13 Tips for Coping with Suicidal Thoughts

How Depression and Suicidal Thoughts Can Be Managed

If you have been struggling with suicidal thoughts, you are not alone. Having thoughts of wanting to take your own life is a common occurrence among those dealing with depression. It is important to remember, however, that what you are feeling does not have to translate into action.

Your life circumstances are constantly changing and your feelings will also change, no matter how hopeless it feels right now. Although it may be hard to see it when you are feeling deeply depressed, there is hope for you.

Depression is a treatable illness and there are many options that may help you. Even if one treatment does not help, this does not mean that another treatment won't. In the meantime, there are steps you can follow to cope with your feelings until they pass.

1
Seek Professional Help

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If you are not currently receiving treatment for your depression, this step could involve setting up an appointment with your family doctor or a psychiatrist to be evaluated and treated. If you are already in treatment, but are struggling, your doctor will be able to help you, either by working with you to make changes in your treatment plan or by helping you to be admitted to a hospital until the crisis passes.

Psychotherapy, also known as "talk therapy," is a first-line treatment that your doctor may recommend for your depression, either alone or in combination with an antidepressant. In studies comparing the two, psychotherapy appears to work about as well as antidepressants at helping to alleviate symptoms, although if you are feeling suicidal and need quick relief, psychotherapy alone may not be your best option.

Combining therapy with an antidepressant is probably a better choice since the two treatments together give better results than either treatment alone. Within a matter of weeks, an antidepressant can correct the chemical imbalance that is causing your depression, while psychotherapy can give you the tools needed to cope with your current depression and help prevent future episodes of depression.

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2
Medications

Prozac, Paxil and Zoloft anti-depressant tablets, close-up. Credit: Jonathan Nourok / Getty Images

Antidepressants are generally the first treatment that your doctor will try. If you have already tried an antidepressant without success, this does not necessarily mean that you should give up. Sometimes it's a matter of trying a different antidepressant or finding the right combination of antidepressants.

In the STAR*D study, which sought to determine the best treatment strategy when an initial antidepressant fails to work, it was found that about one-third of all patients achieved complete relief from their symptoms with their first antidepressant. In addition, another 10-15 percent achieved at least 50 percent improvement in their symptoms.

These may seem like rather dismal statistics, but if additional treatment levels were added -- either changing medications or adding additional ones -- recovery rates improved. In fact, 70 percent of patients experienced complete relief of symptoms when they reached the fourth level of treatment. So don't give up on treatment too early.

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3
Call a Suicide Hotline

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Suicide hotlines are an important resource. They are free and can connect you with a counselor who will allow you to talk about your feelings in a safe environment.

4
Avoid Alcohol and Drugs

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While it may be tempting to hide from the pain by using drugs or alcohol, this is actually a bad idea. Alcohol can intensify your feelings of sadness and hopelessness. In addition, alcohol and drugs may lower your inhibitions, making you more likely to act on your feelings.

5
Problem Solving

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If your depression is related to a situation in your life, it may be helpful to spend some time problem solving. If your problem feels particularly large or difficult, focus on what "baby steps" you can take that will lead you in the direction of a solution. As the Chinese philosopher Lao Tzu once said, "A journey of a thousand miles begins with a single step."

6
Make Your Environment Safe

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This could involve removing items from your home that you may feel tempted to use to hurt yourself, such as pills or guns. If removing these items from your home isn't feasible, remove yourself from the situation by going somewhere else for a while.

7
Go Through Your Reasons for Living

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When you are feeling bad, it's very easy to forget all the positive things that you still have in your life. Are there people in your life who would be hurt by your death?

A beloved pet that needs your care? Maybe you have goals that you still haven't accomplished? Whatever your reasons, take some time to think about them and acknowledge that perhaps your life means more than you think.

8
Seek Human Contact

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Although your first inclination may be to isolate yourself in your home and avoid contact with other people, it can be helpful to do just the opposite: Go out for a walk; go shopping; seek out human contact.

It will help distract you from your thoughts and, by being in a situation where you can't easily act on your feelings, it will keep you from harming yourself.

9
Speak with Someone You Trust

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Often it can be a big help just having someone to whom you can express your feelings. This person could be anyone you trust, such as a friend, relative, clergy or therapist.

10
Distract Yourself

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Often, coping with your suicidal feelings is simply a matter of waiting until the medication kicks in or your circumstances change. While you are waiting, however, it can help for you to find ways to distract yourself from the emotional pain.

Make an agreement with yourself that just for a little while (as long as it takes to watch a movie, phone a friend or perhaps go to work), you will not focus on your darker thoughts. As you string together these shorter periods of distraction, enough time will eventually pass for you to start feeling better.

11
Remind Yourself of Past Experiences

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Have you been through other episodes of depression? Think back to what steps you took that helped you then - and repeat them. Most importantly, remind yourself that the painful feelings eventually passed.

12
Electroconvulsive Therapy and Transcranial Magnetic Stimulation

An rTMS session (repetitive transcranial magnetic stimulation) carried out by a nurse.. Credit: BSIP/UIG / Getty Images

If you are in immediate danger of hurting yourself, you haven't responded well to antidepressants, or there are medical reasons why antidepressants are not a good idea for you, your doctor may opt to prescribe electroconvulsive therapy (ECT). ECT, which involves applying an electrical pulse to the scalp in order to induce a seizure, works rapidly and will provide relief for about 80 percent of patients. Although the procedure may have undesirable side effects, such as memory loss, it may be a good option for you if you need to feel better quickly.

Transcranial magnetic stimulation involves stimulating a particular area of the brain with magnetic pulses but is less invasive than ECT and has fewer side effects. Like ECT, it is targeted toward individuals who have not responded well to antidepressants.

In a study comparing active treatment with the Neurostar TMS therapy device with a sham treatment, it was found that the people receiving TMS had significantly greater improvement in their depression symptoms. And in another study, in which all patients received the TMS treatment, about half of patients achieved significant improvement in their symptoms after six weeks of treatment, while one-third achieved complete relief.

Although one-third might seem like a low figure, keep in mind that the patients recruited for these studies were individuals who were considered to be non-responders to antidepressant therapy. So, this should represent a percentage of patients above and beyond those who have already responded to antidepressants who could, if they don't give up prematurely, achieve complete remission of symptoms.

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13
Vagus Nerve Stimulation

this photographer Caption:Suburban Hospital in Bethesda, Md. Dr. Paulo J. Negro, a psychiatrist at Suburban Hospital, works with patients who have the Vagus Nerve Stimulation device implanted in their chest like a pacemaker, to help combat depression.. Credit: The Washington Post / Contributor / Getty Images

Vagus nerve stimulation (VNS), which has sometimes been referred to as "a pacemaker for the brain," is a more invasive procedure than ECT or TMS -- a pulse generator must be surgically implanted under the skin of the chest.

According to one study, 1 in 3 people who received the therapy for at least a year experienced significant improvement in their depression. All of the participants in the study were considered to be resistant to other treatment.

Sources:

Suicide Prevention Action Network. Substance abuse and suicide prevention: Evidence and implications. Retrieved Feb. 8, 2012, from the Substance Abuse and Mental Health Services Administration website.

Casacalenda N, Perry J C, Looper K. Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. American Journal of Psychiatry 159.8 (2002): 1354-1360.

Demitrack, MA, Thase, ME. Clinical significance of transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant depression: synthesis of recent data. Psychopharm Bull. 42.2 (2009): 5-38.

George MS, Rush AJ, Marangell LB, et al. A one-year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression. Biol Psychiatry 58 (2005):364-373.

Moore, David P. and James W. Jefferson. Handbook of Medical Psychiatry. 2nd ed. Mosby, Inc.: 2004.

O’Reardon, J. P., H. B. Solvason, et al.. “Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial.” Biol Psychiatry 62.11 (2007): 1208-1216.

Rush A.J., et.al. "Acute and Longer-term Outcomes in Depressed Outpatients Who Required One or Several Treatment Steps: A STAR*D Report." American Journal of Psychiatry 163.11 (2006): 1905-17.

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