Suicide

Suicide is a complex behaviour. Many medical, psychological and social factors such as depression, substance abuse, personal crisis, and the availability of firearms or a lethal supply of drugs can put a person at risk of suicide. Response to these risk factors varies dramatically from person to person. It is impossible to predict with certainty who will kill themselves, or attempt to do so.

A suicide attempt is a clear indication that something is gravely wrong in a person’s life. Irrespective of the race or age of the person; or how rich or poor they are, most people who commit suicide have a mental or emotional disorder. The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder. Alcoholism and other drug abuse increase the risk of suicide.

Any one of these symptoms does not necessarily mean the person is suicidal, but several of these symptoms may signal a need for help:
> Verbal suicide threats
> Expressions of hopelessness and helplessness
> Previous suicide attempts
> Daring or risk-taking behaviour
> Personality change
> Depression
> Giving away prised possession
> Lack of interest in future plans

Eight out of ten suicidal persons give some sign of their intentions. People who talk about suicide, threaten to commit suicide, or call suicide crisis centres are 30 times more likely than average to kill themselves.

If someone is suicidal:

> Trust one’s instincts that the person may be in trouble
> Talk with the person about his concerns. Communication needs to include listening.
> Ask direct questions without being judgmental. Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk
> Get professional help, even if the person resists
> Do not leave the person alone
> Do not swear to secrecy
> Do not act shocked or judgmental
> Do not counsel the person oneself

No single therapeutic approach is suitable for all suicidal persons or suicidal tendencies. The most common ways to treat underlying illnesses associated with suicide are with medication, talk therapy or a combination of the two.

Cognitive (talk therapy) and behavioural (changing behaviour) therapies aim at relieving the despair of suicidal patients by showing them other solutions to their problems and new ways to think about themselves and their world. Behavioural methods, such as training in assertiveness, problem-solving, social skills, and muscle relaxation, may reduce depression, anxiety, and social ineptitude.

Cognitive and behavioural homework assignments are planned in collaboration with the patient and explained as experiments that will be educational even if they fail. The therapist emphasises that the patient is doing most of the work, because it is especially important for a suicidal person not to see the therapist as necessary for their survival.

Recent research strongly supports the use of medication to treat the underlying depression associated with suicide. Antidepressant medication act on chemical pathways of the brain related to mood. There are many very effective antidepressants. The two most common types are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Other new types of antidepressants (e.g. alpha-2 antagonist, selective norepinephrine reuptake inhibitors (SNRIs) and aminoketones), and an older class, monoamine oxidase inhibitors (MAOIs) are also prescribed by some doctors.

Antidepressant medications are not habit-forming. Although some symptoms such as insomnia, often improve within a week or two, it may take three or four weeks before one feels better; the full benefit of medication may require six to eight weeks of treatment. Sometimes changes need to be made in the dosage or medication type before improvements are noticed. It is usually recommended that medications be taken for at least four to nine months after the depressive symptoms have improved. People with chronic depression may need to stay on medication to prevent or lessen further episodes.

People taking antidepressants should be monitored by a doctor who knows about treating clinical depression to ensure the best treatment with the fewest side effects. It is also very important that the doctor be informed about all other medicines that are taken, including vitamins and herbal supplements, in order to help avoid dangerous interactions. Alcohol or other drugs can interact negatively with antidepressant medication. One should not discontinue medication without discussing the decision with the doctor.

Suicide survivors: those left behind

When an individual commits suicide or tries to, that person's family and close friends often are devastated and experience intense and persistent pain. Suicide survivors may suffer through repeated nightmares and flashbacks of the suicide scene, and they may avoid people and places that remind them of the suicide. Some survivors lose interest in activities they once enjoyed and grow emotionally numb feeling incapable of caring. Beyond bereavement, suicide survivors may themselves become depressed or develop another mental illness due to severe stress.

It is fairly common for suicide survivors to develop a mental illness, especially depression. Counselling or psychotherapy can help one cope with the crisis. Support groups made up of other suicide survivors also can help one find one’s way through the maze of emotions and physical changes one may be experiencing. Counselling or support groups led by trained professionals are especially important if one does not one have adequate support from family and friends. Many suicide survivors refuse to seek help because they think it is a sign of weakness. But it is just the opposite. Seeking help when one needs it is a sign of strength.