- 1-800-272-8255 American Suicide Prevention Hotline
- 1-800-273-8255 American Veteran Crisis Line
- +81 (0) 6 4385 4343 Suicide Prevention Centre, Osaka
- 08357 90 90 90 The Samaritans, UK
- 13 11 13 Lifeline Australia
- IMAlive Online Crisis Network
- Canadian Association for Suicide Prevention
For any tropers who feel this way... You Are Not Alone
. There are numbers you can call. Please, talk to someone.
Despite what many works may lead you to believe
, suicide is a serious and extremely sensitive topic even with teenagers. Helping the suicidal is hard to do since many have little to no knowledge of psychology, and the warning signs are much more nuanced
than what the media portrays. The pervasive mishandling of the issue, especially by Hollywood, leads to many deaths that could have been prevented if the proper measures had been taken. However, this page is not the end-all guide to diagnosis: This will merely debunk the common misconceptions surrounding suicide, as well as shed light on the reasons for them.
It should be noted that Depression
is one of the leading reasons behind suicide, which is why this page will also discuss the symptoms of depression. If left untreated, a depressed person may consider suicide anyway if they believe that nobody cares enough to confront them about it.
Depression can be either situational or chronic, and is sometimes linked to family history. Cultural views of depression are naturally quite negative, but the specific kind of negativity varies: Western societies view it as a condition that requires support and professional aid, while Eastern societies (in particular Central Asia) either do not see it as serious, or they consider it a stigma and actively refuse
to deal with it. Japan in particular has the combination of stigmatizing depression while viewing suicide in a positive light, and as such has the ninth-highest suicide rate in the world.
But even in Western societies, the stigma around depression is such that sufferers will not
ask for help immediately; occasionally, they will even insist that they feel normal and refuse help if offered
. Constantly refusing help despite evidence that they need it is as much of a warning sign as asking for it: If someone suspects that their friend or loved one is feeling any sort of distress, they should keep offering help no matter how often the person refuses. It is extremely
important that family and friends remain as supportive as possible, because the person is already under considerable mental stress—giving up on them may reinforce or even cause feelings of worthlessness, and suicide may be more likely than if they'd never gotten help in the first place.
While it is impossible to pin down a single cause of depression, there are many diagnosable symptoms that almost entirely stem from widespread changes in brain activity. Sufferers become either agitated (in the clinical sense; experiencing constant irritation, stress, and anxiety) or lethargic (both mental and physical capabilities are severely diminished), but the common result is that neither are able to feel happy
, or even their former baselines of "normal." A correlation (note that the direction of causation is still debated) also seen between depression/suicide and over-general memory; the inability to pinpoint specific happy or depressed periods, leading to the understatement of the former and overstatement of the latter.
The brains of depression sufferers show significant decreases in serotonin, disturbance of normal sleeping patterns (most often insomnia, but oversleeping is not unheard of), and a decreased immune system. Drug prescriptions to remedy the imbalances generally have good results, but they themselves are not sufficient as a treatment plan; a balanced treatment of depression should involve therapy first, with medication second, and even without the physical recovery of a suicide attempt, getting over depression can take anywhere from months to several years.
Depression, however, is not the only mental illness that can lead to suicide, though it is the most common. The eating disorder anorexia nervosa is actually the most
likely to cause suicide of all mental disorders. Untreated or badly treated schizophrenia also has a higher rate than depression. Post-traumatic stress disorder and complicated grief also cause suicide, both directly and because depression is often co-morbid to both. Major depression, however, is the most common mental illness to cause suicide not due to depressed people being more suicidal than some who have other illnesses, but because it's a far more common mental illness with suicide as a possible outcome.
The first scientific study, and indeed the first sociological study
, was written by Émile Durckheim in 1896, studying suicide among different religions and social classes and finding, among other, suicide less common among Catholic, Jews, those with few education and civilians than soldiers, Scandinavians, singles and soldiers.
Note that these are sometimes exaggerations of real symptoms and often overlap with depression-sufferers.
Signs and Symptoms of Depression and/or Suicidal Thoughts
- Misconception: a suicidal person must have substantial reason to feel that way. Many people are only familiar with the extreme form of Driven to Suicide, where a single and severe emotional trauma makes the person's reason for killing themselves clear. While this can be the case, even a long string of disappointments or a series of moderate disappointments in a short enough time can become unbearable. In the case of a family history of depression, there really might be no situational reason to explain their depression; they just had bad luck with genetics.
- In the case of anorexia nervosa or a first episode of bipolar mania, there may be zero external reason appearing. Anorexics are often (though not always) driven perfectionists in all walks of life, and it is said perfectionism that leads to suicidality - the feeling that one is not good enough, while their life may seem absolutely charmed or perfect as a direct result of their devotion to perfectionism. Persons with bipolar mania, especially before diagnosis/treatment/recognition, often have lots of energy and drive and ambition and exaggerated belief in their own abilities - which can actually lead to their living a "larger than life" life and seeming on top of their world (and themselves feeling that way) - except that hallucinations or generally feeling invincible, or the mania switching to depression can lead to suicidal behavior.
- That said, going too far in the other direction and assuming that suicidality is only out of a known biological mental illness is also a huge misconception and mistake. It IS possible to be Driven to Suicide, especially in situations involving Abuse to the point where the abuse (especially emotional abuse) has entirely destroyed someone's self-concept or taken away their will to live. Do not immediately assume that a suicidal person's family or religious organization is somehow always "on their side" or "trying to save them from themselves" - these are two groups that can and sometimes do inflict such pervasive emotional abuse. Also, some people with no or only mild apparent previous mental illness can be Driven to Suicide by a sudden tragedy - sudden loss of a meaningful person such as a relative or spouse/lover to death and severe financial loss are two huge risk factors. note
- Misconception: All suicidality is a result of an episode of mental illness, suicidal people are all "crazy" or "psychotic.": This is one that is a case of Hollywood Psychology and generalization. While it is definitely true that psychosis is a frequent factor in suicide (note the high rate among untreated/badly treated schizophrenics, and mixed manic/depressed episodes in Bipolar 1 are close behind for it), many people attempt or even commit suicide simply because the pain of their life situation has exceeded their ability to cope with said pain, and many times this is a result of hyperrealistic pessimism or actual, real traumatizing events (including abuse, rape, the loss of loved ones, extreme financial loss and/or social ostracism), not loss of touch with reality. As said above, it is possible to be Driven to Suicide, and even the Seen-It-All Suicide out of sheer annoyance and boredom with life is possible. While there is some argument that clinical depression is a part of the inability to cope with pain, to fail to recognize and legitimize the suffering of victims who are in serious, legitimate pain for reasons outside their own mind often only makes the situation worse. This is especially true with those who are contemplating suicide for financial reasons, as mentioned above, because something as simple as keeping them from becoming homeless or providing them with a sufficiently paying job/unemployment assistance/food/needed medical care can itself end the feeling of hopelessness and save their lives.
- Misconception: Men are serious when they attempt suicide, but women are only doing it for attention or as a cry for help. Every single suicide due to depression is a cry for help. The truth is that, for a variety of reasons (media portrayal of attempts by each gender for one, differing ease of access to the violent methods is another), men tend to use more violent methods of suicide such as firearms or carbon monoxide poisoning - methods that are likely to be successful, while women tend to use drugs or knives - methods that are much less likely to be successful. Unfortunately, the belief that men are serious while women are only looking for attention can be found in some older professional handbooks, and has led many to think that a man who attempts suicide is worthy of assistance, while a woman who attempts suicide is just an over-emotional attention whore who needs to be ignored or belittled so she "doesn't learn from the attention to do it again". (It is true that women attempt suicide more often than men but men succeed more often, but it's not necessarily 100 women attempting suicide once to every 20 men who attempt suicide once: it's quite possibly 20 women attempting suicide five times each for every 20 men who attempt suicide once.)
- Misconception: calling police is always the solution. Calling authorities on someone or pressing a "suicide notify" button on a post is a last resort - which too many people take as the proper response. The only time one should call authorities is if there is a threat of harm to others involving the method of choice, or the person is actively violent toward anyone trying to help. If you have any sort of pre-existing friendship with the person threatening suicide (even being an acquaintance), it's generally better to try to talk to them and encourage them to talk to others, or to contact close friends of the person that can help. The reasons why calling police on a suicidal person can be Nice Job Breaking It, Hero are below:
- Police involvement, especially police involvement that ends badly or the threat of police, can shut off communication and encourage someone who needs, above all else, to talk and share and be open with their emotions to instead be so afraid of consequences from a law enforcement visit, that they close off communication and/or pretend happiness rather than openly communicating pain. You do not know if someone is being an Attention Whore or if they actually need to talk, and silencing helps no one.
- Not all police officers are understanding of suicide attempts and suicidality, especially among women and GLBTQIA people or with people they've had prior contacts with for suicide attempts. Having a cop come out and berate someone for being a drama queen or telling them they're better off dead will worsen the situation.
- Police involvement heavily raises the risk of violence. Someone unstable who is otherwise not violent may be mistaken for violent and killed or seriously injured by police feeling threatened. In one two-week period in 2013, there were at least four cases of police shooting dead suicidal people who posed little or no threat to the officers' lives (e.g. the "weapons" they had would have at most bruised or scratched an officer in proper gear if even that), and the trend shows no means of ending. This is because many police officers are trained to force compliance to their orders with violence and are not trained in nonviolent deescalation or in the proper ways to handle a psychological crisis or medical emergency, especially if the person who is ill or in crisis doesn't immediately obey them and respect their authority.
- Police will investigate/arrest for any "criminal activity" going on in many cases. This may include simply having a bag of marijuana around them or unpaid traffic warrants - so police involvement can leave someone with a lasting criminal record and its repercussions for the rest of their life. Worse, the police may even arrest someone for merely having the tool of their suicide attempt, if it is a gun or certain drugs.
- Regardless of the above: If someone is an immediate danger to themselves, calling 9-1-1 (or whatever your local emergency number is) is the proper course of action. Don't get the idea in your head that you can, without any training, "talk someone down" or restrain them to keep them from harming themselves if they're committed to the act. The general rule is: if they're talking about suicide, talk to them; If they're taking immediately lethal action, you need to notify emergency services ASAP.
- At the same time, with some attempts, it is possible to get a person to a hospital without involving the police. This can be accomplished by not mentioning suicide in the emergency services call if the person isn't an active threat (e.g. overdoses, cutting when the cutting implement is no longer in reach/usable) but by explaining that it is an accident/ medical problem (and not requesting no police be sent, as this raises suspicions) and only mentioning that it was a suicide attempt once at the hospital. Or, if the person isn't in danger of immediate death (e.g. they've overdosed but are still awake and breathing, they cut across their wrists and the wrists are bandaged) to call a private medical transport or to drive them to the hospital yourself.
- Misconception: People even experiencing thoughts of suicide (much less attempting it) are dangerously violent. This is one of the absolute worst misconceptions of suicidal people there is (and has led to their being killed or gravely injured "for officer safety" by police officers, see above) as well as causing even well-meaning friends and family to avoid them fearing they will be the next mass murderer or the like. While suicide is the ultimate act of violence toward oneself, most people who consider or even attempt it are not homicidal toward others and never will be. In fact, the majority of suicide attempts are conducted in privacy/isolation both because the person is often alone/isolated, and does not want to harm anyone else with the attempt; and some attempters pick less likely to be successful methods such as drugs or cutting for this very reason. If someone is expressing suicidal thoughts, don't treat them like they are dangerous or evil for doing so.
- As an addenda to this, pretty much the only time suicidal people are dangerous to anyone but themselves is if they express interest in murder-suicide as revenge/TakingYouWithMe/Suicide by Cop or the like and pursue such plans, if they choose a method that is guaranteed to hurt/kill others, or if they are armed with a weapon such as a gun or long knife/sword and interrupted mid-attempt with someone violently trying to take the weapon away.
- Misconception: There is nothing a person who is not a police officer, psychologist, or psychiatrist can do to prevent suicide. There are things a relatively untrained person (especially a friend or lover) can do before the point of "immediately lethal action" is reached if they are present. Those include making sure there are no firearms/sharp knives, razors, or other cutting implements/drugs or chemicals with a lethal overdose capacity/hanging methods accessible to the person (a quick look around the room should suffice at first), talking to and listening to the person as someone who cares about them, and providing distractions. As noted below, suicide is often an impulsive act, and if the impulse can be resisted, many such suicides can be prevented. Also, some people are far more willing to talk to and listen to a lover or friend than they are the police or a doctor, and there are ways of being there for someone and providing support for someone that aren't formal or the result of training but do help far more than professional help does. Finally, believing too much in this misconception leads people to isolate depressed or suicidal people in fear of them or their emotions, believing that they are only capable of being "handled" by professionals - which worsens depression and feelings of being removed from/dissociated from humanity.
- Removing access to firearms, especially, is very important. Guns are the most lethal and irreversible suicide method (shooting yourself in the head has less than a 10% chance of survival, and those who do survive are often left far more permanently physically damaged for the rest of their lives than people who overdose or cut) and many studies have shown their mere presence increases contemplation of suicide.
- Also, even if someone doesn't appear to be immediately suicidal, if they appear to be very drunk, very high on stimulants, in a manic swing, compromised or have been going through major life changes, removing firearms, lethal dose amounts of substances, and hanging/jumping methods is a very good idea to prevent accidental suicide. As is making damn sure they don't have access to a vehicle.
- This is especially important (so much so that laypeople obtaining some degree of at least suicide prevention "first aid" training is a viable strategy for preventing suicide) in communities that don't relate well to outsiders at all (military or emergency services veterans) or that generally see police and/or mental health professionals as adversarial forces of conformity and to whom some may actually be exactly that (among many others, urban poor or minorities, some LGBTQ people, sex workers, and some parts of the arts and music have this issue with police and sometimes therapists). While professionals may be the ideal, there are people who will be angered or frightened or silenced by professional involvement as opposed to gratefully receiving it, and nonprofessional help from their own community before a situation becomes immediately lethal is often the best chance they have at staying alive and/or getting professional help.
- Misconception: it is easy to tell when someone is suicidal. It has a basis in fact, as most people become unhappy before attempting suicide, but there are different ways of showing such an emotion and many are not thought as suicidal until someone discovers the body or takes them to the emergency room. This is due to the person believing their existence is unwanted, not revealing their emotions to be less of a burden to others, or denying their feelings in an attempt to make them go away. Finally, they may attempt to work through it themselves or be too proud to accept help, as it is "only in their head." They often force themselves to appear happy, amused, or "normal," in which the only people who could tell the difference are close friends and family members—of which the vast majority do not have medical backgrounds, and thus don't have the training to deal with it appropriately. On the other side, those who do have family in the medical field may hide their symptoms because "a doctor/nurse/psychologist's kid shouldn't have any problems."
- Conversely, a sudden lift in a depressed person's spirits does not necessarily mean they've "gotten over it" and are starting to recover. Paradoxically, some seriously depressed people will actually feel better just before attempting suicide. This is because they've finally figured out a way to escape their angst, and are therefore feeling hopeful for the first time in ages.
- In many cases, it's the extent of the depression that prevents suicide attempts. The depressed person simply does not have the motivation to kill themselves. If they improve, the motivation can increase without an improvement in feelings, and the person attempts suicide. This can prove a problem for those on antidepressants..
- This is also why mixed episodes in bipolar 1 and cocaine or methamphetamine use in bipolar 1 are so dangerous - often, the person is depressed or agitated yet at the same time having the focus and motivation mania or stimulant use provides, while the mania is not full enough to also provide relief from the depression, or "coming down" from the cocaine or meth high leaves them depressed again and yet fully motivated and focused to do something about it - and unfortunately the "something" often isn't "get help" but "commit suicide" or "make a half-hearted attempt at suicide that actually works too well."
- Misconception: All suicides are planned for a long time. Many times, suicide is impulsive, especially in the severely traumatized, the bipolar, people for whom it is the result of a sudden traumatizing event such as rape or the loss of a loved one, and/or those who use drugs with a rush-crash pattern from alcohol to meth, and a viable strategy for preventing it is to get the person to wait out the impulse to commit suicide, with no judgment on their feelings but simply "running down the clock" and keeping them in a safe or safer environment while they are experiencing the impulse to die until it legitimately recedes, at least for the time being. For some of these persons (those suffering from trauma/PTSD and/or complicated grief), treatment itself involves making a suicide "emergency plan" or "safety plan" that relies on their seeking out people and things to help them get past the impulses, because nothing will entirely eradicate said impulses and a trigger can bring them back.
- For example, if you know that every year, your late lover's birthday/a date meaningful to you both/a holiday/something similar is a trigger for these impulses, you can plan to be in a safe location away from methods to easily commit suicide (whether it be a hospital or simply a relatively-suicide-proofed room with someone trustworthy who can protect you from yourself or who can take you to a hospital or other safe place without police being involved), you can try to monitor other areas of your life to not add other temptations or triggers (e.g. not getting drunk if it makes you a sad drunk, avoiding media that depicts similar deaths/avoiding tributes and memorials if they upset you more) and you can consider ways of distracting yourself until the time passes.
- Misconception: Suicidality consists of a defined attempt using a usual method. Especially for both the chronically mentally ill and even more so for the severely traumatized, many times, there may not even be a specific intent or attempt. Instead, a pattern develops of simply "giving up on life" or "not caring if one lives or dies," which can manifest in everything from unsafe sex and sexual practices (e.g. unprotected casual sex, Erotic Asphyxiation or other "edge play" without a Safe Word or in bad condition) to dangerous use of drugs and substances (e.g. drinking until blackout drunk and becoming The Alcoholic, intentionally going near overdose range, using dirty needles, etc) to unsafe and dangerous driving or work practices. Suicidal self-harmers will sometimes abandon caution while self-harming (e.g. not caring if the cut goes too deep), suicidal people with eating disorders may find it harder to stop because there is no "Oh no, I can die" factor preventing them, and suicidal alcoholics or drug users may not care that they're overdosing or becoming ill. Suicidality is, for these persons, a spectrum, of safe and healthy (or at the very least harm-reducing and responsible) behavior to acts that may or even are likely to result in serious injury or death. This in combination with suicide on impulse (mentioned above) is how accidental suicide happens - people who don't care whether they live or die taking risks that have a large chance of death.
- Misconception: everything goes back to normal right away. While the short-term problem may be dealt with, it can take several months to go back to normal even without the physical recuperation of a suicide attempt. Major depression involves severe chemical imbalance in the person's brain, and relapsing or attempting suicide again after a year is common among nearly half of all sufferers. Even after therapy, it can take several years for the person to genuinely return to normal; further complication is when the person themselves thinks that this is true. They may hide their symptoms of relapse to keep others from worrying, or go for years without further treatment in the mistaken belief that they "should be back to normal." Even worse are the cases where the suicide is taken for a joke or forced to be abandoned, and the depressing events continue.
- And the very worst situations are when someone is left in an abusive or traumatic situation, with no real help to get out of the situation offered. An inventory for abuse of all sorts should always be taken with someone (especially a person with no source of income outside of their spouse, a minor, or someone who fits the profile of a human trafficking victim) who attempts suicide, and if someone is living in a situation of abuse or violence, concrete help should be provided (not just "here's a domestic violence pamphlet, call me") to get them out of that situation.
- Misconception: all suicides leave suicide notes, so if a suicide doesn't leave a note either the attempt wasn't serious or it wasn't really suicide. Again, utter nonsense perpetuated by Hollywood. Most suicides don't leave notes. In some countries fewer than one in ten suicides leave notes. It's more common in the US specifically because of media depictions.
- Misconception: the average suicide victim is a young adult. This varies hugely from country to country, but in most Western countries elders commit suicide at a much higher rate than younger people, and contrary to conventional wisdom it's not due to age or health but almost wholly due to depression.
- Extreme debt or financial loss often has a worse impact with increasing age, as well - a teenager or young adult who has a strong support system may well not be Driven to Suicide by a sudden job loss or finding themselves in extreme debt, while someone in their middle thirties through fifties may well be.
- Misconception: anyone who considers or attempts suicide is being selfish and cowardly. This is a very pervasive stereotype, but for obvious reasons, it's one of the most blatantly untrue ones. People attempt suicide for a variety of reasons, whether that's due to a long history of depression or recent traumas, and oftentimes people in the grip of depression who are considering suicide attempt it out of a desire for it "all to be over." The best way to help someone who's attempted or is about to attempt suicide is not to tell them they're being 'selfish' or 'inconsiderate', but to assist them in getting the help they need. Sometimes, the suicidal person will feel that they are burdening society with their existence and actually feels selfish for not killing themselves.
- The inverse is sometimes the case. People who survive or intentionally botch their suicide won't always be happy at first. Some may in fact feel worse, because either they couldn't even manage to DIE properly, they feel like they've been cheated out of relief, or they feel they "chickened out" and have now burdened their loved ones with financial and emotional stress—the exact thing they wanted to avoid. It is a very twisted form of Survivor Guilt that is often confusing for loved ones to deal with.
- Misconception: all teens aren't really serious about suicide. This applies to children as well - some people believe that teenagers are doing it for the attention, and the children are just joking/can't really want to die. But there are teens who are genuinely suffering. If a teen or child is forced to abandon a suicide attempt, and life continues as normal, this can just make it worse and the child/teen more likely to actually commit suicide.
- Misconception: If someone isn't serious about suicide, they likely won't commit it. This ties into both the aforementioned misconception about suicide notes, the one that teens aren't really serious, and in general the (false) idea that most suicide is not an impulsive act. Accidental suicide doesn't require intent at all - simply ambivalence or not caring as to whether one lives or dies. Most suicides are impulsive, with survivors reporting regretting attempts almost as soon as they were underway. Finally, even some "joke suicides" such as someone engaging in an action likely to cause death on a dare/as a joke have "succeeded," as a short browse of the Darwin Awards will show.
- Misconception: medication and/or hospitalization alone will fix it. Unfortunately, too many people have this view of mental illness (especially depression) as something people just need to "snap out of," or something that can be "fixed." While medication and hospitalization can help some, there are some caveats to believing both are some sort of instantly effective cures for depression.
- Again, as mentioned above, sometimes people contemplate or attempt suicide for actual, legitimate reasons outside their own minds. While hospitalization may help someone in a situation of abuse or extreme financial loss get over the impulse to commit suicide in the short term, it can also make things worse. Especially in regard to abuse, financial loss, or physical pain, addressing the immediate situation (whether placing the person in a domestic violence shelter rather than a hospital, meeting an immediate financial threat, or treating the physical condition/pain) is the best idea both to see if the person is actually severely mentally ill (e.g. are they considering suicide still once they are no longer being screamed at or beat up or at risk of being evicted or fired or in so much pain that death seems a better option), and in making help seem more attractive if they are (e.g. choosing voluntary outpatient treatment themselves, as opposed to their abuser and/or the police forcing them into a hospital and taking away their independence/being able to select lower-cost treatment options than hospitalization/being able to integrate their physical and mental health care)
- Hospitalization (especially forced hospitalization and in some contexts, especially where abuse has been a part of the depression and especially if the abusers insisted on the hospitalization as punitive, or hospitalization in a context of labeling and shaming or forced treatment) can be a traumatic, painful experience itself. While modern-day mental hospitals are NOT generally what would be found in One Flew Over the Cuckoo's Nest or such, not every professional employed by one is necessarily understanding. The "psychiatric survivor" and "mental health consumer" movements have some very good commentary on this - in short, forced hospitalization should be a very last resort much as calling the authorities should be, and do the research to find a hospital where patients are treated with kindness and respect.
- Related, a bad therapist is worse than NO therapist. A therapist who is highly judgmental or commanding, one whose goal is to make someone "behave" or make them "normal," one who has little or no experience with the actual problems their patient has and sees them as a DSM category rather than a human being in legitimate pain, one who is beholden to a religion/method/seminar/similar, one who is very heteronormative in dealing with an LGBTQ person... all of the above are just a few ways a therapist can have very bad effects and make someone angry or fearful and possibly refuse to seek professional help ever again.
- Co-morbid depression originating from abuse, grief, and/or PTSD is very difficult to treat much less cure, because the space between "correcting chemical imbalance" and dealing with legitimate emotions from a horrifyingly traumatic experience is very difficult to define. That doesn't mean recovery is impossible - it just means it is very long, mostly from talk therapy, and that most (currently legal) medication's utility is limited because SSR Is can cure any existing chemical imbalances - but not make painful experiences or memories any less so.
- Antidepressants and neuroleptics are not always the correct medication. A complete physical for physical causes of the depression or depression-like symptoms absolutely needs to be conducted, as does a full mental evaluation for other mental causes. Someone can be anemic and needing iron (and treatment for the anemia-causing disease). Someone can be suffering from hyperthyroid or hypothyroid - both conditions which absolutely cause symptoms easily confused with depression and bipolar alike.
- On the subject of neuroleptics, they generally should be seen as a last resort in cases of depression. Not because they're "antipsychotic drugs" (a stigma entirely unwarranted) but because they are very powerful drugs with often heavily sedating direct effects and severe side effects (the biggest one being extreme obesity and diabetes for modern neuroleptics) and another side effect of causing actual brain damage. They should rarely if ever be used as first-line maintenance treatment for unipolar depression (despite ad campaigns like "Add Abilify") because they can worsen it and cause lasting damage beyond that of the depression itself - and a doctor suggesting them as such generally means one needs another doctor. They are an evidence-based first-line treatment (especially short term) for bipolar 1 manic episodes, though even there much medical opinion leans toward using them as emergency as needed and using lithium and/or anticonvulsant drugs as maintenance medication.
- The depression could also be a rare type - e.g. the serotonin and serotonin uptake system is fine, but the endorphin/endogenous opiate systems are where the problem is, or it is due to a lack of or excess of a sex hormone, or it is due to a physical brain injury...
- Finally, even in cases where the depression is solely the result of a chemical imbalance of brain chemicals, it takes around two weeks for medication to reach its full effect, and somewhat longer for talk therapy to begin to work. Do not give up or insist on adding more/stronger meds because it's not instant, and do give yourself and your mind and body time to heal.
- Misconception: Depressed or suicidal people must be living wrong, getting religion/getting sober/committing to a natural lifestyle/manifesting positive thoughts will fix it! This is one of the most damaging and often suicide-inspiring misconceptions of depression there is (because it makes the guilt and self-blame a depression sufferer already has far worse to believe that their suffering is their own fault), and it's also one that can lead people suffering from depression to make life choices that at best do nothing and at worst destroy their lives with no benefit.
- People of any and all religions suffer abuse, depression, anxiety, bipolar, loss/trauma, and/or other reasons to feel suicidal. No religious belief is a cure for depression or anxiety (or any other illness) in and of itself, especially when the cause of depression or anxiety is entirely biochemical or hormonal or the like. While religious belief and prayer does have some positive effect on depression or anxiety for some believers, and religious groups can provide needed social support, some religious groups can also inflict such pervasive emotional and/or financial abuse that they worsen or even cause depression and suicide, can drive people (especially those who are LGBTQ) to believe they are "sinful" and "evil" or "not doing enough," or add a religious element to the depression/suicidality such as "God hates me" or "I deserve hell." Religious belief can be helpful to those who already have it and/or who are seeking it for the reasons of prayer/meditation/ritual being comforting and social support via meetings/assemblies/etcetera, but it isn't a cure-all, can make things worse, and having depression doesn't mean you're unspiritual or a "sinner" or lack faith. Also, if a religious group offers to heal your mind but requires or insists on increasingly large financial donations to help you, this is a red flag of something that can drive people to suicide and definitely won't help.
- Also, if you are severely depressed (or alternately, in a manic or psychotic episode), while you may be pondering religious ideas or thoughts, you are likely not of a sound enough mind to choose a religion or belief system wisely, and should wait until you are in a better frame of mind. Many highly demanding/outright abusive or fraudulent religious sects actively recruit mentally ill/mentally troubled people, and in such a state you are more vulnerable to making very bad decisions.
- While alcohol and some drugs (especially in addictive use patterns) do cause depression and suicidality, getting sober, while it may be healthy and important, isn't an instant cure-all for depression either for most people. Quitting some substances (alcohol, opiates/heroin, and amphetamine-class drugs especially) can produce a horrific suicidal depression "crash" as part of the withdrawal especially if done cold turkey, even in people who aren't depressed to begin with (and delirium tremens or uncontrolled opiate withdrawal can itself kill, while cold turkey speed withdrawal will just make you wish you were dead). If you were self-medicating depression or bipolar consciously or unconsciously with the alcohol or drugs, being sober won't cure the depression. The only time sobriety can be an "instant cure" is if there was no underlying depression, (as in, the drinking pattern or drug use directly caused depression in someone who wasn't previously ill - example being someone who realizes they become sad and weepy when they drink and stops drinking, or an MDMA user who realizes "suicide Tuesdays" are really making him or her suicidal and quits using MDMA). While becoming sober is a commendable health decision, and joining AA or NA or the like can provide social support, it's one that is often not as simple as "quit and you'll be 100 percent not-depressed" or "quit and you won't feel suicidal ever again."
- Sometimes, total sobriety is sometimes a bad idea for suicide prevention - if the depression is due to a problem with endorphin production for example, your treatment itself may include "drugs" such as cannabis or even an opiate (of course, prescribed by your treating doctor) to properly treat it. With trauma/grief induced depression or suicidality, impulse distraction may involve getting drunk or high enough to forget that one wants to die right now - and while that's not good, it's a better choice than suicide. PTSD or complicated grief sufferers sometimes use cannabis for this reason to deal with trigger-induced suicidal impulses - unlike alcohol or even some prescribed meds, the lethal dose is almost impossible to achieve, and combined with a safe environment, getting stoned ensures safety. For these people, trying to deal with said impulses sober is more likely to result in suicide.
- Another case where drug use actually saves lives from suicide involves chronic pain. Chronic severe pain (or even chronic moderate but unrelenting pain) is a frequent cause of suicide both because of itself and the depression it often induces. While non-drug approaches (and non-narcotic approaches) can work sometimes, if they do not work or if the person is in too much pain to try them at that point, depriving them of pain relief/pain reduction via opiates, other medications, and/or cannabis may very well lead to their suicide.
- Despite what the Granola Girl and All-Natural Snake Oil provider will tell you, committing to a more natural lifestyle is also not an instant depression cure. While exercise is a valuable tool for depression and anxiety relief (studies have proven exercise is as valuable as SSRI antidepressants to overcoming depression), and sunshine (unless you suffer from porphyria) and fresh air and a good diet etcetera will make you feel better, none are cure-alls, some parts of the "more natural lifestyle" can become just as bad at guilt-inducing as religion, by making you feel guilty for "not doing enough" or "not being natural enough," and moving to a farm or collective or isolated location might worsen depression or anxiety via isolation and financial restriction, and possibly provide better access to firearms, dangerous machinery, or poisons. If you are so depressed you are suicidal, "going natural" won't, in and of itself, fix it.
- Positive thoughts and "faith" and manifestation CANNOT fix suicidal depression, because a suicidally depressed person physically cannot maintain positive thinking, especially in the absence of anything realistic to be positive or happy about, as such things as "The Secret" and prosperity faith healers demand that one do. This does not make them a bad or evil person, a "black hole of negativity," it is simply part of the pain they are suffering, and to tell people that if only they could think positively all their problems would be solved and they'd be able to manifest a new boyfriend, millions of dollars in the bank, and perfect health (among other things) is offensive and can be triggering and suicide-inducing if they believe it (and therefore blame themselves and hate themselves and feel guilty that they can't, or can't maintain it in the face of no proof of improvement). It's the equivalent of telling someone with major injuries from a car accident or fall to just get up and go run the Ironman Triathalon and believe they weren't ever hurt in the first place.
- If preventing suicide was as easy as "thinking positively," and "having faith," bipolar 1 manic episodes would have zero suicide risk - as opposed to the increased risk of suicide that they actually have. Persons who are manic are definitely thinking positively and having faith (in fact, too much of both - it's called "grandiosity" and a "feeling of invincibility"), so much that it is out of touch with reality and that they are likely to commit accidental suicide by taking risks that have a large chance of death (e.g. believing they can walk on a freeway without being hit by cars, using firearms with no regard for safe practices, believing they are truly physically invincible or simply not thinking of how risky an activity is until they are already risking their life).
- Persistent feelings of sadness or worthlessness, for at least two weeks. (Obvious sign of depression.) A common description by sufferers is that they feel "empty" or "hollow" inside. Unfortunately with teens, it is often dismissed as typical moodiness. This leads to the perfect storm of feeding their self-destructive thoughts, making them reluctant to seek help from adults, and instilling the belief that they have to prove their unhappiness is genuine—regrettably, some of those attempts work.
- Lack of interest in previously enjoyed activities for at least two weeks. (Obvious sign of depression.) An extreme sign is when the person is trying to enjoy themselves, but cannot even feel anxious about their lack of enthusiasm. They may simply stop participating in their hobbies, but some people retreat into their homes altogether and rarely leave the house.
- Intensely elevated mood with no apparent reason (such as happy life events or cocaine/amphetamine/MDMA use) and a general sense of invincibility or grandiosity, combined with extreme risk-taking behavior as listed below and lasting for at least two weeks. (Obvious sign of bipolar mania.) An extreme sign would be someone who is acting as if they are on a constant cocaine or amphetamine high, but not actually using either substance, and who is taking risks such as walking in traffic believing they won't be hit or gambling away their rent money believing they will win it all back with more.
- Frequent breakdowns and crying episodes. (Known, but exaggerated.) This is rarely witnessed first-hand, despite common media depictions. Depressed people in real life will more often seek out quiet and isolated places during such episodes, either because they want privacy or because they want others to notice that they're gone. Whether male or female, the sufferer may have an (un)conscious desire to be found, as the act has a dual purpose of validating their feelings and giving them "proof" that someone cares about them. Alternately, though...
- Unusual or constant anger/irritability or irrational rage. This is more common in male sufferers (due to many cultures viewing anger/rage/violence as more acceptable for men than crying, and to a lesser degree due to how the male brain is wired and due to testosterone itself - men are hormonally less prone to crying episodes), and it's also common as a result of mixed states in bipolar, or bipolar people who are heavy drinkers or stimulant users.
- Absolute lack of displayed emotion and/or The loss of ability to speak and/or express emotions at all. This is, as well as being far more common in male sufferers of depression, also highly common in victims of abuse or other PTSD sufferers, and far more rarely, is one of the cardinal "negative" symptoms of schizophrenia. If someone cannot express emotion at all, even in a legitimately emotional situation, and/or especially if they literally are unable to speak - this is a major sign of something being wrong.
- Sleeping too much, or being unable to sleep. (Known, but may not be recognized as a symptom in itself.) This is frequently due to the chemical imbalances. Bipolar mania or mixed states can also produce insomnia, whereas major depression can produce either oversleeping or insomnia.
- Unexplained, frequent aches or pains due to the immune system shutting down. (Little-known/overlooked.) A variant of this is when minor injuries or illnesses take too long to heal, such as a cold persisting for a month or scrapes and bruises lasting for days. Those with no medical experience often cannot connect this to depression.
- Feeling cold in inappropriate weather, or the coldness persisting in adequate warmth. (Little-known/overlooked.) This may be the reason for the stereotypical depictions of a black-clad "emo" teen, as dark colors absorb and retain heat better than light clothes. It also is one of the most frequently-overlooked symptoms, as wearing sweaters is not unusual in certain climates and even the person in question may not realize that this is a symptom.
- Changes in appetite and the subsequent weight gain/loss. (Little-known/overlooked.) As stated before, depression involves large-scale physiological changes, and subsequently affects the person's appetite. On the other hand, this can be hard to detect as those with decreased appetite will either remind or force themselves to eat normally, and those with increased appetite may hide the bulk of their overeating. Both sides may play it off as insignificant, or even joke about it to keep people from worrying. Extreme weight loss, lack of or intense attempts to suppress appetite, and/or being dangerously underweight are also the primary symptom of anorexia - and sudden unintentional weight gain in someone with anorexia often can inspire suicidal thoughts out of disgust with one's body/with one's "lack of control" over their weight.
- All of the above four symptoms are also warning symptoms of thyroid conditions - hypothyroid, hyperthyroid, and/or Hashimoto's disease, Graves' disease, or thyroid cancer where the thyroid levels can vary between too low and too high. If you have any one of those four and "depression/bipolar" symptoms, insist on seeing a thyroid specialist endocrinologist or oncologist and proper testing for all of the above. All of these illnesses mimic depression and bipolar - and if untreated, they can kill you in many other ways than driving you to suicide.
- Sudden loss of care for dangerous activities, beyond that possibly explained by apathy or experience. Someone may begin driving under the influence of alcohol or drugs, driving far more recklessly or at higher speeds than usual, act out in "road rage," get into repeated or serious non-fatal vehicle accidents or otherwise become an outright dangerous driver. Someone may overwork or work in a dangerous manner (e.g. removing protective equipment or ignoring safety precautions, especially when doing so could lead to death or serious injury, working until the point of physical collapse from lack of sleep or pain). Someone may suddenly take up risky or dangerous hobbies, or, if they previously rode dirt bikes or skydived or chased storms for example, ignoring their usual safety precautions while doing so, or may allow a previously controlled illness from diabetes to an eating disorder to get out of control, and it can also overlap with the symptom below. The key here is that while people tend to become more lax on safety the more they do something due to apathy and familiarity, the changes are more obvious than that and persistent - it is someone who consistently acts in a manner that hints at "not caring about living or dying."
- Changes in consumption of alcohol, recreational drugs, work hours, and/or forms of escapism. This is a more recently recognized sign, and one that appears to be more common among adult athletes, entertainers, musicians, doctors, lawyers and law enforcement, high-level business and finance workers, and others who live high-stress and yet relatively high income and high access to any or all of said options for escape. Much like overeating and under eating and oversleeping and insomnia, either side of the coin can be present. for example, one depressed / suicidal musician might lock himself in his studio and work nonstop using work to avoid the pain, and another who used to work nearly nonstop might suddenly quit and do no work at all. Or a lawyer who drank relatively little to begin with might go Off The Wagon, or alternately, a lawyer known for heavy drinking suddenly goes sober and begins self-recrimination as a part of "recovery." The key here is major changes either way that are either not connected to any apparent reason or that are tied to an obvious triggering event.
While these are the major signs, it is not the case with everyone and there are many more symptoms that may be particular to a specific person.
It should be noted that a great deal of depression and suicide involves appearances and (often) self-imposed pressures: Depression stems from both an inability to express emotions and the underlying, if warped, desire to protect their loved ones from such "unsafe" or "wrong" emotions. The major issue during therapy is that the person
accepts that they have a problem, that they need help, and that the steps for returning to normal will not happen right away. Generally, a good therapist will help their client figure most of it out by themselves instead of trying to set deadlines or goals for them. This is also why therapy is overwhelmingly one-on-one or in groups of fellow sufferers, rather than with family members or friends—the emotional involvement would impede the person's progress for a number of reasons.
To those who only know the media portrayals (which are greatly watered-down, particularly the physical side of depression), seeing what a genuinely depressed person would look and act like would be a huge shock, and most sufferers are understandable in their refusal to let loved ones into the actual therapy sessions.
There are numerous other sites that go into detail about suicide and depression, but knowing what's wrong is only half the battle: If you or anyone you know is showing signs of depression, seek professional help immediately.
If the professional seems controlling, condemnatory, dismissive or especially insistent that you convert to their religion or similar, keep looking
even if it means going elsewhere.
And one more note...
Suicide statistics and official reports of deaths from suicide are often very skewed and inadequate. Some of the problems in determining an accurate death toll from suicide/successful suicide attempts are as follows:
- An undercounting of deaths from suicide itself, due to accidental suicides often being listed as accidents (this is especially a problem with vehicle accidents, work accidents and overwork) and occasionally even being considered as acts of bravery or heroism or tenaciousness when said "bravery" or "heroism" or "tenaciousness" was unnecessary or useless, and is actually suicidal behavior. It is arguable that if all accidental and stress deaths that were actually suicides were counted as such, the suicide tolls would be somewhat higher.
- At the same time, too many homicides are counted as suicides. This includes all cases of abusers or bullies or others driving someone to outright suicide or so damaging them mentally that suicidality is the ultimate result. This includes cases written off as Suicide by Cop that were actually the result of Police Brutality, and other police brutality or police negligence related deaths in custody. This includes outright murders that just happen to look like suicides, either whether intentionally set up to be so by the killer, or that just turned out that way, as well as suicide pacts and cases of kink gone horribly wrong when it involves a person who could demand activities be Safe, Sane and Consensual. It applies to those who intentionally and knowingly leave suicide methods for people who they know to be unstable or at risk. It also applies to people who create situations almost guaranteed to lead to accidental or overwork deaths among those who aren't safety-conscious. If all cases of felony homicide, negligent homicide, or homicide were subtracted from the suicide death toll, the effect would be significant and potentially terrifying.