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Suicidal Thoughts (cont.)

Treatments for Suicidal Thoughts or Behaviors

There are no treatments that specifically stop suicidal thoughts. However, for each individual, identifying and treating any mental illness, and dealing with any stressors can reduce the risk of suicide. Some treatments for mental illness, including major depression and bipolar disorder, have been shown to reduce suicide risk. Certain medications have been shown to reduce the risk of suicide. Lithium (Eskalith, Lithobid), a mood-stabilizing medication used for bipolar disorder or major depression, has been shown to decrease suicides associated with depression. Similarly, clozapine (Clozaril, FazaClo), an antipsychotic medication, can reduce the risk of suicide in people with schizophrenia. It is not clear if these medications reduce suicide risk when used to treat people with other diagnoses.

In contrast, there have been concerns that antidepressants actually increase the risk of suicidal thoughts. In fact, the U.S. Food and Drug Administration (FDA) has required a warning stating that antidepressants may increase the risk of suicidal thoughts in children, teens, and adults in their 20s. There was no evidence that these medicines increased suicidal behavior in older people. This warning was based on a review of studies that suggested this increase. Some researchers and clinicians disagree with this warning and feel that not prescribing antidepressants has actually increased suicidal thoughts and attempts, since fewer people are treated for depression. Ongoing studies will hopefully answer these questions more clearly. In the meantime, it is important that people taking antidepressants know about this risk and are given information about how to get help if they have suicidal thoughts.

People who frequently have suicidal thoughts may benefit from specific types of psychotherapy ("talk therapy" or counseling). Cognitive behavioral therapy (CBT) addresses negative thoughts and cognitive distortions. Cognitive distortions are ways that the mind reads things around us in an overly negative way (for example, if someone receives a critical comment from one person, they believe everyone thinks badly about them). By repeated practice, people can learn to overcome these thought patterns and reduce depression and suicide risk. CBT has been shown in many research studies to help improve symptoms of depression and anxiety disorders. Similarly, dialectical behavioral therapy (DBT), a type of therapy developed to help people with borderline personality disorder, also can reduce suicidality. DBT uses mindfulness and other coping skills to decrease impulsive and destructive urges that can lead to suicide attempts.

Helping Someone With Suicidal Thoughts

  • Take statements about suicide, wanting to die or disappear, or even not wanting to live, seriously -- even if they are made in a joking manner. Don't be afraid to talk to someone about suicidal thinking; talking about it does not lead to suicide. Discussing these thoughts is the first step in getting help, treatment, or safety planning.
  • Help them to get help. Encourage or even go with them to get help. Call a hotline, clinic, or mental-health clinic.
  • Remove risky items from their possession or home. It is particularly important to remove any firearms. The majority of suicide deaths used a gun, and most (90%) of suicide attempts with a gun are lethal. Other risky items may include razors, knives, and sharp objects. Prescription and over-the-counter medications should be secured.
  • Avoid alcohol or other drugs; these can increase impulsive actions and suicidal thoughts. Alcohol is a "depressant" because it can make depression worse on its own. Almost one-quarter of suicide victims had alcohol in their system at their deaths.
  • Practice methods to "slow down." If people can distract themselves, even for a short time, the worst suicidal thoughts may pass. This could involve anything from meditation, deep breathing, listening to music, going for a walk, or being with a pet. With a partner, friend, or family member, talking or even just being there may help.
  • If someone is still feeling suicidal, it may be helpful to stay with them or to help find others to stay nearby. This type of support or suicide watch can help keep someone safe until they can get help.
  • If these strategies are not working, get help now. Go to a mental-health center, an emergency room, or even call 911. Suicide hotlines may also be able to connect you to local help.
  • Remember, get help -- it can get better.

Preventing Suicides the Community

Suicide affects many people, young and old, in every country and culture of the world. Almost a million lives are lost every year to suicide, with at least 10 million other suicide attempts, and 5-10 million people affected by the suicide death of someone close to them. Suicide remains one of the most frequent causes of death around the world. The impact of suicide makes prevention an important public-health priority and has been identified as a priority by the World Health Organization (WHO), as well as national, state, and local agencies.

Some things to prevent suicide are best done on an individual level, like watching for signs of suicidal thoughts and talking to those you know. However, some changes can be implemented on the community, state, and even national level:

  • Restrict access to means for suicide. If highly lethal items such as pesticides, poisons, and firearms are less available, many deaths can be prevented.
  • Improve access to health care, including mental-health treatment.
  • Educate people about mental illness, substance abuse, and suicide.
  • Work to reduce physical and sexual abuse. Advocate for reducing discrimination based on race, culture, gender, or sexual orientation. Provide support to vulnerable individuals.
  • Fight stigma against mental illness and those suffering its effects.
  • Support those bereaved by suicide.

How to Cope With the Loss of a Loved One to Suicide

  • Find a support groups, such as a survivors of suicide (SOS) group. It helps to know you are not alone.
  • Grief is very different for everyone. Don't feel like you have to be on someone's schedule or timeline. It might take longer than you (or others) think it will.
  • Get help for yourself, particularly if you have symptoms of depression or suicidal thoughts.
Medically Reviewed by a Doctor on 11/18/2014
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