Depression and Suicide: How to Know When You Need Help

Depressed manWhile most Americans will experience some level of depression in their lives, some will experience an intense and serious depression which requires the help of friends, family, or a mental health professional. The severity of a depressive state will fluctuate based on a variety of factors, including the availability of a support system, treatment options such as a therapist or psychiatrist, emotional coping skills, and a history of successfully navigating previous mental health episodes. However, when depression worsens, suicidal ideations (or thoughts) may develop, and are therefore often seen together. The focus of this article is to help identify common signs and symptoms of suicidal thoughts related to severe depression and how to recognize when to seek help.

Common depressive symptoms include a loss of interest in previously enjoyed activities, low energy, changes in sleep and appetite, concentration and focus problems, and changes in libido. When depression worsens, often people will experience hopelessness, a desire to isolate and withdraw, and may begin to have thoughts about how to make the pain (depression) stop. These are symptoms most commonly associated with the onset of suicidal ideations. This is where outside help is needed. The vulnerability experienced with hopelessness and a desire to make the pain stop sometimes leads to irrational actions and decisions. Once this hopelessness manifests as a desire to “go to sleep,” “make the pain go away,” or identifying ways to die and how to obtain the means (guns, pills, etc.), the suicide risk is dramatically heightened.

Other factors must be considered when determining how soon help should be acquired during a worsening depression. First, if a firearm is in a person’s possession or at least accessible to the person, help should be sought as soon as the depression is apparent. The firearm should be secured by a third party or by law enforcement. Next, any use of recreational drugs or alcohol limits a person’s insight and judgment, making him or her more impulsive and less likely to consider available resources. If a person is likely to use drugs, help needs to be called before a person becomes intoxicated and possibly makes a dangerous mistake. A previous history of suicide attempts increases a person’s suicide risk; thus, help should be attained immediately if a suicide survivor begins to experience suicidal thoughts.

Risk Factors

Numerous risk factors need to be evaluated to determine suicide risk level. Below is a listing of the more serious factors which warrant immediate intervention. If any of the following become present in a person’s thoughts or behavior, help should be sought immediately (note that this is not a comprehensive list but rather an overview of the more common risk factors):

  • Decreased or no sleep: Without adequate restorative sleep, a person’s insight and judgment become significantly affected.
  • Developing a suicide plan: A person moves thoughts into an action plan.
  • Identifying ways to access suicide means or storing means (pills, guns, etc.).
  • Giving away personal items of value and/or getting one’s affairs in order with the anticipation of dying.
  • Any psychotic symptom such as auditory or visual hallucinations.
  • Hopelessness: Seeing no hope for the future.
  • Intent to die.
  • History of mental health treatment in the past, especially a history of suicide attempts.
  • Family history of a completed suicide.
  • Limited or absent support system: Few or no friends or family to call for help.
  • Serious/chronic medical condition(s).
  • Withdrawing from sources of support, such as family, work, or friends.
  • Happiness immediately after feeling severely depressed: This may suggest a person has resolved to die and is now hopeful for his or her plan.
  • Impulsive and/or high risk taking or careless behavior which is different from the person’s normal functioning.

Treatment Options

Depression and thoughts of suicide are serious, but they are also highly treatable. The sooner a person elicits help from friends, family, or a mental health professional, the sooner he or she will gain healthier perspectives and views of how to handle his or her current state. Help will likely instill hope and begin the process of returning to a happier and stable state.

It is important to know some available resources for those experiencing suicidal ideations. First, call 911 immediately if a person is expressing that he or she can no longer remain safe. Second, if safety permits, a person can be taken by friends or family to any hospital emergency department, where the person will receive a comprehensive evaluation and possible placement inside a mental health facility. Third, many therapists have after-hours support available, but this should be used only if there is not an imminent threat to personal safety. Fourth, the National Suicide Prevention Lifeline (24 hours, seven days a week) can be reached at 1-800-273-8255, where a trained person will listen and help a person decide the best route for help. And lastly, many communities have local-based suicide-prevention crisis lines and clinics. Check with your local mental health department to see what resources are available.

Developing a safety plan before depression worsens is a key element in the treatment of those at risk for suicide. Having support systems early and risky behavior identified (e.g., thinking of ways to die, acquiring means to harm self, etc.) can be a life-saver. It is best to have a plan of prevention and response in place before a crisis; trying to develop a safety plan amid an active crisis is often unsuccessful. A mental health professional can help you develop an excellent care and safety plan in your very first session.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrew Mendonsa, PsyD, therapist in Sacramento, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Loren

    March 19th, 2014 at 11:36 AM

    I don’t know whether a depressed person is the one on whom we should depend to ask for help for themselves. Maybe we as their friends have to stop and pay better attention to them and make sure that we have better views on what is going on with them so that we can get them some help if we see that they are spiraling out of control.

    I have this feeling that with someone seriously depressed like this they are going to be too far gone before they see that they could use some help and even by then it might begin to feel like it might not even be worth bothering with, like it could be better if they would just end it all.

    I am not sure, I have never been in this situation, but I would be to worried to leave it to them and tend to think that if I had a friend who I thought was depressed I would feel far better if I took the reins and got them some help instead of waiting on them to ask for it.

  • sadie

    March 20th, 2014 at 3:53 AM

    Any of us who have lost a family member to suicide I think are always going to be on the lookout for the same sort of signs within ourselves.
    We instinctively know the kind of pain that we suffered as a result of that loss and would never want to inflict that same sort of hurt upon the people in our own lives whom we love.

  • John S

    March 20th, 2014 at 12:22 PM

    I especially worry about anyone who is very sick and has no family to support them through it. That can be a very tough time and if they have no hope for improvement then they could have a tendency to fall into a deep depression.

  • Dr. Andrew Mendonsa

    March 20th, 2014 at 2:01 PM

    Great comments everyone. I always enjoy folks talking about such an important topic. I look forward to reading many many more!!

    Dr. Andrew Mendonsa
    DrMendonsa.com

  • stressmom

    March 21st, 2014 at 4:01 AM

    Suicide is such a terrible way to have to lose a loved one that I can’t imagine that someone who has gone through this would ever wish that kind of loss on anyone else, and yet if this has happened in your family you could be even more susceptible to the lure of thinking that this would be the perfect way to end that kind of pain. You may be more aaware of it but that doesn’t mean that you could know how to control or even end the pain once it began. There has to be more to this than just being self aware. It has to be something where there is a whole big system in place and hopefully you have done a lot of processing and hard work in advance so that you could never get to the point of thinking that this could be an option or a way out.

  • ronald p

    March 21st, 2014 at 11:27 AM

    You see someone who has been down getting their things together and taking care of business, like they won’t be here tomorrow, then you don’t want to ignore that kind of stuff. They have something in mind, like maybe they won’t be here to take care of it tomorrow, so you need to step in today and do something.

  • Aiden

    March 22nd, 2014 at 6:09 AM

    As someone unschooled in this I would say that it is hard to know when someone is serious in their intent or when someone is merely putting out a cry for help. I know that neither should be ignored but obviously one would be a little more serious than the other. But how would someone like me be able to differentiate? And what if the person in need was very ambivalent about asking for or receiving help? I mean, I can’t just take them to a mental hospital and drop them off! There has to be another way, and I would feel like such a failure if I wasn’t the person who was able to talk them down if they really were on the edge of doing something terrible.

  • spencer

    March 22nd, 2014 at 1:42 PM

    It is important to remember that depression does not automatically lead to suicidal thoughts. Just because someone is depressed does not mean that they will always get to the point where they would wish to end it all. This could happen to some people and sadly it does but this is not always the case. There are just some people for whom depression is a fact of life and they have to be careful about that and make sure that they receive treatment for it. There are so many things that can help them too, be it therapy or medication or even just a change of scenery can work wonders. Depression of course is not something that you will want to play around and ignore but it is not automatically going to lead to a worse case scenario all the time.

  • Tiffany

    March 24th, 2014 at 4:00 AM

    I have a question that veers off topic just a little bit but I thought why not ask here. I have a friend who is always talking about how depressed she is and stuff and it almost seems like overkill, you know? Like she is just wanting attention? And I am afraid to not do anything because I don’t want that hanging over my head but then when I suggest that she go get some help she just kind of laughs it off like I have no idea what I am talking about. This confuses me, hurts me, even though it really shouldn’t even be about me at all! What should I do to make sure she gets the help but at the same time not feel like I would have to feel so guilty about it?

  • Rena

    March 25th, 2014 at 4:36 PM

    Maybe the recent death of designer L”wren Scott will bring this issue into the spotlight even more

    Apparently friends and family both were shocked at her suicide so no one was aware of the pain she was inwardly living with

  • kris

    March 26th, 2014 at 5:00 PM

    When you are aorund someone all the time then it should be easy to pick up on the signs but sometimes they are pretty good actors and can be good ast masking their true feelings. You don’t have to feel guilty at not picking up on the clues but you can listen to their words and try to be sensitive when there could be something serious going on in their life. You know that a good friend os going to listen and do the same for you, this is simply what you will do for one another. Look beyond the mask when you think that they have put one up and try to get behind those layers of emotions, because this might be a time when they really need you but could be unwilling to say so.

  • JJ

    May 28th, 2014 at 9:46 PM

    I can say personally the only reason I am still breathing is that I loved the ones who loved me more than I loved myself. I have been dealing it by myself for over a decade now since I was young and while not all methods the most safe, I still have this notion I can do it you know? With the other depressed people I’ve talked to, we know we are depressed it is just the matter of actually confiding it to the people we loved. Somehow I think love is the wrong word to use for me. I have always had low self-esteem, and suicide seem the lowest I can sink into. This mindset will probably not sit well with a lot of people but I think that if I actually commit suicide, its the most selfish thing I will ever do and no matter how much I belittle myself, this is the limit for me. Maybe its the only thing that keeps me functioning and keeping it all at bay. In relation to this article, what I really wanted from people is not really a listening ear, but for people to tell me that I am strong and to cheer me on? I mean depression is a very isolating experience, a little bit like swimming a very long pool with a hidden end. I just want people to be the supporters cheering on the side, I won’t be able to see you clearly or hear you but I know you’re there. Maybe this works for me because I know I am depressed and I’ve accepted it.

  • Kelly

    June 16th, 2014 at 3:28 PM

    Well I have struggled with depression all my life and tick all the boxes.I think its only a matter of time that eventually it will be the end of me.I have had all the help I can get and know one day I will just have had enough and will quietly go

  • Melvin S.

    August 12th, 2014 at 3:09 PM

    I am a survivor of multiple attempts..I know of the despair and pain, have struggled with depression since my late teens..a few years ago I diagnosed with a progressive degenerative neurological condition not long after the end of my marriage.
    It got to the point to where I could no longer work and provide for my young son.I had battled with depression for what seemed like forever and with the mood swings and behavior I had driven my family away. So I felt I had NOTHING left …I was the failure I ALWAYS believed I was ..
    So I had all the signs and plans..I would have completed sucide if not for 2 friends who hadn’t given up on me..
    Thank the Lord!!!!
    With help of meds and caring people, I survived…was given a hundredth second chance at life.
    I had spent my entire adult life as both a respiratory therapist and a nurse…taking care of other people and destroying me.

    So please never give up..even if you can’t see the light there is ALWAYS someone who can and will help.

    If you know of anyone showing these signs. PLEASE intervene.

  • mom

    August 12th, 2014 at 11:33 PM

    Sometimes, you’re just sad. Depression is heightened most especially for post partum moms. Just be there. You don’t have to talk much.
    The only reason i havent tried killing myself is because i want to be with my kid when he grows up.
    They say that time is faster when you’re older. But when you’re depressed, time is at its slowest pace. And when you’re in pain, you either want time to go faster or you want the pain to go away.
    You don’t have control over time, but you can do something about the pain. So things get in your head and you lose yourself in these thoughts. And for some people, they give in.

  • Chris

    September 13th, 2014 at 2:07 PM

    “Depression and Suicide: How to Know When You Need Help”

    Speaking as a survivor of three serious overdoses and eight inpatient hospital stays, if you’re depressed enough to be experiencing suicidal ideation you’re already PAST the point you should be seeking help. The better scenario would be therapeutic intervention before a depressive episode becomes so severe.

    Please be aware of the earlier signs of depression in yourself and others to help minimize how many of us must cope with the hell of suicidal thoughts and actions.

  • hester

    January 25th, 2015 at 2:25 PM

    6 days ago I felt so tired and alone, despite having two beautiful children who love me… I drank half a bottle of gin and took a combination of mirtazipine paracetamol and ibuprofen.
    I can’t remember much…other than I trashed my bathroom. Was vilantly sick and have bruises all over me. I was sick a lot and slept alot. Obviously I didn’t take enough to die. Yesterday was the first day i felt normal. Worried about the damage I could’ve done but sure I’m fine. My worry is for the next time. It will come. Though right now I’m filled with guilt…for wanting to leave my responsibility as a mother. I love my beautiful angels so much but I can’t take anymore on my own. I’m either lucky or unfortunate… I don’t know which.
    Depression isn’t a feeling…it’s deeper. I don’t know where I go from here. … People don’t understand if untouched by this nightmare I feel I’m in.

  • Lisa

    January 26th, 2015 at 1:45 AM

    Hester, it sounds like you are in so much pain right now. You love your children on one hand, but are struggling with deep depression on the other. Feelings of guilt on top of it all make it even tougher. Please call the National Suicide Prevention Lifeline. 1-800-273-TALK) The people who answer are very caring and talk to lots of people who are dealing with similar feelings and circumstances. They can help you, in a very safe and non-judgmental way, by listening to what you are going through and helping you explore options to keep yourself safe. So glad you shared! You’re not alone.

  • TopKat

    January 26th, 2015 at 3:42 AM

    I was diagnosed with a type of depression called Dysthmia a little over a year and a half ago. Plus I was diagnosed with GAD… I have experienced a lot of crazy drastic life changes and its been really hard to get my footing so to speak.
    I scared myself one night a few months back, because when I was standing outside on my balcony I contemplated falling off. Me? I’m never like that… And why?
    Between my divorce, moving away from family and lived ones, death of my parent and grandparent, having to live with my childhood sex abuser as an adult, and putting my beloved pet down and relationship struggles… I have become isolated and lonely.
    These feelings I battle with are not me.. So I get frustrated.. Its like I know better but my feet are stuck in tar, and sometimes I can’t get motivated, I can’t concentrate, negative thoughts play like a nonstop record. I feel like wherever I step its not a good direction.
    How do I get out of this prison I’ve allowed myself to get into? How? What if that dark thought of ending it all comes back? What then? If I can’t understand this how can I expect to tell someone to get help when it just snuck up on me like that?…

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    January 26th, 2015 at 8:57 AM

    Hi TopKat,

    We received the comment that you submitted on our blog earlier today. Thank you so much for visiting GoodTherapy.org. If you are experiencing a life-threatening emergency, in danger of hurting yourself or others, feeling suicidal, overwhelmed, or in crisis, it’s very important that you get immediate help! You can do one of the following immediately:

    • Call your local law enforcement agency (911);
    • Go to the nearest hospital emergency room;
    • Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TTY:1-800-799-4TTY)

    The National Suicide Prevention Lifeline is equipped to take a wide range of calls, from immediate suicidal crisis to providing information about mental health. Some of the reasons to call are listed below:

    • Call to speak with someone who cares;
    • Call if you feel you might be in danger of hurting yourself;
    • Call to find referrals to mental health services in your area;
    • Call to speak to a crisis worker about someone you’re concerned about.

    If you are a victim of domestic violence, you can call your local hotline and/or call the National Domestic Violence Hotline at 1−800−799−SAFE (7233) (TTY 1−800−787−3224)

    RAINN provides support for sexual assault victims and their loved ones through two hotlines at 800.656.HOPE and Online.RAINN.org. Whether you are more comfortable on the telephone or online, RAINN has services that can guide you in your recovery.

    • The National Sexual Assault Hotline: If you need support, call 800.656.HOPE, and you will be directed to a rape crisis center near your area.
    • The National Sexual Assault Online Hotline: is the first secure web-based crisis hotline providing live and anonymous support through an interface as intuitive as instant messaging.
    • For more information visit http://rainn.org/get-help/national-sexual-assault-online-hotline.

    Warm regards,
    The GoodTherapy.org Team

  • Thomas C.

    September 6th, 2016 at 2:36 AM

    I am bipolar and have been in a severely depressed state for several weeks. For the past couple of weeks I have been having continuous suicidal ideations. My wife died a little over a year ago and that was when I started to have trouble, she was a stabilizing influence on me and the loss of her has hit me hard. Ever since, I have been living by sheer force of will. It is exhausting, and I dont know how much longer I can go on.

  • The GoodTherapy.org Team

    September 6th, 2016 at 12:14 PM

    Hi Thomas,
    Thank you for your comment. We hope you will consider the resources mentioned above if you are ever in danger of harming yourself or others, or are ever in crisis. Please remember there are people who care, and help is available.

    We are thinking of you and wishing you the very best! ♥
    Warm regards,
    The GoodTherapy.org Team

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