on who checks in on which days.

A local person can also help with something you cannot do from a distance: making sure the household stores medications and any firearms securely during this hard stretch, as a general precaution.

Help with the practical load

Sometimes the most useful thing a faraway sister can do is take a task off the list. Find a therapist who takes her insurance. Help schedule a doctor's visit, if she agrees. Have groceries delivered. Take over a week of calls with your mother's care team so she can rest. If you can manage it, book a flight and simply show up for a few days.

A treatment option worth knowing about

If her doctor is weighing next steps for depression that includes suicidal thoughts, this is one option that may come up. 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.

Keep calling, even if the calls are short. Recovery from depression is real, and many women look back on a hard season and remember the sister who kept dialing.

If she is curious about that option, many clinics that offer it start with a free first conversation where she can ask whether an evaluation makes sense. She can bring someone with her, and if you cannot be there in person, she can ask whether you may join by phone.