Coping With Feelings and Thoughts of Suicide

Dr. Alan Lewis talks about "Coping With Feelings and Thoughts Of Suicide." We also covered the difference between thinking about suicide and dying by suicide, the different levels of depression, symptoms of depression and treatment for depression, the ability to cope and coping skills for handling intense emotional pain, and how to help a suicidal person.

David: HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening, I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic is "Coping With Feelings and Thoughts Of Suicide." Our guest is Alan Lewis, Ph.D., who has a private practice in Tampa, Florida. He specializes in behavior therapy.

Good evening, Dr. Lewis and welcome to HealthyPlace.com. We appreciate you being our guest tonight. What is it in an individual that allows them to cross the line from thinking about suicide to actually going through with suicide?

Dr. Lewis: When someone feels like their pain exceeds their resources and their ability to cope, suicide begins to seem like the only option.

David: So, maybe at this point it's good to talk about different levels of depression. Can you describe to us how depressed someone can be before suicidal thoughts really start to take a grip?

Dr. Lewis: It depends on the individual. In fact, some people have suicidal thoughts, and if you ask them if they're depressed they'll tell you, "no." Usually, though, someone has to be severely depressed for an extended period of time, before they attempt suicide. Although, that's not a hard-and-fast rule.

David: That leads to my next question. Can someone who is suffering from depression really tell how depressed they actually are?

Dr. Lewis: Sometimes, denial is pretty powerful. Many people, especially males, don't like to admit that they are depressed. They see it as a character flaw or a sign of weakness (Depression in Men: Understanding Male Depression).

David: Could you give us some guidelines on how to measure when you are really in trouble?

Dr. Lewis: Well, it helps to know the symptoms of depression:

• low mood for an extended period of time
• thoughts of hopelessness
• suicidal thoughts
• sleeping too much or too little
• no energy
• not getting pleasure out of things that one used to enjoy

David: What are the most productive ways to cope with thoughts of suicide?

Dr. Lewis: First, I think, it's helpful to tell yourself, "that people do get through depression and thoughts of suicide." It's also helpful to know that help and treatment for depression exist. The difficulty, sometimes, is knowing where and how to get it.

David: That's a good point. Where and how do you get help?

Dr. Lewis: It's usually best to start with your primary care physician or gynecologist, to rule in or rule out any physical factors that may be causing depression. If physical factors are ruled out, the next stop is a mental health professional. Usually, a psychiatrist or psychologist is what people think of, but there are other disciplines that can certainly treat depression, as well as provide a diagnosis.

David: I also want to mention, if money or no insurance is an issue, that there are county mental health clinics, university medical school psychiatric departments, the local United Way gives referrals, and women's shelters offer low or no-cost counseling. You don't have to be battered to take advantage of their services.

Dr. Lewis, many people, I'm sure, at one time or another think about dying by suicide. What stops them from following through?

Dr. Lewis: Having a good support system helps, although the problem is that as depression gets worse, so does isolation from other people.

We have a lot of audience questions. Let's start with this one:

arryanna: If suicide is something I often think of and have tried once, does this increase my chances of actually going through with suicide one day?

Dr. Lewis: Yes, one of the things I get very concerned about is if someone has made a previous suicidal gesture.

Cirafly: What is the best thing to do if you are feeling suicidal?

Dr. Lewis: First, give yourself some time to say, "I'm going to wait twenty-four hours before I do anything." Next, try and take some action to feel better. Talking to a friend, or some resource like a suicide hotline.

The web has definitely made getting information and help easier. The important thing is to use whatever is out there.

Mayflower: I have been suicidal in the past, and I'm looking at a three month anniversary of being out of the hospital. How can I keep out of the hospital this time and keep suicidal thoughts away?

Dr. Lewis: It's also important to remember that some people may not react well to your suicidal thoughts. That's most likely due to their fears, not something about you.

2psycho: Does one ever get totally over the feeling of wanting to die?

Dr. Lewis: It depends on how the depression has lifted and what coping skills you can learn. Remember that suicidal thoughts are a symptom of a larger problem which we have termed depression.

ccunningham: My best friend is depressed, and often has thoughts of suicide and tells me about them. She is already seeing a psychologist, but what can I do to help her the best I can?

Dr. Lewis: Be supportive, be there for her, but realize that you are her friend and that you can't be her therapist.

Keatherwood: As an online moderator of various mental health support groups, what do you suggest is the best way to deal with people who come into groups saying they are going to kill themselves, or when I receive email saying the same thing? The email is the most bothersome, as I feel a need to respond, but know they need real life help.

Dr. Lewis: Yes, that will really grab you when that happens. It helps to have ready a list of possible things they can do, but also to have some firm rules and guidelines about what is or isn't acceptable. Often, you're dealing with things like personality disorders along with the depression and suicidal thoughts and statements.

David: Here's the link to the HealthyPlace.com Depression Community. You can click on this link and sign up for the mail list on the side of the page so you can keep up with events like this.

HiddenSelf: Do you feel that self-injury is just a stepping stone towards suicide? I was depressed a few years back and suicidal. Now I just cut, but my friend fears my cuts will get worse.

Dr. Lewis: Self-injury, like cutting, usually means there's a lot more pain involved than in an uncomplicated depression. People who are cutting themselves don't necessarily want to commit suicide, but the danger is that they go further than they intended.

David: By the way, in our self-injury chat conferences, the Doctors have said that although self-injury isn't the same as trying to commit suicide, many self-injurers do suffer from depression and can feel suicidal.

2psycho: What do you do if you really want to die, but you don't want to kill yourself, because you'll hurt people around you?

Dr. Lewis: Correct, and it brings up the problem that often people are struggling with more than one problem: depression combined with anxiety, a personality disorder that complicates or worsens the anxiety and the list goes on. There's a difference between wanting to die and wanting to commit suicide. Those differences are usually best sorted out in psychotherapy.

gayisok: I have been depressed all my life, so many of the symptoms of depression you describe are normal for me. What should I watch for if things go downhill? What can I do to turn it around?

Dr. Lewis: It's really a problem when someone becomes so accustomed to their depression that it feels like the normal state of affairs. People close to you, as well as, a therapist you trust can serve as a monitor, especially on the clinical end via instruments that can help measure and scale someone's depression. Turning things around is usually a combination of the appropriate antidepressant medication and the appropriate kind of psychotherapy (not all psychotherapies are equal).

Sarah_2004: Can someone say they are depressed without a doctor saying so? I mean with it being true?

Dr. Lewis: Sure, if they're well-versed in what the symptoms of depression are. However, those kinds of decisions are usually best done by someone who is qualified to do so.

ropesEnd: David, I'd like to ask the doctor about antidepressant medications, and at what point should you be asking a doctor to take them.

Dr. Lewis: The "party line" these days for moderate to severe depression is that a combination of antidepressant medication and cognitive-behavioral psychotherapy is what works best. Some people respond to therapy alone, although it usually takes longer, some people respond very well to medication (after about 2-6 weeks, depending on the drug).

blair: Are bipolar individuals more likely to attempt suicide due to the drastic mood changes?

Dr. Lewis: Great question. The answer is, yes. Bipolar disorder (also known as Manic-Depressive Disorder) is woefully under-diagnosed in adults and children.

David: Here are a few audience comments about what's been said so far, then we'll continue with the questions:

gayisok: I know from experience you need no great degree of depression to attempt suicide, just a general malaise is enough.

lilangel: I had a similar problem as "HiddenSelf." I was cutting for some time, then became suicidal. The doctors admitted me to a hospital because I was in pain with severe depression. They were right when they said it was all in my head! That's what I believed in the beginning and I didn't want to die!

shiloh: I have a question. I've been depressed for several years, and have been in therapy and on medications for about one year. I was into self-injury for awhile and became anorexic, both to help deal with my pain. I have no coping skills, which is something I'm trying to work on in therapy. The only thing I can do when I feel helpless is cry, which doesn't seem to help much. What else can I do to cope?

Dr. Lewis: It would be helpful to know what kind of psychotherapy you've been getting. Garden-variety "talk" therapy or psychoanalytically-oriented therapy doesn't seem to help. Teaching someone alternatives to negative or depressed thoughts, strategies to cope with anxiety, all seem to do much better.

David: For those in the audience, I'm interested in knowing if you have any suggestions for dealing with the psychological issues that have come up tonight, like depression, loneliness, handling thoughts of suicide. Hopefully, by sharing some ideas here, we can also help each other.

Cirafly: Is someone more likely to commit suicide if no one is taking them seriously? How can they get people to take them seriously?

Dr. Lewis: Yes, especially adolescents. Unfortunately, they see a suicidal gesture as the only way to get someone to listen to them and to see that they're in pain. That's why it's useful to see a mental health professional, they make their living taking these things seriously!

jaymedecas: I hesitate to tell anyone in the mental health system about feeling suicidal. They will hospitalize me to keep me "safe," but hospital abuses are the reasons behind my suicidal thoughts? What else can I do?

Dr. Lewis: Definitely a dilemma. There is a difference, as I said before, about what's called "suicidal ideation" and having a plan, an intent, or having committed a suicidal gesture. Thoughts and ideas are not necessarily a reason for someone to be in a hospital. I guess it depends on how competent and trustworthy your therapist is.

David: Here are a few positive ways to cope with severe depression and thoughts of suicide:

Mayflower: Two things have been helpful to me. One is getting psychological help, and two is keeping busy. The busier I am, the less likely I am to think about suicide and be depressed. Though sometimes, this is very hard.

gayisok: I have no training, but it seems to me the best medicine is love. Even if you don't know the person, you can show them you care about them.

MKW: I found that after my serious suicide attempt, I felt better by helping others through their bad times.

trace79: I never thought that I was suicidal, but I also am trusting myself less and less. The pain in life is so much, that I'm finding it unbearable. How can I assure myself that this is not the way?

Dr. Lewis: You have to know that your thoughts are a reaction to pain. Relief is a feeling, and you have to be alive to feel relief. You also need to know deep down that help is possible and available.

beyondromanc: How can I get over my thoughts of suicide? I have a nine-year-old daughter and it tears her apart.

Dr. Lewis: Again, it depends on what's driving or causing those thoughts. If it's depression, anxiety, or a combination, those are things that have to be dealt with.

David: One thing I want to mention here, and I'm not belittling beyonddromanc, but I'm wondering how you feel, Dr. Lewis, about sharing your depression or emotional pain with your children?

Dr. Lewis: This is something that children should be kept out of. What can happen if they're not, is that they begin to feel responsible for their parent's feelings and wellbeing. In essence, it deprives them of their childhood and definitely has an impact on them when they become adults.

Morrissey: I'm a very inhibited person. I keep everything to myself. As far as I know, my family knows nothing about my depression, suicidal thoughts, or even my cutting. I can't flat out ask them for help (at least, I don't know how). What can I do?

David: There are many teens, and even adults, who are afraid to share their feelings with their parents or other family members. How would you suggest that be handled?

Dr. Lewis: It depends on how old you are. If you can seek help, do so quickly. However, have your therapist assist in dealing with your family. If you're under eighteen, you may want to find a counselor, cleric, etc. to help.

David: As I'm thinking about it, it is tough to tell someone, but if you don't, how can you expect to get help? So, as Judith Asner said last night, maybe you just have to "buck up" and ask for it directly (Surviving Bulimia Conference Transcript).

Cirafly: How do you help a suicidal person see the light at the end of the tunnel?

Dr. Lewis: Usually, things that people feel are awful, forbidden, and look a lot less dangerous in "the light of day." Once you've said things out loud, they become "dirty laundry" not "demons." As we've said before, education and knowledge are the key. Knowing that suicidal thoughts and depression can be helped is the first step in seeing the light at the end of the tunnel.

pavanne: Is it okay to say something simple like "mommy is sad" or "mommy is tired?" Kids notice something is wrong, and I think it helps to give a simple explanation, but what do you think?

Dr. Lewis: That's fine, but remember that kids are a lot more sophisticated than we think they are. It's also a matter of degree how often is mommy "tired," or "sad," and does it interfere with normal routines around the house?

David: Are there any special precautions people should take over the holidays, Dr. Lewis?

Dr. Lewis: The holidays always seem to pose a problem. People have expectations about having "the best Christmas" or the "best presents". If people would stop and think about the true meaning of the holidays, perhaps we'd have less "holiday blues."

David: Thank you, Dr. Lewis, for being our guest tonight and for sharing this information with us. To those in the audience, thank you for coming and participating. I hope you found it helpful. 

Dr. Lewis: It's been my pleasure. Thank you!

David: Thank you again, Dr. Lewis. I hope everyone has a good weekend. Good night.

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Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.