Ask HN: How do you deal with suicidal thoughts ?
For the past couple of weeks, I have been having extremely suicidal thoughts.
I am getting paranoid, and even though I am sure that I am not capable of committing suicide nor do I want to, it is extremely disheartening, and very counterproductive.
If any of you have dealt with a similar situation, please let me know how to deal with this.
Thanks in anticipation.
EDIT: email: xoxo(at)hush.ai
87 comments
[ 2.0 ms ] story [ 155 ms ] threadMedical statistics seem to show otherwise. For people who undergo a first bout of depression, most people who don't medicate get better in 6-18 months and then never relapse. Whereas those who medicate have a much higher chance of relapsing multiple times later in life.
source: Anatomy of an Epidemic by Robert Whitaker.
While it's not theoretically impossible that depression is caused by a neurotransmitter imbalance, most of the evidence is against it and most researchers now reject the hypothesis. Wikipedia has a nice summary of the current consensus on the serotonin imbalance hypothesis.
Drugs can help.
If you've been tested for every nutritional imbalance, and you're getting daily exercise, and socializing sufficiently, and if your work/family situation is good, and if you're taking the appropriate nutritional supplements, and if you've already tried various therapists, then trying one of the various drugs on the market might make sense. But the fact is that these drugs aren't very effective for most people, are extremely addictive, and have a high rate of causing serious side effects, including ones that lead to permanent disability or death.
What's more, the drug makers often lie about the safety and efficacy of their drugs in the clinical trials to get them approved, so the reality is almost certainly worse than what's already being acknowledged. (C.f. all of the scandals surrounding the approval of prozac, lexapro, benzo usage, washing out placebo responders, etc.)
Among other things I didn't know, he recounted how many of the leading articles on antidepressant efficacy were in fact written by advertising companies (yes, you read that right). The pharmaceutical companies would then pay famous psychiatrists to use their names as the authors of the already-written piece. These studies were published in all the leading journals (New England, etc.). The interviewer asked this guy what consequences there had been for the psychiatrists who had been bought off in this way. He said there had been none.
He also said (no surprises here) that he and other psychiatrists routinely tell their patients the chemical imbalance theory despite knowing that there is no evidence for it, on the grounds that people want a little "knowledge" about how the drugs they're being prescribed.
That's not really true. There are several different purely biological things that have been identified as root causes of depression: chronic illnesses, inflammation, nutritional imbalances, alcohol abuse, etc. These alone probably account for more than half of all cases of depression. (IIRC just inflammation is thought to account for 30% of cases.)
Similarly, there are many more lifestyle choices that clearly contribute: stressful work/family situation, lack of exercise, poor diet, poor social life, chronic sleep deprivation, etc.
Certainly there are individuals who are doing everything right and still end up suffering from a bout of depression that lasts more than two years even with therapy. However, these are fairly rare, as in almost certainly less than 5%.
As for treating the symptoms, it's not pointless but it can be extremely damaging. It can lead to more more severe mental illness (bipolar, schizophrenia), chronic depression, psychosis, suicide, violent behavior, sexual disfunction, etc.
There definitely are times when drugs are appropriate. But telling someone who has had suicidal ideations to look into drugs as a first line treatment is extremely irresponsible. It's like telling a 13 year old kid with a pimple to look into accutane.
http://en.wikipedia.org/wiki/Major_depressive_disorder#Antid...
I cited a book that references hundreds of academic studies. You cited six paragraphs of a wikipedia article, which doesn't even cover any of the real issues/questions. Are you fucking kidding me?
There are plenty of organizations that will talk to you for free. Most large corporations have an Employee Assistance Program (EAP) that can provide you with three therapy sessions for free and virtually every healthcare plan under the sun covers mental health, it'll cost you a $15 co-pay. Go as often as you need.
I hope that you you find someone that can help you work through these issues.
- Read this: http://whitehottruth.com/white-hot/the-manifesto-of-encourag...
- If you have sappy depressing music playing all the time, turn it off. Mood is affected by music.
- Go for a walk.
- Don't drink alone.
- Go to church.
- Realize that there are things in your life that you can't change. And things that you can change. Accept the things you can't change. Change the things that you can change.
Yes, exercise.
I have dealt with this issue for 20 years. The first 10 years, I thought I was going to die. But I've learned to lower my suicidal ideation levels tremendously by trial and error.
It was reassuring for me to learn from a psychologist friend that (A) suicidal ideation is the "lowest rung on the ladder of risk", so to speak, in terms of the risk of actually killing yourself. The next rungs on the ladder are: (B) deciding to kill yourself, (C) deciding when to kill yourself, and (D) deciding how to kill yourself. With that said, if you go up a rung, you're in trouble and need to escalate your remedies.
In my experience, if you are sure you are not capable of committing suicide and/or do not want to, it's possible to live a long time with suicidal ideation, although it sucks.
Here are some tips:
* Stop drinking if you lose control of yourself while drunk, especially if you're a sad drunk. Or at least limit the number of drinks you consume.
* Suicidal ideation is a symptom of depression, which is an mechanism that evolved to tell us that our body/mind is thinking: "I don't like something about your life and you need to change it." Focus on changing those somethings.
* You are allowed to have "bad thoughts" like "I am so depressed". However, you cannot allow yourself to have "bad thoughts about bad thoughts" or what I call "meta thoughts". In other words, you can't think "I am so depressed that I'm still depressed." Meta thoughts lead to bad thought spirals which increases suicidal ideation.
* Exercise does not ameliorate this condition for me, but it may for you, try it?
* Reduce the amount of stress in your life. This definitely contributes to depression. But really, you need to figure out why your body/mind is rebelling against you. If you're trapped in a bad job/relationship, you need to fix that.
* Watch this video to learn about the three levels of happiness: http://blog.sokanu.com/building-a-happiness-framework-in-you...
* Like me, you probably have a very low positive affect (don't smile a lot naturally, aren't bubbly/happy). Focus on spending as much time in Flow (the second level) as possible: http://www.youtube.com/watch?v=fXIeFJCqsPs
Good luck!
Freudian/Yungian take a "mental illness model" approach that doesn't work for people like us, I believe. Cognitive Behavioral Therapy and other approaches are much more effective, in my opinion.
You should also read Martin Seligman's books (Learned Optimism and What You Can Change and What You Can't) as well, and Dan Gilbert's new book: http://en.wikipedia.org/wiki/Stumbling_on_Happiness
Research shows that medication, cognitive-behavioral therapy, interpersonal therapy, and marriage/family therapy are all beneficial.
As you've intuited, psycho-dynamic therapy (along the lines of Freud) is not shown to be especially efficacious in alleviating depression except in cases where other measures were already being somewhat effective and only over a long time.
Coming from someone who struggles with anxiety and paranoia, the first thing I was told when I went to the psychiatrist was to quit drinking. I am by no means an alcoholic, but I used to go out probably twice a week and I'd also have a beer after work to unwind.
The results were like night and day. All I had to do was not drink during the week and go out less (maybe once every two weeks). You may not be in this boat, but if you are you're doing yourself a favor to cut back.
http://pubs.niaaa.nih.gov/publications/aa41.htm
https://secure.wikimedia.org/wikipedia/en/wiki/Alcohol_use_a...
Obviously the answer then is to start drinking in the morning.
;-) ;-) ;-)
Smoking marijuana arguably leads to a 10% increased risk of developing psychosis. Whereas drinking alcohol raises your risk of developing psychosis by 800%. The public school drug propaganda programs always talk about the risks of drunk driving and liver damage, all while being completely silent about the biggest risk of all.
source: http://en.wikipedia.org/wiki/Long-term_effects_of_alcohol
I am in shape, and do exercise regularly. I don't think it makes a difference in my case.
Thanks for the links, and comments. I don't usually have a cheerful face, but yesterday I tried to keep a forced smile for the most part, because I read some literature that suggested it can improve how an individual feels. It hasn't really been useful.
I plan on seeing a doctor, but I don't have an appointment till this Tuesday.
Marty Seligman would say we have a low "happiness set point" which is extremely hard to change. I know that Paul Ekman (http://en.wikipedia.org/wiki/Paul_Ekman) says smiling can make you happier. That may be true for others, but it didn't help me. In other words, I think that trying to change your happiness set point is a low ROI investment.
In contrast, for me, sleeping well and on a regular schedule is a very high ROI investment. So is lowering stress and spending lots of time in Flow.
The poster immediately above is being genuinely helpful, but I added some caveats in response to his P.S. below.
Depression can be physiological. It can be virtually impossible to change by sheer willpower alone.
If you are going to incorporate some exercises or ideas from positive psychology (which again, should be a complement to, not a replacement for, therapy of some form), a good place to start would be the book The How of Happiness, a relatively new book by one of the most respected scientists in the field of positive psych.
It contains a popular review of the science of subjective well-being and how that relates to an individual's quest to become happier. There's also a good section about depression include a self-assessment tool that is widely used in diagnosis of depression to help place you on the scale.
What she'll say, though, in addition to explaining much about the science and its application, is that this is something you should treat as seriously as any other emerging medical condition.
I wish you the best. If you reply to any of my posts, I'll be glad to discuss the issue with you further.
Here is a NYT article about this: http://www.nytimes.com/2010/02/28/magazine/28depression-t.ht...
This really changed the way I think about depression. I now think about depression as a signal to ruminate, have insights, and make change.
However, don't try this at home, kids. I mean, it makes a lot of sense to work with a therapist/doctor, if you can find an effective one.
I'm certain there are many people here that can relate to your problems, but most of them might not want to speak up in a public forum about these issues and may prefer to contact you privately.
There was a somewhat similar post a few months back (http://news.ycombinator.com/item?id=937430) where the submitter was urged to set up an e-mail for private conversations. I think it might have helped him/her to talk to othe HN'ers in private.
Don't stay up late by yourself, sleep immediately or go somewhere where you /aren't alone/.
If there is someone, a family member or significant other that you trust, be sure to tell them how you are feeling. When you are in a dark place, it's easy to get tunnel vision. They may not be able to "fix it" the way a professional can, but they may be able to help you along and give you the perspective you need.
There is a book "Change Your Brain, Change Your Life" which has been great for me and my husband. Basically, you find out which profile fits you, and then it gives you specific advice for how to improve yourself. When I was reading my own profile, and that of my husbands, I was like yes, yes that's it! It was like it was describing us personally. And we had already learned through self-study some of the benefits that helped us. But once we saw them reinforced, we know to do them more consciously.
I can assure you right now that if you ever went through with it, there would be several (if not dozens) of devastated people going "If I had only known...!"
As for how to involve other people while still "saving face" and not being too much of a burden, I always liked Jane McGonigal's "recovery game" idea, maybe this can give you some ideas: http://blog.avantgame.com/2009/09/super-better-or-how-to-tur...
I wish you all the best!
He seemed fine. He hid his feelings well, and expected people to ask how he was doing. When people did ask him how he was doing, he'd say he was fine, again, expecting people to dig deeper.
He's gone. Forever. I think about him nearly every day and I wish he was here.
You really do have an effect on people, even if you don't think so. You do. If you're gone, people will miss you. They won't just miss you, but they'll be so stricken with grief they might not recover for a long, long time.
Fuck that. Not worth it. Not worth it for yourself or for the people you love and the people who love you.
Failing that, please please talk to your friends or even just acquaintances!
Finally, http://www.reddit.com/r/suicidewatch is a good resource for you... that's a very caring and useful community.
I hope you do fine.
If you succeeded in faking your death (very hard to do in modern society, I would suspect) you may gain some benefit from it, but you will cause problems for a lot of other people. Not to mention the problems you bring on yourself if you are caught could be very substantial.
(I thought it was a funny post though, even if attached to a serious topic. In all seriousness, if you are having suicidal thoughts, seek help.)
<Edited for length>
Hear me out for a moment.
I really like bananas... I buy a couple bunches and they're gone in a few days. Yummy. But then I don't get to the store for a while, and so on. One day not too long ago, I saw a bit of a correlation between my mood and the days I had bananas.
Digging around a bit, bananas (or papaya or dates) turn out to be one of the fruits that increase serotonin levels, one of the chemicals that might play a role in depression.
So... at this point it might be all placebo, but I don't care. I eat bananas every day and feel generally good! (Hey, it's only a couple bucks to try out, and at least it's not heroin or something!)
Naturally, the banana is no substitute for professional help, etc.
Sometimes just some proper food and sleep is all you need.
The dangerous threshold you cross is when you jump from extremely graphic, horrifying thoughts to physical activities that motion you on towards suicide. Once you, for example, start driving to a point where you want to jump off from or shopping for antihistamines to keep poison in your system, you're beyond the point where self-help can be effective.
I've been through this, and despite all the points where you tell yourself you're just going to do it, you reach a moment of mental clarity where you truly internalize the notion of suicide. You'll either push forward and decide to go on with it, or you'll realize that you just feel like shit and suicide is your pre-programmed pattern of thought for coping with it. If you decide on the former, stop and call emergency services so someone can save you from yourself.
This advice isn't pulled out my ass, either. I wake up every other day or so with the desire to crash my car into the local river or hang myself. But after thinking it through, I know it's because I have a shitty, non-relevant job and attend a crappy school in a backwater state in a country full of and run by ignorant loons. Just rationalizing my emotions removes the stinging pain that makes me want to kill myself, although I still feel the desire to bulldoze everyone in my local Wal-mart, so go figure. (-;
If you have a preferred contact method, let me know. I'd be happy to talk to you. Although I AM NOT A DOCTOR, NOR A DECENT SUBSTITUTE FOR ONE, I have been through something like this, so I may be able to provide more insight.
Take care.
We could all guess a million causes for this (drugs/alcohol/etc) - but in the end it doesn't matter. You've noticed something going on in your head, and you feel that it's not right.... so go see a doctor. or two. or three.
This by no way means you're headed towards offing yourself or going nuts. But still, see a doctor - if for no other reason than you've observed a disturbing and sudden change in your mental state that you can't explain. That's enough of a reason right there.
Probably the biggest thing(s) I've learned that help:
1. Fish-oil is considered to have an anti-depressant effect. And of all the "folk remedies" you sometimes hear about, this one has a fair amount of legitimate scientific research backing it up. I've been really depressed before, took a couple of fish-oil capsules and felt more cheerful within an hour or two.
2. Exercise does help for me. Just being "in the zone" working hard in and of itself helps, as does the "runner's high" effect. Plus it's a chance to plug my headphones in, put on some heavy metal and tune the rest of the world out and just jam. Trail running is fun and it's great exercise. I highly recommend it, along with mountain biking. But pick your own favorite.
3. Pay attention to the dialogue that's going on in your head. When you find yourself thinking "bad" thoughts, ask yourself "Wait, why am I thinking this? This is stupid, I don't want to think this crap, I'm going to think happy thoughts now." It sounds weird, but this kind of "meta" thinking does work (well, for me anyway). I was inspired by some stuff on CBT (Cognitive Behavioral Therapy), so you may find reading up on that to be useful.
There are a zillion books on dealing with this kind of stuff in the self-help section at Barnes & Noble or Borders. I have a couple, but I basically bought them, set them aside, and never read them. But you might find it useful to go in one day, browse that section, take a couple of books and go sit in the cafe and skim / read a little...you may find something useful.
4. Studying Zen Buddhism has also been helpful to me. I don't consider myself a Buddhist per-se, but I think their way of thinking to be useful. I'm still trying to adapt to it, but just reading Zen literature usually makes me feel better.
5. Eliminate negative influences as much as you can. If you have "toxic" people in your life (wife, girlfriend, friend, co-worker, boss, whatever) find some way to get away from them. The last thing you need is negative people dragging you down, or influencing you in a negative way.
And while I've never done it myself, a support group of some sort might be useful. Even if it's online and not in meatspace. If you believe - as BobbyH says below - that suicidal thoughts are a symptom of depression, you might find the /r/depression sub-reddit to be useful. I browse it every once in a while and some good stuff gets posted sometimes.
And if all else fails, my default advice is "get drunk and listen to Motley Crue." \m/
Edit: also, if you ever just want to talk, feel free to email me. My email is in my profile.
Links:
http://www.webmd.com/depression/features/fish-oil-to-treat-d...
http://abcnews.go.com/WNT/Health/story?id=129498&page=1
http://www.mayoclinic.com/health/fish-oil-supplements/AN0139...
http://www.reddit.com/r/depression
But don't be afraid to get help. Seriously, if it has come down to this low, you probably need it.
I have dealt with suicidal ideation off & on since I was around 7 years old. My brother committed suicide, and mental illness (including depression) runs in my family. I'm not crazy though, I swear :-)
I've read a number of people say things like, "It's completely normal. You just have to deal with it like everyone else." That's wrong, and really, really dangerous advice. Suicidal ideation is very different from feeling 'blue' every now and then. Suicidal ideation is an indication of something more serious, and if left unchecked can get much worse (did you read my opening line?). Not everyone can get out of depression on their own or with 'natural remedies'. Depression is an illness just like diabetes or hypertension. Sometimes medication is necessary to get better.
I'm glad to hear that you have an appointment with a doctor. That's an important step to take, even if you don't start medication or therapy. After my suicide attempt I saw a psychiatrist 2-3 times and never took medication or did any therapy, but it was honestly very helpful.
I wanted to say that point number 3 above is a huge key to getting better. Remember this: Thoughts lead to emotions, emotions lead to actions. If you don't want to commit suicide (the action), prevent what comes before it (emotions, thoughts). Don't think about suicide and you'll avoid feeling like suicide is the answer. It's hard, but it gets easier over time.
What also helped me--which my psychiatrist recommended--was to create and follow a daily routine. I freelanced from home at the time and found myself with a very erratic sleep pattern, I didn't exercise, and I rarely left my apartment. I got a part-time job that got me out of the house, stopped staying up until 2, 3, 4 in the morning, started exercising, and forced myself to do more socially with my friends. Now, I'm happy and productive.
As a side note, if you're interested in trying any natural remedies for depression, there are basically three options: 1) SAM-e, 2) 5-HTP, 3) St. John's Wort. I have listed them in the order of their generally accepted effectiveness for treating depression and, how would you say, time before affect? St. John's Wort typically takes 2-3 weeks (IIRC) before you start to feel it's effects. SAM-e is supposed to work with in a few days.
Hang in there man. Things are never as bad as you may think, and they will get better in time.
But yes, I would certainly advocate that anyone who has serious questions about their mental state see a professional therapist.
Doctor? Not me... maybe that bit was meant for somebody else? I don't go to doctors unless I see large amounts of my own blood or there's a bone sticking through the skin. :-) Interesting stuff. What's SAM? Never heard of it. 5HTP is interesting, but from what I've seen there isn't a lot of research on it. I used to drink an "energy drink" before my workouts that had 5HTP in it, but it's hard to quantify how much (if at all) it helped my mood.The comment about 'just dealing with it' wasn't directed towards you.
The comment about seeing a doctor was meant for the OP.
Perhaps I should have commented on the original post and not in reply to your comment.
SAM is S-Adenosyl Methionine (http://en.wikipedia.org/wiki/S-Adenosyl_methionine#Polyamine...). "SAM is required for cellular growth and repair. It is also involved in the biosynthesis of several hormones and neurotransmitters that affect mood, such as dopamine and serotonin."
I tried 5-HTP for a short while and felt like I had a very slight improvement in mood. I was quite depressed at the time though, so I doubt a dietary supplement would have cut it anyway.
"SAM-e" is S-Adenosyl-methionine and is messing with methylation rather than neurotransmitters directly. It can have very different effects on different people and I believe is generally more dopaminergic than serotogenic and can actually increase anxiety in some people.
If you want something 10x as effective as any listed above, look into low-dose 2,5-dimethoxy-4-iodophenethylamine .
Depression is mainly alleviated by doing something productive almost every day. That way, your night feels good because you got something done, and so does your next morning.
This http://www.informationisbeautiful.net/play/snake-oil-supplem... indicates that it's provably effective against mild depression.
I had a suicidal ideation when I was young but I realized that no matter how worthless I feel dying is the most dumbest, useless, worthless thing I can do. The ultimate loss. Ultimate fail. And no one would care so theres no epic in this. Also it would hurt only my mom who is the person I am most reluctant to hurt.
Plus even if I don't see any future for myself I am extremely curious what will future bring to the world.
Of course maybe I didn't actually learned anything and it's just my mind chemistry changing due to growing up.
http://andersonthomson.com/wp-content/uploads/2009/10/Andrew...
People rationalize to maintain their preferred emotional state. Thus, to find problems thoroughly, it helps to think the whole system is thoroughly fucked.