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Suicide
Prevention and Mood Disorders: Understanding
Suicidal Thinking
Suicidal
thoughts are temporary. Suicide is permanent.
Don’t
give in to suicidal thoughts— you can overcome them.
If
depression or bipolar disorder (also known as manic depression) affects
you or someone you care about, you know that one symptom of these
illnesses may be feelings of hopelessness and thoughts of suicide. If
such thoughts occur, there are ways to respond with strength and
courage. Many suicides can be prevented with the right kind of care,
treatment, and support.
Here
are some facts to keep in mind:
-
Mood
disorders are not character flaws or signs of personal weakness, nor
are they conditions that will just “go away” if a person
“thinks positive.”
-
Mood
disorders are medical conditions caused by changes in the chemistry
of the body and brain. Depression and bipolar disorder may cause
symptoms such as intense sadness, hopelessness, low energy, loss of
appetite, changes in sleep patterns, inability to concentrate,
decreased ability to perform one’s usual tasks, loss of interest
in once-enjoyed activities and thoughts of death or suicide that can
be difficult to ignore or overcome.
-
Depression
and bipolar disorder are treatable with medication, psychotherapy,
support from others and changes in lifestyle. With the right
treatment, all symptoms can improve, including suicidal thoughts.
-
The
act of suicide is often a desperate attempt to control the symptoms
of a mood disorder. During a severe depression or mania, a person
has little or no control over painful and disturbing thoughts and
feelings. These are symptoms of the illness, not a part of a
person’s true self.
Some facts about treatment:
There
are many different medications and therapies available for successful
treatment.
Treatment can be effective in reducing and preventing mood disorder
symptoms.
Finding
the right treatment may take time. Different
people respond differently to medication and therapy. Medication usually
takes two to four weeks to reduce symptoms and may take several more
weeks to provide complete relief. Some people need to try more than one
medication or combination of medications before they find the one that
works best. Keep this in mind as you work with your doctor to develop a
treatment plan and stick with it. Never stop taking your medication
without first discussing it with your doctor.
Don’t
get discouraged if your symptoms come back. Brief
re-occurring episodes of depression should not threaten your recovery if
you keep in touch with your health care professional, work to find the
right treatment plan, and follow that plan.
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If
You Are Feeling Suicidal
The
belief that there is no hope is not the truth. When you feel this way,
it’s your illness talking— your mind is lying to you. Remind
yourself that suicidal thoughts are not reality.
If
you are thinking of suicide, it is important to recognize these thoughts
for what they are: expressions of a treatable medical illness. They are
not true and they are not your fault. Don’t let fear, shame or
embarrassment stand in the way of communication with your physician,
therapist, family, or friends; tell someone right away.
Tell
a trusted family member, friend, or other support person, someone you can talk with honestly. Try not to be alone when you feel
this way. This may mean sitting quietly with a family member or friend,
going to a support group or going to a hospital.
Get
help. Tell your health care professional. Suicidal
thinking can be treated. When suicidal thoughts occur, they are your
signal that, more than ever, you need help from a professional.
Know
that you can get through this. Promise
yourself you will hold on for another day, hour, minute, or whatever you
can manage.
Suicide
Prevention
It’s
very helpful to have a plan of action ready before thoughts of suicide
re-occur.
Stay
in contact with your doctor. Always
have your doctor’s phone number with you—an office number as well as
a pager or after-hours number—and a back-up number such as an
emergency room or suicide crisis line like 1-800-273-TALK.
Stay
in contact with trusted friends. Develop
a list with phone numbers of dependable family members and friends who
can give you support during a crisis. Keep the list with you.
Make
a Plan for Life (example
at end of page) and promise yourself that you will follow it when you
start to have suicidal thoughts.
Give
a copy of your plan (including your list of phone numbers) to family and
friends before it’s needed, so
they can be prepared to act quickly if needed.
Recognize
symptoms for what they are. With
your doctor, therapist (counselor) or trusted friends, identify the
symptoms you are likely to experience when your illness is at its worst.
Always remember: feelings are not facts. Suicidal feelings are not your
fault; they are a symptom of your illness. They may not seem temporary,
but they are. As you learn to manage your illness, you will be able to
spot your warning signs sooner and get help earlier.
Write
down your thoughts. Spend a
little time each day writing down your thoughts about the things and
people you appreciate and value in your life, and your hopes for the
future. Read what you’ve written when you need to remind yourself why
your own life is important.
Connect
with other people socially. When
you are feeling suicidal, don’t stay alone. Walk around a mall, or go
to a library or go to a park – get around people who are active and
busy. Visit family and friends who are caring and understanding, even if
it’s difficult. Attend support group meetings where you can meet
others who understand what it’s like to live with a mood disorder.
Avoid
drugs and alcohol. Many
suicides result from sudden, uncontrolled impulses. Since drugs and
alcohol can make you more impulsive, it is important to avoid them.
Drugs and alcohol can also make your treatment less effective.
Know
when it’s best to go to the hospital. There
may be times when your illness becomes so severe that hospitalization is
the best way to protect your health and safety. Discuss this possibility
and your options with your doctor before the need arises.
Understand
your health coverage. Know
whether your insurance, HMO, Medicaid or Medicare plan provides
psychiatric hospitalization coverage, and how much. Keep copies of
policy numbers and important health care information in an easy-to-find
place. If you don’t have insurance coverage, find out what other
options you have, such as community or state-run facilities.
Keep
yourself safe. Make
sure you do not have access to weapons or anything you could use to hurt
yourself. Have someone hold on to your car keys when you are feeling
suicidal. Throw away all medications you are no longer taking.
Give
yourself time to get better. When
you are first treated, or when you have recently had a severe depressive
or manic episode, give your brain and body time to heal. Allow yourself
to take life a little more slowly, and don’t get discouraged if you
aren’t up to your previous activity and lifestyle levels right away.
With continued treatment, you can feel better.
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If
You are Worried that Someone is Considering Suicide
You
cannot make someone suicidal by asking straightforward, caring
questions.
With
courage and understanding, you can help a friend or family member
overcome thoughts of suicide. If you are prepared and informed, you will
be better able to help.
It
is extremely important for people with mood disorders to receive early,
quality treatment from health care professionals. If you believe someone
close to you has serious depression, help that person find and stick
with effective treatment. Be supportive, reassuring and willing to talk
about suicidal feelings and thoughts.
Take
any mention of death or suicide seriously. If
someone you know talks about suicide, asking direct questions about how,
when, and where he or she intends to end his or her life may help
prevent the attempt.
It’s
natural to fear that a question about suicide may anger or offend
someone you care for—or even that it may put the idea of suicide into
a person’s mind. However, you cannot make someone suicidal by
asking straightforward, caring questions. A person considering
suicide may welcome the chance to talk about these feelings.
Warning
Signs that Someone may be Considering Suicide
Take
any mention of death or suicide seriously.
Unbearable
feelings: Depression
causes some people to have powerful, extreme feelings of hopelessness,
despair and self-doubt. The more intense these feelings become, and the
more often they are described as “unbearable,” the more likely it is
that the idea of suicide may enter the person’s mind.
Taking
care of business, making
final plans, preparing wills or life insurance or arranging for the
family’s welfare is another warning sign. The person may give away
valued possessions or make reference to what others will do “after
I’m gone.”
Rehearsing
suicide, seriously
discussing one or more specific suicide methods, purchasing weapons and
collecting large quantities of medication are all signs. Even if the
person’s suicidal thoughts seem to come and go, it is important to
step in early and help.
Drug
or alcohol abuse is
often a separate, treatable condition that must be addressed along with
the mood disorder in order for treatment to be successful. Intoxication
may cause impulsive behavior and make a person more likely to act on
suicidal thoughts.
Isolation: If a
person seems determined to cut off friendships and social connections,
there is a chance that the person might be experiencing serious
depression and/or preparing for suicide.
Sudden
sense of calm: A
person with a mood disorder may be most likely to attempt suicide just
when he or she seems to have passed an episode’s lowest point and be
on the way to recovery. If a person who was recently feeling upset or
hopeless suddenly seems very calm and settled, it may be a sign that he
or she has decided on a plan.
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Who
Might Be At Risk
Anyone
might have suicidal thoughts at any time, but there are certain groups
of people who
may be at higher risk.
Older
adults are
at a higher risk because of the many stresses they may be facing, such
as loss of loved ones, lifestyle changes, moving to assisted living
facilities, loss of physical independence, or other illnesses. Sometimes
other illnesses or medications can cause or mimic symptoms of
depression, so it’s important for older adults to have complete
physical examinations if they seem to have depression or suicidal
thoughts. Watch for signs such as preoccupation with death, increased
visits or calls, hopeless statements, or refusal to follow doctors’
orders for medication or diet.
Young
people may
be at a higher risk because of family and school pressures, major life
changes and hormonal changes. Watch for signs like deliberate self-harm
(such as cutting), reckless behavior, frequent “accidents,” talking
or joking about death, aggression, rage, impulsive behavior, running
away from home, perfectionistic behavior, and other problems such as
eating disorders or alcohol/substance abuse.
People
who have recently had a major loss or life change: It
is normal to experience grief after a loss or need time to adjust to a
major change, but if a person’s mood remains constantly down for
several weeks and the person shows other symptoms of depression, there
may be a more serious problem. Watch for major changes in attitude,
changes in eating or sleeping habits, loss of energy, loss of interest
in things once enjoyed, and statements about feeling worthless or
wanting to escape.
People
who are recovering from an episode of depression or have attempted
suicide before: If
the person has attempted suicide before and seems to be showing signs of
depression, falling back into old habits such as isolation, or refusing
to take medication or follow a treatment plan, the person may be at
risk. Studies have shown that people who have been hospitalized for
depression are most likely to consider or reconsider suicide six to 12
months after hospitalization. No matter who the person is or what the
signs may be, if you are worried about someone, talk to that person, or
his or her family or doctor as soon as you can.
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What
You Can Do to Help
Don’t
promise confidentiality. Support your loved one in getting professional
help.
Express
understanding and concern. Severe
depression usually causes a self-absorbed, uncommunicative, withdrawn
state of mind. When you try to help, the person may be unwilling to
talk. At such times it is important to let the person know you
understand the reality and severity of the painful and hopeless
feelings. If the person is not comfortable talking with you, encourage
him or her to talk with someone else.
Describe
specific behaviors and events that worry you. Don’t
be afraid to point out particular ways the person’s behavior has
changed, or things that lead you to think he or she may be considering
suicide.
Try
to help him or her overcome feelings of guilt. Your
friend or family member may be unwilling to communicate because of guilt
or shame over the depression and suicidal thoughts. Remind the person
that he or she is not alone, and that guilt is also a treatable symptom
of the illness.
Stress
that the person’s life is important to you and to others. Remind
the person in specific terms why his or her life is important to you and
makes your own life better.
Don’t
take responsibility for making the person well. Be
supportive and encouraging as you help the person find professional
treatment and stick with it.
During
hospitalization, you
can support someone by making regular visits or calls, and offering to
take care of the person’s errands, home, children or pets.
Support
the person as
he or she recovers and help him or her stick to a treatment plan, make a
Plan for Life, and connect with a support group.
If
Someone is Threatening to Take his or her Life
Remind
the person there is help and hope. Don’t try to handle the crisis
alone.
Take
the person seriously. Stay
calm and let the person know you are willing to listen.
Involve
other people. Don’t
try to handle the crisis alone or put yourself in danger. Get help from
a suicide hotline, or call 911 if necessary. Contact the person’s
family, psychiatrist, therapist or others who are trained to help.
Express
concern. Ask
direct questions and listen. Try to find out if the person has a
specific plan for suicide and what it is.
Be
understanding, not judgmental. Remind
the person that suicide is a permanent solution to a temporary problem,
and that there is help and hope.
Never
promise confidentiality. You
may need to speak to the person’s doctor in order to protect the
person. Secrecy can endanger your loved one’s life.
If
possible, don’t leave the person alone until
you are sure he or she is in the care of professionals.
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Difficult
Situations
It
takes courage to help a person who is considering suicide. If the person
is also abusing drugs or alcohol or is verbally or physically abusive,
helping may seem impossible. You may have correctly decided that you
cannot tolerate this behavior and want to keep your distance. However,
even if you keep your distance or live far away, you can still help by
informing the person’s doctor or another friend or family member who
lives nearby, of the person’s suicidal thoughts. People with severe
depression--no matter how unreasonable or angry they become-- need help
finding help.
When
you are helping someone else, it is also important to take care of
yourself. You may be feeling many difficult emotions as you support
someone close to you who is considering suicide. Be honest with yourself
about your own feelings, and be sure to let yourself feel them. Don’t
be afraid to ask for help. Even if you are not severely depressed,
therapy and support from your family and friends can help.
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If
You Have Lost Someone to Suicide
Give
yourself time to grieve. You
may have overwhelming feelings of anger, guilt, confusion, sadness and
forgetfulness, as well as physical aches and pains or trouble eating or
sleeping. Allow yourself to feel these things and know that they are
normal reactions. Try not to make any major changes in your life right
away.
Get
support. Talk
to other friends and family members about what you are feeling. Find a
support group for survivors. Don’t be afraid to seek professional help
to get you through this difficult time. You may even have suicidal
thoughts. If you do, get help right away.
Don’t
blame yourself. You
may have thoughts such as “What if I had done this?” or “Why
didn’t I say that?” A mood disorder is not the fault of the person
who has it, or of anyone else, and no one is the sole influence in
another person’s life. Know that this was not your fault. Allow
yourself to feel angry at the person or at yourself, but work to forgive
yourself and the person, too.
Reach
out to others. When
you are honest about how you feel and what you are going through, you
can help others who are having similar experiences.
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DBSA
Support Groups: An Important Step on the Road to Wellness
DBSA
support groups provide the kind of caring and help that is important to
lasting recovery. Members are people with depression or bipolar disorder
and their loved ones. Each group has a professional advisor and
appointed facilitators. People attending support groups say their
groups:
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Provide
a safe and welcoming forum for mutual acceptance, understanding and
self-discovery.
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Give
them the opportunity to reach out to others and benefit from the
experience of those who have “been there.”
-
Motivate
them to follow their treatment plans.
-
Help
them understand that mood disorders do not define who they are.
-
Help
them rediscover their strengths and humor.
Contact
DBSA to find a support group near you or learn more about starting one.
Take the next step toward wellness for yourself or someone you love.
There is help, and there is hope.
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Plan
for Life
I
Promise Myself: If
I start to think about suicide, I will contact these family members or
friends:
Name:
____________________________ Phone: ____________________________
Name:
____________________________ Phone: ____________________________
Name:
____________________________ Phone: ____________________________
I
Will Also
-
Call
my doctor or a suicide hotline, or go to a hospital if necessary
-
Remember
that suicidal thoughts are a treatable symptom of my illness
-
Remember
that my life is valuable and worthwhile, even if it doesn’t feel
that way right now
-
Stick
with my prescribed treatment plan
-
Remember
to take my medications
-
Remember
to see my counselor/therapist/psychiatrist
-
Remember
to call my doctor if I don’t feel safe or if I’m having problems
-
Get
in contact with other people who have a mood disorder
-
Stay
away from alcohol and illegal drugs
-
Have
someone take away my car keys and anything I could use to hurt
myself
-
Stay
aware of my moods, know my warning signs and get help early
-
Be
kind to myself
-
________________________________________________________________.
-
________________________________________________________________
-
________________________________________________________________
My
Contact Information
Name:
________________________________________________________________
Address:
______________________________________________________________
Phone
Number(s): ______________________________________________________
Diagnosis:
_____________________________________________________________
My
Doctors
Primary
Care Provider Name:_________________________________________________________________
Address:
______________________________________________________________
Phone:
_________________________________Pager: _________________________
Psychiatrist
Name:_________________________________________________________________
Address:
______________________________________________________________
Phone:
_________________________________Pager: _________________________
Therapist
Name:_________________________________________________________________
Address:
______________________________________________________________
Phone:
_________________________________Pager: _________________________
If
my doctors are not available, contact these health care professionals:
Name:
____________________________ Phone: ____________________________
Name:
____________________________ Phone: ____________________________
My
Local Suicide Hotline Phone:
____________________________________
National
Hopeline Network Phone:
1-800-784-2433 (1-800 SUICIDE)
My
Health Care Information
My
preferred hospital: _________________________________________________
Address:
______________________________________________________________
Phone:
_________________________ Emergency room phone: ________________
2nd
choice hospital: __________________________________________________
Address:
______________________________________________________________
Phone:
_________________________ Emergency room phone: ________________
Health
Insurance Company/HMO/Medicaid Provider (attach photocopy of ID card)
Name:
________________________________________________________________
Phone:
________________________________________________________________
Policy
number: _________________________________________________________
My
DBSA Support Group
Contact
name: _________________________________________________________
Phone:
_______________________________________________________________
Medications
I’m taking (for all illnesses):
1.
_________________________________ Dosage: __________________________
2.
_________________________________ Dosage: __________________________
3.
_________________________________ Dosage: __________________________
4.
_________________________________ Dosage: __________________________
5.
_________________________________ Dosage: __________________________
6.
_________________________________ Dosage: __________________________
7.
_________________________________ Dosage: __________________________
8.
_________________________________ Dosage: __________________________
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