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Suicide and suicidal thoughts
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/suicide/DS01062
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Definition
Suicide is a tragic reaction to stressful life situations — and all the more tragic because suicide can be prevented. Whether you're considering suicide or know someone who feels suicidal, learn suicide warning signs and how to reach out for immediate help and professional treatment. You may save a life — your own or someone else's.
It may seem like there's no way to solve your problems and that suicide is the only way to end the pain. But you can take steps to help you stay safe — and start enjoying your life again.
Symptoms
Suicide warning signs or suicidal thoughts include:
- Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I was dead" or "I wish I hadn't been born"
- Getting the means to commit suicide, such as getting a gun or stockpiling pills
- Withdrawing from social contact and wanting to be left alone
- Having mood swings, such as being emotionally high one day and deeply discouraged the next
- Being preoccupied with death, dying or violence
- Feeling trapped or hopeless about a situation
- Increased use of alcohol or drugs
- Changing normal routine, including eating or sleeping patterns
- Doing risky or self-destructive things, such as using drugs or driving recklessly
- Giving away belongings or getting affairs in order
- Saying goodbye to people as if they won't be seen again
- Developing personality changes, such as becoming very outgoing after being shy
Warning signs aren't always obvious, though, and they vary from person to person. Some people make their intentions clear, while others keep suicidal thoughts and feelings secret.
When to see a doctor
If you think you may hurt yourself or attempt suicide, get help right now:
- Call 911 or your local emergency number immediately.
- Call a suicide hot line number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach to a trained counselor.
If you're feeling suicidal but you aren't immediately thinking of hurting yourself:
- Reach out to a close friend or loved one — even though you may be reluctant to talk about your feelings.
- Seek help from your doctor, a mental health provider or other health care professional.
- Contact a minister, spiritual leader or someone in your faith community.
- Call a suicide crisis center hot line.
- Make an appointment with your primary care doctor or other health care provider or mental health provider.
It's perfectly normal to occasionally feel sad, upset or unhappy with situations in your life. But if these feelings linger or leave you thinking about killing or harming yourself, seek medical help as soon as possible. Suicidal thinking usually doesn't get better on its own — so get help.
Causes
Suicidal thoughts have numerous causes. Most often, suicidal thoughts are the result of feeling like you can't cope when you're faced with what seems to be an overwhelming life situation. These situations could include financial problems, the death of a loved one, a relationship breakup or a debilitating illness. If you don't have hope for the future, you may mistakenly think suicide is a solution. You may experience a sort of tunnel vision, where in the middle of a crisis you believe suicide is the only way out.
There may also be a genetic link to suicide. People who complete suicide or who have suicidal thoughts or behavior are more likely to have a family history of suicide. While more research is needed to fully understand a possible genetic component, it's thought that there may be a genetic link to impulsive behavior that could lead to suicide.
Risk factors
Suicide risk factors include:
- Having a prior suicide attempt
- Having an underlying psychiatric disorder, such as depression or post-traumatic stress disorder
- Being intoxicated — a large percentage of suicides are committed under the influence of alcohol or drugs
- Having a substance abuse problem
- Behaving recklessly or impulsively
- Feeling hopeless
- Having a family history of mental disorders or substance abuse
- Having a family history of suicide or violence, including physical or sexual abuse
- Recently undergoing a stressful life event, such as the loss of a loved one or a breakup
- Having firearms in your home
- Having a significant medical illness, such as cancer or chronic pain
- Feeling socially isolated or lonely
- Having legal problems
- Having trouble in school, social problems or disciplinary problems if you are a child or young adult
- Being male — men are more likely than women to complete suicide because they typically use more lethal means, such as a firearm
- Being homosexual with an unsupportive family or in a hostile environment
- Being a man age 65 or older
Murder and suicide
In some cases, people who are suicidal are at risk of killing others and then themselves. This is known as a homicide suicide or murder suicide. The types of feelings that trigger this tragic behavior can stem from a number of sources. Some common risk factors for murder suicide include:
- A history of conflict with a spouse or romantic partner
- Current family legal problems
- A history of mental health problems, particularly depression
- Alcohol or drug abuse or addiction
- Having access to a firearm — nearly all murder suicides are committed using a gun
Starting antidepressants and increased suicide risk
Some studies have shown a possible link between starting treatment with an antidepressant and an increased risk of suicide. The Food and Drug Administration (FDA) requires manufacturers of all antidepressants to include a warning stating that antidepressants may increase suicide risk in young people during the first two months of treatment.
However, the link between antidepressants and suicidal thinking isn't clear — and not taking an antidepressant when it's needed also increases the risk of suicide. To be safe, anyone who starts taking an antidepressant should be watched closely for signs of suicidal thinking. If you — or someone you know — has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.
Complications
Suicide and suicidal thoughts have many potential complications. The most obvious and tragic, of course, is death.
But suicide and attempted suicide exact a toll in other ways, too — both for those who want to take their own life and for their loved ones. You may be so consumed by suicidal thoughts that you can't function in your daily life, for instance. And while many suicide attempts are impulsive acts during a moment of crisis, they can leave you with permanent serious or debilitating injuries, such as organ failure or brain damage.
For those left behind after a suicide — people known as survivors of suicide — grief, anger, depression and guilt are common.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist. If you're in danger of committing suicide, your doctor may have you get emergency help at the hospital.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Take these steps before your appointment:
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. Some basic questions to ask your doctor include:
- Are my suicidal thoughts most likely linked to an underlying mental or physical health problem?
- Other than the most likely cause, what are other possible causes?
- Will I need any tests for possible underlying conditions?
- Do I need immediate treatment of some kind? What will that involve?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other mental or physical health problems. How can I best manage them together?
- Is there anything special I should do to stay safe and feel better?
- Should I see a psychiatrist? What will that cost, and will my insurance cover it?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin having suicidal thoughts?
- Have your suicidal thoughts been continuous or occasional?
- Have you ever tried to commit suicide?
- Do you have a plan to kill yourself now?
- If you have a plan, does it involve a specific method, place or time?
- Have you made any preparations, such as gathering pills, changing your will or writing suicide notes?
- Do you feel like you can control your impulses when you feel reckless or like killing or hurting yourself?
- Do you have friends or family members who you can talk to or go to for help?
- What are your feelings about the future? Do you have any hope that things will improve?
- Do you drink alcohol, and if so, how much and how often?
- What medications do you take?
- Do you use illegal drugs?
- What, if anything, seems to improve your suicidal thoughts?
- What, if anything, appears to worsen your suicidal thoughts?
What you can do in the meantime
If you've scheduled an appointment and can't see your doctor immediately, make sure you stay safe. Contact family members, friends or other people you trust to help you. If you feel you're in any danger of hurting yourself or attempting suicide, call 911 or get emergency help immediately.
Tests and diagnosis
Your doctor will do a physical exam. He or she will ask you a number of questions about your mental and physical health to help determine what may be causing your suicidal thinking and to determine the best treatment.
Mental health conditions
In most cases, suicidal thoughts are linked to an underlying mental health issue that can be treated. These can include:
- Depression
- Bipolar disorder
- Personality disorders
- Post-traumatic stress disorder
- Anxiety
- Detachment from reality (psychosis) or paranoia
- Drug or alcohol use disorders
If your doctor thinks you may have an undiagnosed mental health condition that could be causing suicidal thinking, you may need to answer further questions or fill out a psychological questionnaire. You may need to see a doctor who specializes in diagnosing and treating mental illness (psychiatrist) or other mental health provider.
Physical causes
In some cases, suicidal thinking may be linked to an underlying physical health problem. You may need blood tests or other tests to determine whether this is the case. Some conditions that can be linked to depression and suicidal thinking include:
- Thyroid disease
- Inflammatory bowel disease
- Lupus (systemic lupus erythematosus)
- Wilson's disease
Alcohol and drugs
Your doctor will want to know whether you have any problems with alcohol or drug use - such as bingeing or being unable to cut back or quit using alcohol on your own. For many people, alcohol or drugs play a role in suicidal thinking and completed suicide.
Although drinking or using drugs may seem to help because it numbs emotional pain, it's likely to worsen depression and suicidal thinking. Substance abuse also makes you more likely to act on impulsive thoughts of suicide or behave recklessly. Many people who feel suicidal need treatment to help them stop using alcohol or drugs for their suicidal feelings to improve.
In some people, certain prescription or over-the-counter drugs can cause suicidal feelings. Your doctor will want to know about any medications you take to see whether they could be linked to your suicidal thinking.
Children and adolescents
Children who are feeling suicidal generally need to see a psychiatrist experienced in diagnosing and treating children with mental health problems.
With children and adolescents, the doctor will want to get all the information possible to determine what may be causing the problem and whether the child or adolescent is at risk of suicide.
The doctor will want to get information from as many sources as possible to get an accurate picture of what's going on. Sources can include the young person, parents or guardians, other people close to the child, school reports, and previous medical or psychiatric evaluations.
Suicide in children or adolescents often follows stressful life events. However, keep in mind that what a young person sees as serious and insurmountable may seem minor to an adult — such as problems in school or the loss of a friendship. In some cases, a child or adolescent may feel suicidal due to certain life circumstances he or she may not want to talk about. Some of these include:
- A history of physical or sexual abuse
- Problems with alcohol or drugs
- Becoming pregnant
- Having a sexually transmitted disease
- Being the victim of bullying
- Being homosexual
Physical examinations, tests and in-depth questioning may be needed to help determine an underlying cause.
Treatments and drugs
Treatment of suicidal thoughts and behavior depends on your specific situation, including your level of suicide risk and what underlying problems may be causing your suicidal thoughts or behavior.
Emergency situations
If you've made a suicide attempt, you need to go immediately to the emergency room. It's safest to call for an ambulance rather than go with someone else.
At the emergency room, you may need medical treatment for whatever injuries you may have caused yourself. You'll need to have someone with you at all times until it's clearly established that the immediate danger of suicide has passed. The hospital staff will make sure you don't have access to any means of harming yourself by removing any potentially dangerous items from your possession.
The doctor will ask you a number of questions and may want to examine you for any sign of injury, including recent or past signs of suicide attempts. Depending on your state of mind, you may need medications to calm you or to ease symptoms of an underlying mental illness such as depression.
After an initial exam and treatment, your doctor may decide it's safe for you to leave the hospital. However, you may need to stay at the hospital for a while if:
- You've made a suicide attempt
- You seem to be in immediate danger of harming yourself or committing suicide
- You have uncontrolled symptoms of an underlying mental illness that might put you in danger
- You're detached from reality (psychotic)
- You're intoxicated
- You have a history of drug or alcohol abuse
- You don't have supportive family or friends who can make sure you're safe and that you're getting the help you need
- You're acting impulsively or recklessly
Your doctor may want you to stay in the hospital long enough to make sure any treatments are working, that you'll be safe when you leave and that you'll get the follow-up treatment you need.
Nonemergency situations
If you have suicidal thoughts but aren't in a crisis situation, you may need outpatient treatment. This treatment may include:
- Psychotherapy. In psychotherapy, also called counseling or talk therapy, you explore the issues that make you feel suicidal. You and your therapist can work together to develop treatment plans and goals. If you were already in therapy, you and your mental health provider may meet more frequently until your thoughts of suicide are better managed.
- Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help you feel less suicidal.
- Addiction treatment. Alcohol and substance abuse can worsen thoughts of suicide and make you feel impulsive enough to act on your thoughts. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings.
- Family support and education. Your loved ones can be both a source of support and conflict. Involving them in treatment can help them understand what you're going through, give them better coping skills, and improve family communication and relationships.
Helping a loved one with suicidal thoughts
If you have a loved one who has harmed himself or herself, or if you think he or she may be in danger of doing so, get emergency help. If you have a loved one you think may be considering suicide, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.
Lifestyle and home remedies
There's no substitute for professional help when it comes to treating suicidal thinking and preventing suicide. However, there are a few things that may reduce suicide risk. One is having a strong support network — such as family, friends or members of your church. Religious practice has also been shown to help reduce the risk of suicide.
Coping and support
Don't try to manage suicidal thoughts or behavior entirely on your own. You need professional help and support to overcome the problems linked to suicidal thinking. However, be an active participant in your care. Along with getting the professional help you need, follow these self-care steps:
- Go to your appointments. Don't skip therapy sessions or doctor's appointments. Go to your appointments even if you don't want to or don't feel like you need to.
- Take medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, your suicidal feelings may come back. You could also experience withdrawal-like symptoms from abruptly stopping an antidepressant or other medication.
- Learn about your condition. Learning about your condition can empower you and motivate you to stick to your treatment plan. If you have depression, for instance, learn about its causes and treatments.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your suicidal feelings. Make a plan so you know what to do if suicidal thoughts return. Contact your doctor or therapist if you notice any changes in how you feel. Consider involving family members or friends in watching for warning signs.
- Get active. Physical activity and exercise have been shown to reduce depression symptoms. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy.
- Avoid drugs and alcohol. Alcohol and illegal drugs can worsen suicidal thoughts. They can also make you feel less inhibited, which means you're more likely to act on your thoughts.
- Seek help from a support group. A number of organizations are available to help you cope with suicidal thinking and recognize that there are many options in your life other than suicide. Such organizations include the National Suicide Prevention Lifeline, Befrienders Worldwide and the National Hopeline Network.
Prevention
There are a number of steps you need to take to keep yourself from feeling suicidal:
- Eliminate potential means of committing suicide. If you think you might act on suicidal thoughts, immediately get rid of any potential means of committing suicide, such as firearms, knives or dangerous medications. If you take medications that have a potential for overdose, have a family member or friend give you your medications as prescribed.
- Get the treatment you need. If you don't treat the underlying cause, your suicidal thoughts are likely to return. You may feel embarrassed to seek treatment for your mental health problems, but getting the right treatment for depression, substance abuse or another underlying problem will make you feel better about life — and help keep you safe.
- Follow your treatment plan. Go to follow-up appointments, take medications exactly as directed, and take the other steps your doctor or mental health provider recommends.
- Establish your support network. It may be hard to talk about suicidal feelings, and your friends and family may not fully understand why you feel the way you do. Reach out anyway, and make sure the people who care about you know what's going on and are there when you need them. You may also want to get help from your church, support groups or other community resources.
- Know your warning signs. Learn to spot the danger signs early, and decide what steps to take ahead of time. It may help to write out what steps you will take if you start feeling suicidal. You may want to make a written agreement with a mental health provider or a loved one. A written plan or contract can help you take the right steps when you don't have the best judgment.
- Remember, suicidal feelings are temporary. If you feel hopeless or that life's not worth living anymore, remember that the feelings will pass. Take one step at a time and don't act impulsively. Work to regain your perspective — and life will get better.
- Schreiber J, et al. Suicidal ideation and behavior in adults. http://www.uptodate.com/home/index.html. Accessed Feb. 9, 2010.
- Kennebeck S, et al. Evaluation and management of suicidal behavior in children and adolescents. http://www.uptodate.com/home/index.html. Accessed Feb. 9, 2010.
- Barbara Woodward Lips Patient Education Center. Understanding attempted suicide. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2005.
- Understanding suicide fact sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/pub-res/suicide_factsheet2008.pdf. Accessed Feb. 2, 2010.
- Logan J, et al. Characteristics of perpetrators in homicide-followed-by-suicide incidents: National Violent Death Reporting System - 17 US States, 2003-2005. American Journal of Epidemiology. 2008;169:9.
- The risk factors for suicide. American Association of Suicidology. http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-186.doc. Accessed Feb. 2, 2010.
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