If you or someone you know is living with depression or bipolar disorder, you understand all too well that the symptoms may include feelings of sadness and hopelessness. These feelings can also include thoughts of self-harm or suicide. Whether we have suicidal thoughts ourselves, or know a person who does, there are ways that we can respond with strength and courage.

Understanding Suicidal Thinking

The most important thing to remember about suicidal thoughts is that they are symptoms of a treatable condition. These symptoms are not character flaws or signs of personal weakness, nor are they conditions that will just go away on their own.

Depression and the depression experience in bipolar disorder may cause symptoms such as

  • intense sadness,
  • hopelessness,
  • lethargy,
  • loss of appetite,
  • disruption of sleep,
  • decreased ability to perform usual tasks, and
  • loss of interest in once pleasurable activities.

Taken together, these symptoms may lead someone to consider suicide. However, with proper treatment, the majority of people do feel better and regain hope. Recovery is possible!

During severe depression, people may often think only of things that are negative, hopeless, and sad. Physicians refer to this as “selective memory”—only remembering the bad times or the disappointments in life. This type of thinking is a symptom of the condition; it does not define who the person is. And with proper treatment, the individual will start to remember the good times and develop a more positive outlook.

If You Are Feeling Suicidal

If you have begun to think of suicide, it’s important to recognize these thoughts for what they are: expressions of a treatable, medical health condition. Don’t let embarrassment stand in the way of vital communication with your physician, family, or friends. Take immediate action and talk to somebody today. Remember, suicide is a permanent solution to a problem that is temporary.

When people don’t understand the facts about suicide, they may respond in ways that can cut off communication and worsen their feelings. That’s why it’s important to find someone you trust and can talk with honestly and openly. It’s also why your mental health professional is an important resource in helping you—and your family.

What You Can Do to Fight Suicidal Thoughts

  • Keep a journal to write down your thoughts. Each day write about your hopes for the future and the people you value in your life. Read what you’ve written when you need to remind yourself why your own life is important.
  • Go out with friends and family. When we are well, we enjoy spending time with friends and family. When we’re depressed, it becomes more difficult, but it is still very important. It may help you feel better to visit, or allow visits from, family and friends who are caring and can understand.
  • Avoid drugs and alcohol. Most deaths by suicide result from sudden, uncontrolled impulses. Since drugs and alcohol contribute to such impulses, it’s essential to avoid them. Drugs and alcohol also interfere with the effectiveness of medications prescribed for depression.
  • Learn to recognize your earliest warning signs of suicidal feelings. There are often subtle warning signs your body will give you when an episode is developing. As you learn to manage your health, you’ll learn how to be sensitive to them. They are signals to treat yourself with the utmost care, instead of becoming ashamed or angry with yourself.

Protective Factors to Help Prevent Suicide Course

Recognizing Warning Signs in Others

Sometimes, even health care professionals have difficulty determining how close a person may be to attempting suicide. As a friend or family member, you can’t know for certain either. If you sense there is a problem, ask your friend or loved one direct questions and point out behavior patterns that concern you.

Remind your friend or loved one that you care about them and are concerned. Talking about suicide with someone will not plant the idea in their head. If necessary, recommend that they make an appointment to see their doctor and offer to go with them if you sense they would have difficulty doing it on their own. If you believe that immediate self-harm is possible, take the person to a doctor or hospital emergency room immediately.

Warning Signs

Feelings of Despair and Hopelessness

Often times, individuals with depression talk with those closest to them about extreme feelings of hopelessness, despair, and self-doubt. The more extreme these feelings become, and the more often they’re described as “unbearable,” the more likely it is that the idea of suicide may enter the person’s mind.

Taking Care of Personal Affairs

When a person is winding up his or her affairs and making preparations for the family’s welfare after they are gone, there is a good chance the individual is considering self-harm or suicide.

Rehearsing Suicide

Rehearsing suicide, or seriously discussing specific suicide methods, are also indications of a commitment to follow through. Even if the person’s suicidal intention seems to come and go, such preparation makes it that much easier for the individual to give way to a momentary impulse.

Substance Use

Someone with worsening depression may use drugs or alcohol as a coping mechanism. These substances can worsen symptoms of depression or mania, decrease the effectiveness of medication, enhance impulsive behavior, and severely cloud judgment.

Beginning to Feel Better

It might sound strange, but someone dealing with depression may be most likely to attempt suicide just when he or she seems to have passed an episode’s low point and be on the way to recovery.

Experts believe there’s an association between early recovery and increased likelihood of suicide. As depression begins to lift, a person’s energy and planning capabilities may return before the suicidal thoughts disappear, increasing the chances of an attempt. Studies show that the period 6 to 12 months after hospitalization is when patients are most likely to consider or reconsider, suicide.

Responding to an Emergency Situation

If someone is threatening to end their life, if someone has let you know they are close to acting on a suicidal impulse, or if you strongly believe someone is close to a suicidal act, you can help.

Consider these tips for helping someone in a mental health crisis

  • taking the person seriously, stay calm but take action;
  • involve other people, don’t try to handle the crisis alone or jeopardize your own health or safety, call 911 if necessary, contact the individual’s doctor, the police, a crisis intervention team, or others who are trained to help;
  • express concern and give concrete examples of what leads you to believe the person is close to suicide;
  • listen attentively, maintain eye contact, use open, supportive body language;
  • ask direct questions, find out if the person has a specific plan for suicide, determine, if you can, what method of suicide they are considering;
  • acknowledge the person’s feelings, be understanding—not judgmental or argumentative, do not relieve the person of responsibility for their actions;
  • offer reassurance, stress that suicide is a permanent solution to a temporary problem, remind the person that there is help and things will get better;
  • don’t promise confidentiality, you may need to speak to the person’s doctor in order to protect the person from themselves;
  • make sure weapons, old medications and other potentially harmful items are not available; and
  • if possible, don’t leave the person alone until you’re sure they are in the hands of competent professionals, if you have to leave, make sure another friend or family member can stay with the person until professional help is available.


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