Suicide Prevention and Depressive Disorders

Suicide Prevention and Depressive Disorders

If you or someone you know suffers from depression or manic depression, you understand all too well its  symptoms may include feelings of hopelessness and thoughts of suicide. Whether we are experiencing suicidal thoughts ourselves or know a severely depressed person who is, there are ways that we can respond with strength and courage.  Suicide can be and often is prevented with the right kind of care, treatment and support.

This brochure provides information on the worst symptom of depressive disorders — : thoughts of ending one’s own life. It offers sound advice on what to do before and during suicidal episodes, emphasizing that professional help from a mental health professional and support from family and friends can offer stability and restore hope.  It was prepared by doctors and patients who have everyday experience with depressive disorders–doctors who, thanks to an impressive range of current treatments, help people lead hopeful and productive lives; patients who have endured suicidal symptoms and want to share their experience.

Understanding Suicidal Thinking

To understand why people with sever depression or bipolar disorder may want to end their own lives, the most important points to remember about depressive disorders are:

  • Depressive disorders are medical conditions associated with fluctuations in the chemistry of the body and brain.   Depression and the depressive phase of bipolar disorder may cause symptoms such as intense sadness, hopelessness, lethargy, loss of appetite, disruption of sleep, decreased ability to perform ones usual tasks, loss of interest in once-pleasurable activities and persistent thoughts of death or suicide.
  • Depressive disorders are not signs of personal weakness or character flaws, nor are they conditions that will just “go away” by themselves.
  • Clinical depression and bipolar disorder are treatable with medication, changes in lifestyle, and psychotherapy.   With proper treatment, there can be dramatic improvement of all symptoms, including suicidal thoughts.  Without treatment, these illnesses interfere with a person’s ability to relate with others and can often be life-threatening.

The act of suicide is very often a desperate, final, effort of control over the symptoms of depressive disorders.  What happens to people during severe depression, as the systems that regulate emotion become disturbed, is they selectively retrieve memories that are dark and sad.  Many physicians have found it helpful to point out to people with severe depression that this selective memory–only remembering the “bad times” or the disappointments in life–is a symptom of their illness, not who they are.

If You Are Feeling Suicidal

If you have begun to think of suicide, it is important to recognize these thoughts for what they are:  expressions of a treatable medical illness.  Don’t let embarrassment stand in the way of vital communication with your physician, family, and friends; take immediate action.

  • Tell you mental health professional.  Suicidal thoughts can be treated.  When these thoughts occur, they are your signal that, more than ever before, you need his or her professional care.
  • Tell a trusted family member, friend, or other support person.  When people don’t understand the facts about suicide and depressive disorders, they may respond in ways that can cut off communication and worsen the problem.  That’s why it is important to find someone you trust and can talk with honestly.  It’s also why your mental health professional can be an important resource in helping you and your family understand the facts about depressive disorders.

Treatment Will Help

Thinking of suicide isn’t just one symptom of depressive disorders; it is what you experience when you can no longer fight the other symptoms of depression.  Even when suicidal thinking occurs, treatment can help you manage your illness and gain control of your life again.

Some facts about treatment:

  • There are many different medications and therapies available for successful treatment.  The question is usually not if but when treatment will begin to work for your.  Stick with it, and recognize that your doctor is your partner in the battle to overcome symptoms.
  • Finding the right treatment may take time.  The right medication takes typically three to fur weeks to reduce symptoms and perhaps several weeks longer to achieve complete relief.
  • When depression is beginning to come under control, don’t despair if your symptoms reappear.   Brief temporary episodes of recurrence should not threaten your recovery if your keep in touch with your mental health professional.

Plan for Life

Most depression-related suicides occur during the first three depressive episodes before a person has learned that an episode of suicidal thinking is always temporary.  As people learn from experience that any given episode will eventually pass, the likelihood that they will actually act on suicidal impulses drops sharply.  It is important to have a course of action ready before thoughts of suicide occur.   So the only think you’ll need to focus on is following your Plan for Life.

Discuss your plan with your doctor and trusted family and friends so that if you need their help, they can respond quickly and effectively.  Listed below are some items you may find helpful to include in your Plan for Life.
More than 15% of people untreated or undertreated for depressive disorders kill themselves

  • Contact your doctor.   Have your mental health professional’s phone number with you and a back-up number such as a psychiatric emergency room or suicide crisis line.  Remember you can call if you reach a desperate state.
  • Educate those you trust about your condition before it becomes a crisis so they can be prepared if they are called upon to help.  Provide key support people with your Plan for Life so they can act quickly if you are in danger.
  • Recognize symptoms for what they are.  With your doctor, identify the symptoms you are likely to experience with your depression is at its worst.  Writing down your symptoms will help you keep perspective, especially in the event of a suicidal episode.  Always remember:  feelings are not facts!
  • Write down your thoughts.  Each day, write about your hopes for the future and the people you value in your life.  Read what you’ve written when you need to remind yourself why your own life is important.
  • Engage other people socially.  We are all emotionally attached to each other; it’s a primary human drive.  In depression, this drive is disturbed and weakened, but it is still there.  Visiting or allowing visits by family and friends who are caring and empathetic can help override the distorted vision that may occur during severe depression.
  • Avoid drugs and alcohol.  Most deaths by suicide result from sudden, uncontrolled impulses.   Since drugs and alcohol contribute to such impulses, it is essential to avoid them.   Drugs and alcohol also interfere with the effectiveness of medications prescribed for depressive disorders.
  • Recognize the earliest warning signs of a suicidal episode.  There are often subtle warning signs your body will give you when an episode is developing.  As you learn to manage your illness, you will learn how to be sensitive to them.  This is a signal to treat yourself with the utmost care, as opposed to becoming angry or disgusted with yourself.
  • Know how much hospitalization coverage your insurance company or HMO provides.  Keep a copy of your insurance card, policy number, and other relevant health care information accessible.

With courage and understanding, you can help those with depressive disorders confront and defeat the prospect of suicide.  When serious depression strikes someone close to us, it may be so disruptive to our own lives that we are taken off-guard by the threat of suicide, making us less able to provide the support and care we otherwise could.  If you are prepared and informed, you can help.

It is extremely important for people with depressive disorders to receive early, quality treatment from mental health professionals.  If you believe someone close to you is seriously depressed, you can help by emphasizing the importance of treatment and its effectiveness.

Talking About Suicide

Your ability to explore the feelings, thoughts, and reactions associated with depressive disorders can provide valuable perspective and reassurance to your friend or loved one.

Not everyone who thinks of suicide actually attempts it.  For many, it’s a passing thought that diminishes over time.  For a significant number of people, however, the hopelessness and exaggerated anxiety brought on by untreated or undertreated depression may create suicidal thoughts that they cannot easily manage on their own.   For this reason, take any mention of suicide seriously.
70% of people who die from suicide suffer from depression

If someone you know is very close to suicide, direct questions about how, when, and where he or she intends to commit suicide can provide valuable information that may help prevent the attempt.

It’s natural to fear that a question about suicide may anger or offend someone we care for — or even that it may plant the idea of suicide in his or her minds.  Always remember that you cannot make someone suicidal by asking a forthright, caring question.   On the contrary, if a person is suicidal they will usually welcome the chance to talk about their feelings.

Warning Signs

Even professionals have great difficulty determining how close a depressed person may be to attempting suicide.  As a friend or family member, you can’t know for certain.   You can help his or her doctor by looking for the indications that he or she may be contemplating suicide.

Depression plagues some people with powerful, extreme, and unreasonable feelings of hopelessness, despair, self-doubt, and “world weariness”–feelings people with depressive disorders often express to those closest to them.  The more extreme these feelings grow, and the more often they are described as “unendurable,” the more likely it is that the idea of suicide may enter the person’s mind.  As hopelessness and anxiety deepen, suicide seems like the only escape

  • You can also help a suicidal person by learning the warning signs of suicide and taking threats seriously.  For instance, when one is “winding up his or her affairs”  and making preparations for the family’s welfare after he or she is gone.
  • Rehearsing suicide, or seriously discussing specific suicide methods, are also indications of a commitment to follow through.  Even if the person’s suicidal intention seems to come and go, such preparation makes it that much easier for the individual to give way to a momentary impulse.  Friends and family should step in, asking direct questions about symptoms and pointing out behavior patterns that concern them.

A person with depression may be abusing drugs or alcohol.  These substances can trigger symptoms of depression or mania, decrease the effectiveness of medication, enhance impulsive behavior, and severely cloud judgment.  Although substance abuse is a serious risk factor for suicide, it is treatable and must be addressed along with depression in order for treatment to be successful.

  • A person with depression may be most likely to attempt suicide just when he or she seems to have passed an episode’s low point and be on the way to recovery.  Most experts believe there is an association between early recovery and increased likelihood of suicide.  As depression begins to lift, a person’s energy and planning capabilities may return before the suicidal thoughts disappear, enhancing the chances of an attempt.   Studies show that the period six to twelve months after hospitalization is when patients are most likely to consider or reconsider suicide.

What Can I Do to Help?

Among the many things you can do to help a depressed person who may be considering suicide, most involve simply talking and listening.  Though this may be difficult, here are some approaches that have worked for others:

  • Express empathy and concern.  Severe depression is usually accompanied by a self-absorbed, uncommunicative, withdrawn state of mind.  When you try to help, you may be met by an individual’s reluctance to discuss what he or she is thinking.  At such times, it is important to acknowledge the reality of the pain and hopelessness  he or she is feeling.  If the individual is not comfortable talking with you, encourage him or here to talk with someone else.
  • Describe specific behaviors and events that trouble you.  If you can note particular ways in which his or here behavior has changed, this may help to get communication started.
  • Try to help him or her overcome feelings of guilt.  Compounding the lack of interest  in communication may be guilt or shame over having suicidal thoughts.  If there has already been a suicide attempt.  guilt over both the attempt and its failure can make the problem still worse.  It is important to reassure the individual that there is nothing shameful about what they are thinking and feeling.  Keep stressing that thoughts of hopelessness, guilt, and even suicide are all symptoms of a treatable medical condition
  • Work with professionals and others.  You may come to believe that suicidal ideas have indeed taken firm grip of the person’s mind.  Sometimes, this is not easy to determine.  In either case, do not promise confidentiality if you believe someone is imminently close to suicide.  The best thing to do is to find help.  When a life is at stake–and in severe depression is often is–there should be no secrets between an individual’s family and his or her doctor.
  • Stress that the person’s life is important to you and to others.  Many people find it awkward to put into words how another person’s life is important for their own well-being.   Emphasize in specific terms the ways in which the person’s suicide would be devastating to you and others.  You may encounter negative reactions from the individual who believes that his or her condition is hopeless and will never get better.   Listen as attentively as you can and emphasize the success rate and effectiveness of today’s treatments for depressive disorders
  • During hospitalization, you can support a severely depressed person by talking with the individual’s doctor, making daily visits or calls, and resisting the urge to have the individual released before hospital treatment is complete.

Above all, remember that frank and honest discussion about suicide is the foundation upon which doctors, patients, friends, and family can build a treatment this devastating symptom of depression.

Difficult Situations

It takes courage to help a person with severe depression.  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 live separately from a person with severe depression or live far away, you can help by informing the person’s mental health professional of his or her suicidal thoughts.  People with severe depression–no matter how unreasonable or resistant to treatment they become —need help finding help.

Resist the urge to function as a therapist, which can ultimately create more feelings of rejection for the person, who doesn’t want to be “told what to do.”   Remain a supportive friend and encourage continued treatment.  Be proactive, take care of yourself, and don’t lose hope.

To Learn More

If your friend is already receiving treatment for a depressive disorder, he or she should have been educated by a mental health professional about the nature of the disorder, its symptoms, and its treatment.  If not, you can learn more about depressive disorders by contacting National DMDA at (800) 826-3632; to learn more about suicide prevention, contact the American Foundation for Suicide Prevention at (888) 333-2377 or www.afsp.org.

If Someone Is Threatening to Commit Suicide

If someone has indicated they are close to acting on a suicidal impulse, or if you strongly believe he or she is close to a suicidal act, these steps can help you manage the crisis

  • Take the person seriously. Stay calm, listen, but don’t under-react.
  • Involve other people.   Don’t try to handle the crisis alone or jeopardize your own health or safety.   Call 911 if necessary.  Contact the person’s mental health professional, a crisis intervention team, or others who are trained to help.
  • Express concern.   Give concrete examples of what leads you to believe the person is close to suicide.
  • Listen attentively.   Maintain eye contact.  Use body language such as moving close to the person or holding his or her hand, if appropriate.
  • Ask direct questions.   Find out if the person has a specific plan for suicide.  Determine, if you can, what method of suicide is being considered.
  • Acknowledge the person’s feelings.  Be empathetic, not judgmental.  Do not relieve the person of responsibility for his or her actions.
  • Offer reassurance.   Stress that suicide is a permanent solution to a temporary problem, reminding the person that there is help and things will get better.
  • Don’t promise confidentiality.  You may need to speak to the person’s doctor in order to protect the person from him or herself.  Don’t make promises that would endanger your loved one’s life.
  • If possible, don’t leave the person alone until you are sure they are in the hands of competent professionals.
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