# Suicide and suicidal thoughts



## David Baxter PhD

Suicide and suicidal thoughts
By Mayo Clinic Staff 
Mar 28, 2008 

Suicide is the act of taking your own life. Suicide and suicidal thoughts and behavior are tragic reactions to distressing life situations ? and all the more tragic because suicide can be prevented. Suicide often occurs as an impulsive act in the midst of a crisis, sometimes fueled by intoxication. But simply talking to someone about what you're going through may give you new perspective that shows you that suicide isn't a solution. 

Whether you're considering suicide or know someone who may be, learn the warning signs and how to reach out for immediate help and professional treatment. You may save a life today ? your own or someone else's. 

*Signs and symptoms*
Typical warning signs of suicide 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" 
Securing the means to commit suicide, such as getting a gun or stockpiling pills 
Withdrawing from social contact and wanting to be left alone 
Dramatic 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 
Engaging in risky or self-destructive behavior, 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. You may try to keep your suicidal thoughts and feelings secret. 

*Types of suicidal behavior*
Suicide is actually a complex set of behaviors that exists on a continuum, from ideas to actions, including: 


_Suicidal ideation_. Having thoughts of harming or killing yourself. 
_Suicidal behavior_. Engaging in acts intended to cause your death, or acts that while unlikely to cause your death indicate that you're self-destructive or suicidal. These may include overdosing, reckless driving or excessive drinking. 
_Suicide attempt_. This is a nonfatal, self-inflicted destructive act that was intended to cause your own death. 
_Parasuicide_. This is an act that may resemble suicidal behavior but that isn't intended to cause your death. Such acts may include deliberately injuring yourself, such as cutting. Some people find these acts emotionally soothing. These acts may result in accidental death. 
_Completed suicide_. This is taking your own life.
It's important to understand the types of suicidal thoughts, behaviors and intent in order to get the appropriate type of treatment. 

*Causes*
Suicide and suicidal thoughts have numerous causes. Most often, suicidal thoughts are the result of an inability to cope when you're faced with what seems to be an overwhelming life situation ? financial problems, a personal crisis, emotional turmoil and despair, for instance. If you don't have hope for the future, you may think suicide is a solution when, in fact, it's not. You may experience a sort of tunnel vision, where in the middle of a crisis you believe suicide is the only way out. 

Emerging evidence suggests that 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*
Because of its devastating toll, suicide is considered one of the biggest public health problems worldwide. In the United States, suicide is the 11th-leading cause of death, with 32,000 suicides a year, or about 89 a day. Among Americans ages 10 to 24, it's the third-leading cause of death, accounting for about 4,600 deaths a year. 

There are many more suicide attempts than actual suicides, and hundreds of thousands of people are treated every year for self-inflicted injuries. Overall, there's one completed suicide for every 25 attempts. 

Men are more likely than women to complete suicide because they typically use more lethal means, such as a firearm. Women are more likely to attempt suicide, though. Males over age 75 have the highest suicide rate. 

Factors that increase the risk of suicide include: 


A prior suicide attempt 
Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia or personality disorders 
Being intoxicated by alcohol 
A family history of mental disorders or substance abuse 
A family history of suicide 
A family history of violence, including physical or sexual abuse 
Having firearms in the home 
A significant medical illness, such as cancer or chronic pain 
Social isolation, or feeling alone 
Legal or disciplinary problems, especially among children and young adults ages 10 to 24 
School problems 
Having never been married 
Feeling hopeless 
Impulsive or reckless behavior 
Having limited life activities because of health problems caused by combat
*When to seek medical advice*
It's perfectly normal to occasionally feel sad, upset or unhappy with situations in your life. But if these feelings are intense, linger for weeks, months or even years, or leave you thinking about suicide or harming yourself or someone else, seek medical help as soon as possible. Suicidal thinking usually doesn't get better on its own, and it may lead you to take drastic steps to cope with your pain. 

If you don't feel at immediate risk of acting on feelings of suicide or self-harm, contact your primary care doctor or other health care provider or mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone else about your feelings, whether it's a friend or loved one, a health care professional, a faith leader, or someone else you trust. They can help you take the first steps to successful treatment. 

If you're considering suicide or self-harm now and have the means available, reach out to someone immediately for help. The best choice is to call 911 or your local emergency services number. If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone to stay safe: 


Contact a family member or friend 
Contact a doctor, mental health provider or other health care professional 
Contact a minister, spiritual leader or someone in your faith community 
Go to your local hospital emergency room 
Call a crisis center or hot line
*Helping a loved one with suicidal thoughts*
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. 

If you have a loved one who has harmed himself or herself, or is seriously considering doing so, take him or her to the hospital or call for emergency help. 

*Screening and diagnosis*
Current U.S. health guidelines don't recommend screening the general public to see if someone is having suicidal thoughts or behavior. But if your health care provider believes you may be at risk of suicide or that you have suicidal thoughts, he or she may ask you about it in more detail. This will help ensure that you're getting the proper treatment. 

When you see a health care provider for the first time, whether on an emergency basis or not, you'll have a detailed evaluation. This evaluation will help determine the nature of your suicidal thoughts and behavior. Such assessments generally include discussion about: 


Specific plans you may have for suicide 
Your past suicidal or self-injurious behavior 
Review of previous treatment and diagnoses 
Your family history of suicide or mental illness 
Your current living situation and circumstances 
Stressors in your life, such as work, finances or relationship problems 
Changes in your mood or behavior 
Your use of alcohol or substances
*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 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. 

*Treatment*
Treatment of suicidal thoughts and behavior depends on your specific situation, including your level of suicide risk. 

*Emergency situations*
If you're in a crisis or emergency situation, the first goal is to keep you safe from harming yourself. You will first have a psychiatric evaluation. Psychiatric hospitalization may be recommended if: 


You've made a near-lethal or violent suicide attempt 
You're in a psychotic state 
You lack a strong support system that could help keep you safe 
You're acting impulsively or recklessly 
You have strong or persistent urges to take your life
While in the hospital, you'll receive necessary medical care. You'll also receive treatment for any mental health disorders you may have, such as depression, schizophrenia or bipolar disorder. This treatment may include medications, psychotherapy or electroconvulsive therapy (ECT). 

*Nonemergency situations*
If you have suicidal thoughts but aren't in a crisis situation, your care may be able to take place on an outpatient basis. 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.
*Prevention*
Prevention of suicide involves both individuals and communities. Suicide prevention strategies include: 


Learning the warning signs of suicide and suicidal behavior 
Honest discussion with someone who may be suicidal 
Increasing access to mental health care 
Learning skills such as resilience and assertiveness 
Anger management 
Conflict resolution 
Improved awareness among primary care doctors of suicide risks and warning signs 
Restricting access to lethal weapons of suicide, such as not keeping guns in your home 
Better treatment of depression and other mental illnesses 
Developing a strong network of friends and social support
*Self-care*
Don't try to manage suicidal thoughts or behavior entirely on your own. It's best to seek professional medical care. But you can become an active participant in your care. You can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care steps: 


_Stick to your treatment plan_. Don't skip therapy sessions, even if you don't feel like going. 
_Take your medications as directed_. Even if you're feeling well, resist any temptation to skip your medications. If you stop, your negative feelings and thoughts 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 illicit drugs can worsen suicidal thoughts. They can also make you feel less inhibited, which means you're more likely to act on your thoughts.


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## Retired

Although implied, but not explicitely mentioned, according to my understanding of risk factors:



> Being intoxicated by alcohol



would include being impaired by drug abuse.

(an extension of a implied family history of drug abuse)


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## Elizabeth

I have self ideation but not as strong as last year and beginning of this year.
I do not want to seek any help for that or my depression. I know I should but it scares me and anyway am on holiday for a year now, so no doctor here to talk too. I prefer to talk to Mark about my feelings. Though sometimes I keep some private as he lost someone to suicide so would not be able to cope with my problems, he does know I got images as I told him.


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## Into The Light

what about getting help scares you?


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## Elizabeth

I will be labelled forerver as a depressive person no-one will trust me they will always be wary of me, my actions, will not be able to get work, understand??
:hide:


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## ladylore

There are still stigmas in society, at least in some parts. But fortunately depression and other mental illnesses are being seen more and more as just that, illnesses that are treatable.

Its actually between you and your doctor and possibly a therapist. Everything is confidential and no one needs to know that you are being treated for depression.

I think you would be amazed at how many people there are that have had a depressive episode or other mental illnesses.

Really glad you decided to join us here. There is plenty to read and specifically a section about depression that you may be interested in. There are also many self-help articles that you may also benifit from.


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## Elizabeth

Thanks!


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## ladylore

your welcome.


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## white page

Just now recieved a phone call which has triggered me , all those thoughts have come back , I am not coping , no one to talk to . I know it will go away , I just need to tell some one , I was doing well . I have to pull myself together . just need someone to write in black and white on this screen that it won't last long 
that these thoughts will soon go away .


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## Jazzey

I'm right here WP, talk to me...The thoughts go away, I promise.  I've had them, I continue to have them, and they always go away.  I saw the beautiful picture of your garden the other day.    the flowers you pictured for Mari's b-day are my absolute favorite.  You know in Canada, those flowers only grow in the wild?


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## white page

Thank you Jazzey , feeling much less distraught now .  just being heard helps so much .


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## Jazzey

I'm happy to hear that WP - take good care of yourself :airkiss: :hug:


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## Jazzey

I'm still here if you want to chat some more WP...


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## Halo

I am sorry that you got a distressing phone call, WP.  I know the feeling of having one thing just set me off and the need to reach out.  I think you did great by coming here, reaching out to your friends and knowing that you will get through it.

How are you feeling now?


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## white page

much better this  morning , thank you JJazzey and Halo , a good cry , after very  kind and understanding words,  so glad I managed to come here last night , couldn't think of anywhere else to go .at that time of night.


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## Banned

Glad things are better for you today, WP.  So glad.


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## arlene

Thanks for the info...Every problem that we encounter I think its good that we have someone to share what we feel.


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## amastie

I'm here too WP.
the thoughts, like all thoughts, will go away.  I'm surrounding you with love and light, with pillows to fall onto and hoping that you find something really funny to watch on tv.  Do you have anything on DVD or video you can watch?  I recently saw the film "Nany McFee" and it was light and funny.  Anything to help the thought move away a bit more quickly.

:hug: 

(Glad you're feeling better this moring )


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## forgetmenot

thoughts just thoughts fear it might happen again how does one shut their minds off to this fear i don't knwo


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