When Your Loved One Plans to Die: How to Prevent Imminent Suicide

Suicidal Thoughts…?

“Nah, she’s not going to kill herself. She’s too afraid of pain.”

“He’ll never follow through…he just keeps threatening… he’s just looking for attention…”

…“I’m so shocked he did this.  I had no idea he was thinking about suicide… I feel so bad…”

If you’re depressed, or you know someone who is, your heart may break when you hear people say things like this. Or…maybe you say these things yourself. 

Let’s talk about how depression leads to thinking about suicide… and how thinking about suicide may lead to attempting it – or worse – dying.

If you ever think about suicide yourself, I hope this discussion will give you new hope and you’ll reach out for help.

And if you love someone who thinks about suicide, I hope we can help you help them.

Suicide is the 10th leading cause of death, according to the National Center for Health Statistics, and it’s rising.  If you love someone who’s depressed, and has spoken of death or wanting to not live, you and your loved one have both suffered from this epidemic.

The higher the statistics climb, the greater urgency we all feel to find ways to stop these tragedies. But to do it, we must understand how to recognize the signs and help those caught in suicide’s web to break free, and live… really live.

Clearly this is a multi-faceted quest for everyone in healthcare, as well as families and friends of people at risk.

So, how do we know that someone near us is at risk..? 

That in itself is complicated.  Because there are those with suicidal ideation, and there are those who progress from ideation, or thinking about suicide …to doing it. 

How can we know when someone is thinking about death and suicide…and how can we tell if they’ve moved on to planning to take action…?

How can you even know who’s really at risk?

Risk Factors for Depression that Lead to Suicidal Ideation

If someone has these risk factors in place, you can know they’re at risk for eventually thinking about suicide unless something changes.

So risk factors signal a possibility of danger for this person within the coming months or years. The danger to their life isn’t imminent at this point. 

Risk factors for suicidal thoughts include depression, hopelessness, the presence of nearly any psychiatric disorder, and impulsiveness.

These risk factors certainly herald the likelihood of someone thinking about death and suicide. However, they’re no help in differentiating between someone who just thinks about it, and the person who will follow through. Of course, it’s possible that any person who thinks about death and suicide, who wishes for an escape from their pain, may advance beyond the thinking stage to taking action…tragic action.

So how do we identify that person?  How can we get them help before it’s too late…?

Suicidal Ideation vs. Intent

What’s suicidal ideation? “Ideation” is a weird word, and no one really uses it, to speak of. Except in psychiatry. It means the “formation of ideas or concepts.” So it means that thoughts about suicide begin to form where they didn’t exist before. And over time those thoughts may continue to evolve.

As they unfold, sometimes they progress to more dangerous ideas and concepts, like how to commit suicide… and even when.  So it’s vital to learn to recognize the difference between when someone you love has passive thoughts of death as a relief (like if I didn’t wake up … was killed in an accident…or had a heart attack, it wouldn’t be a relief), or active and intrusive thoughts about suicide, or has active, increasingly frequent, intrusive thoughts about suicide with a detailed plan or date. Someone who has added purpose and decision to those thoughts.

As a friend or family member, hearing someone you care about talk about such terrible things can be unsettling… shocking… alarming. But it’s important to recognize these signs, pay attention to them. Give them the credibility they deserve, because shocking or not, they’re real.

E. David Klonsky and his research team published a review of the recent research about warning signs for someone likely to attempt suicide soon.  These are warning signs in someone who has the risk factors we talked about. Depression, other psychiatric disorders, hopelessness, and impulsiveness.

This focus is to go a step – or maybe two – deeper. And it’s laid out like this. Does he or she:

1. Think about death and suicide, or about hurting himself

2. Seem isolated, withdrawn, disconnected from important relationships

3. See no purpose or meaning for his life

4. Seem obsessed with death, and writes about it 

5. Display sudden changes in his personality, his sleeping patterns, his eating patterns

6. Use an increased amount of substances

7. Struggle with guilt feelings

8. Show loss of interest in academics or work

9. Exhibit paranoia and irritability

10. Feel trapped

Capability for Suicidal Action

Klonsky makes an important distinction about determining if the suicidal person is in imminent danger of taking deadly action. In addition to the warning signs above, does this person have the capability to take a decisive action to end his life or to end her life, such as: 

• High tolerance for pain

• Diminished fear of pain

• Increased fearlessness about pain

• Persistence through pain and distress

• Knowledge of and access to a lethal means of committing suicide

• Experience with self-inflicted injury

Pay attention, because this is huge. These traits and features, when paired with all the other risk factors we’ve talked about, indicate not only the serious warning of imminent deadly action, but also the capability to follow through. This is the person who sees no reason to live and is equipped to end his life when he decides to. Within minutes. Or hours. Or possibly days.

Now is the time to intervene.

But…how?

Start with calling 911 if the situation calls for it.

If calling 911 seems like an over reaction, think about the items on the lists above. If he seems isolated, withdrawn, if she seems disconnected from important relationships, step up and engage them in conversation. Look for ways to connect with him, show him he’s loved and that he matters.

If he has access to a method for ending his life, find ways to remove items that he might think of using. Reduce his capability.

At the very least, encourage him to get help. Immediately. And encourage him to not give up. If needed, encourage him to allow himself to be treated through admission to a psychiatric hospital unit to help him stay safe and stabilize on treatment.

As long as he stays alive there is hope.

So let’s talk more about that hope.

But first… there’s another element you might need to consider.

Rethink Your Trite Empty Words

What do you say to him once you intervene?  What hope can you offer?  If she’s been depressed, tormented, troubled…even agitated…for a long time, you’ve probably told her before that this situation will pass.  That their symptoms will eventually subside. That life is worth living.

He may not believe that at all anymore. At this point he may have become resigned to the belief that there is just no hope.

And quite honestly…for some there really was NO HOPE. They couldn’t see it.

But the horizon for people who battle severe depression, intractable bipolar disorder, crippling PTSD, and terrifying panic disorder… has changed.  There is new hope now.

IV Ketamine Prevents Imminent Suicide

IV ketamine treatment erases suicidal thoughts. Now that’s some HOPE for you!  It’s a 50-year-old anesthesia medicine that has all kinds of history in operating rooms, war zones, and emergency rooms around the world. This remarkable medication still hasn’t tapped all its talents.

In the last 15 years it’s been at the center of great victories and outstanding therapy for treating psychiatric mood and anxiety disorders in all ages. By applying different actions in the brain, it rejuvenates and restores synapse connections throughout the brain and helps rebuild the very structure of brain cells themselves — called dendrites and dendritic spines — prolifically branching a dense communication system between nerve cells to turbo boost the signals that make the brain function and come alive.

For children with the Fear of Harm form of Bipolar Disorder, ketamine treatment has dramatically reduced symptoms and allowed these children to feel joy, happiness, love. To have the ability to do their homework and contribute at school without torment. Some of these children feel happiness and joy for the first time with the help of ketamine. It’s like a child who’s been blind seeing for the first time.

In men and women with PTSD, it has calmed the fear, restored peace, balance, and in enjoyment in life.

For those deeply depressed, it has restored their energy, creativity, initiative, and hope.

And for those with suicidal thoughts or imminent suicidal plans, it has erased suicidal thinking fast. In minutes or a few short hours. Once those thoughts disappear, treatment can proceed to relieve depression.

No medication has been shown to erase suicidal ideation in less than 4 hours.  Well, nothing except IV ketamine. IV ketamine prevents imminent suicide so you can pause, catch your breath, and work on treatment and recovery.

IV ketamine stops suicidal thoughts.

When you help your loved one stop suicidal thoughts, there’s hope for relieving the depression, too. If he’s been taking antidepressants that haven’t helped, he’s likely a candidate for IV ketamine treatment.

No longer do you have to say, “It’s going to get better someday, I promise…somehow…”

You can say, “Dr. Calabrese has advanced treatment options. You’re going to feel so much better very soon.”

And what about you?

Suicidal Thoughts vs. Intent to Act

Do you have thoughts about death…suicidal thoughts… or even a strong plan for suicide?

Do you think about death, or about yourself dying…?

These thoughts…these images… are a sign of severe depression and your need for treatment.

IV ketamine treatment provides relief, restoration, and relaxation for 80% of patients with treatment-resistant depression at Innovative Psychiatry. We see it every day.

We know that the literature speaks of 70-75% positive outcomes with IV ketamine treatment. But keep in mind those are studies conducted to learn about ketamine using strict protocols. Research protocols don’t allow for the many adjustments we make to fit your need like we can as your doctor.

Our goal is to achieve the best outcome for each patient — taking into account all of the complexity that comes with your history, your biology, and your previous treatments. And we’ve learned that some patients need varied adjustments in dose, or perhaps a slightly longer infusion time or longer infusion series in order to achieve remission. For these reasons, some private practices are able to achieve better outcomes than larger published studies. We consistently see excellent outcomes, relief, restoration, and enjoyment of life in 80% of our patients, even when nothing else has worked.

There are the naysayers.

Who believe IV ketamine treatment is a “passing fad” or has too many “side effects.” (There is no weight gain, no sexual problems — or other side effects antidepressants are known for.) That we should wait. That it hasn’t been studied enough. And some who say that using it is premature.

Here’s what’s premature: dying before your time.

IV Ketamine Treatment – A New Frontier

IV ketamine treatment is a new frontier in psychiatric treatment.

We’re also learning that some of the 20% who aren’t helped immediately by ketamine treatment can get better over time. Weeks or months later, ketamine seems to take hold and they emerge better than ever.  We have some theories working as to why that happens.

So there’s still so much to learn, and that’s why it’s important that you communicate with us during and long after your infusion treatments are over, so we know how you’re doing. It helps us learn more about how IV ketamine treatment works for you. We offer state-of-the-art daily mood monitoring tools to make it easy. To keep you well. So you feel safe. And connected. 

If you experience visual images of death or of yourself dying, if you think about it, if you find yourself planning it…there is hope, and a way out without harming yourself. Hang on. Find safety. And call us.

IV ketamine treatment can give you relief and erase those thoughts from your mind. You can have an opportunity to redirect your life and your treatment.

We offer innovative treatment options for those with treatment-resistant mood and anxiety disorders like depression, panic disorder, bipolar disorder, PTSD, social anxiety, and OCD. If you’d like to see if IV ketamine treatment can pull you up out of despair, schedule an appointment and let’s work together to help you get better.

We’re eager to work with you and your doctors to help you achieve a healthy, balanced, restored life, and the desire to live it. 

To the healing of your best self in 2018,

Lori Calabrese, M.D.