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Suicidal Thoughts

Intro

A call to the health care provider or to 911 is warranted when someone admits to suicidal ideation. That is, if someone actively wishes his or her own death, then evaluation by a medical professional is absolutely essential.

Any form of suicidal ideation — actively wishing one's own death—should prompt immediate evaluation by a medical professional.

By the time someone admits to having a thought or plan to end one's life, the person may have already initiated the plan.

  • It is not uncommon for a person with suicidal ideation to be treated in the emergency department for having taken an overdose but have told no one.
  • Guessing about a person's true intentions when suicidal ideation is a concern is dangerous and wrong.

Professionals often speak of a "suicidal gesture."

  • This occurs when a person harms himself or herself in such a way as to bring sympathy but not death.
  • Even if you believe a person is doing it just for attention, you must not rely on this feeling.

Many people make gestures that are unintentionally lethal.

  • For instance, someone may take an overdose of acetaminophen (Tylenol) in order to gain sympathy, not understanding that an overdose of Tylenol can be fatal. It is not your job as a concerned friend or family member to evaluate the intent of the person with suicidal ideation. Your job is to get the person to the hospital as soon as possible.

concerns that the person might be depressed or have other difficulties, then home care is not appropriate.

A concerned friend or partner should inquire directly about thoughts of suicide.

  • Contrary to conventional wisdom, asking about suicidal thoughts or plans does not put the idea in the person's head.
  • If you are concerned that someone may be depressed   or suicidal, then ask in a direct and caring manner.
  • You might simply say, "You seem down to me, and I'm concerned. Is everything all right? Are you experiencing thoughts about death or suicide?"

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Follow-up

Persons who actually attempt suicide need close psychiatric follow-up and counseling.

  • This may seem obvious, but many suicidal people do not get good follow-up treatment and often end up thinking of suicide (or even attempting it) again.
  • Follow-up usually consists of counseling and medication for depression.

Keeping follow-up appointments in the case of suicidal thoughts is so important that the referring health care provider will likely contact the consultant before discharging the person from the office or the emergency department.

Prevention

Suicidal thoughts can be prevented by following the recommendations of the health care provider. Whether treatment is recommended or medications and counseling are suggested or not, following through on treatment is the best means of prevention.

Suicidal thoughts can be frightening, and they can indicate a serious illness. People with depression or other forms of mental illness are not weak-willed. They have a real disease. Real medications are usually successful in treatment.

If you feel that someone is depressed, ask. If you are concerned that someone might be considering suicide, ask. If someone volunteers to you that they are thinking about suicide, please listen. It might be the only cry for help they utter.

Outlook

The outcome for a person experiencing suicidal thoughts depends on the cause of the thoughts.

  • The occasional thought about death without the worrisome symptoms can be ignored. Many people having suicidal thoughts are depressed. For those diagnosed with depression, the prognosis is good for a full recovery with the aid of antidepressant medication and counseling. For those with alcohol or drug problems, recovery can be long and difficult, but can be done. Those with more severe mental illnesses such as schizophrenia may hope for great improvement in their disease with the aid of medication and regular psychiatric care.

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