Suicide: Is there anything we can do?

Recently, I was asked “if someone wants to kill themselves, is there really anything that you can do to stop them? Aren’t they going to kill themselves if they want to?” As someone who has worked in mental health almost all of my adult life, this question came as somewhat of a surprise. I have worked with many individuals with suicidal thoughts and suicide attempts. I have seen so many of these individuals recover to where they no longer think about ending their own life. I have even witnessed people who have chronic suicidal thoughts, sometimes thinking about suicide multiple times in a day, stop having these thoughts or at least thinking about it far less often. Yet, I have spent years talking to people about suicide. Most people have not. So, when people hear about rising suicide rates, it is understandable to wonder if anything can be done about it.

Fortunately, there are real interventions that matter. It is important to know that most people who attempt suicide and survive do not attempt again [1], which emphasizes how important it is to help someone during a suicidal crisis. Someone who attempts suicide is not necessarily doomed to always be suicidal. However, a past suicide attempt does remain a very serious risk factor for suicide in the future [1,2], highlighting the importance of making sure these individuals receive adequate care.

So, what can be done? 

A variety of interventions have support showing that they may help reduce suicide.

Among medication options, Lithium has support showing that it may reduce suicide.[3] Antidepressants have a black box warning from the FDA that they may increase the risk of suicidal thoughts, feelings, and behavior in young people. However, studies have shown that antidepressants, in general, may help reduce suicidal behavior in older people.[3] Prozac (fluoxetine) and Effexor (venlafaxine) specifically have support showing they reduce suicidal thinking and behavior.[3] Ketamine in IV form also has data showing it reduces suicidal ideations.[3] Clozaril (clozapine) is FDA indicated for reducing suicidal behavior in patients with schizophrenia or schizoaffective disorder.[4] Other research also suggests that Clozaril (clozapine) may help in severe cases of suicidality or self-injury for individuals diagnosed with bipolar disorder or borderline personality disorder.[5] 

Psychotherapy has also been shown to be effective for reducing suicidal thoughts and behavior. Specifically, Cognitive Behavioral Therapy has been shown to reduce suicidal thoughts in adults with depression or borderline personality disorder.[3] Dialectical Behavioral Therapy also has support in reducing suicide attempts in individuals with borderline personality disorder.[3]

The various forms of treatment discussed above are important. However, as someone who has spent years working with people suffering with mental illness, the importance of human caring cannot be overstated. Someone who is thinking about harming or killing themselves needs attention and care. It is no surprise to me that some research supports that reaching out, even doing something as simple as sending a post-card to someone recently discharged from the hospital after a suicide attempt, can reduce future suicidal behaviors.[3] Providing extra care and attention is particularly important the first year after a hospital discharge from a suicide attempt, as this is a period of very high risk for re-attempt.[3]

Another important intervention to take for individuals experiencing suicidal thoughts is to reduce access to those things that these individuals could use to kill themselves. There is strong evidence that removing the means by which a person is likely to kill themselves does reduce suicides.[6] Most suicides in the United States are from firearms [3], and helping a person who is having suicidal thoughts reduce their access to firearms may save their life. Another step that can help is properly disposing of old medications, especially opioids.[6] Removing access to other means of harm may also be of benefit.

While this blog has not covered every intervention to help prevent suicide, I hope it makes clear that if you or someone you know is having thoughts of suicide or harming themselves, help does exist. Reaching out and obtaining help is essential. Being open to talking about suicide and suicidal thoughts is important. Please be aware that 988 is available 24/7 for support if you are having suicidal thoughts. If you or someone you know is at imminent risk of harming themselves, please call 911 to make sure a life is not needlessly lost. Make sure that help is obtained even after the crisis period, as the risk does not end there. Let’s make sure we are taking care of ourselves and one another. Wishing you continued success on your mental health journey!

David Newby, APRN, PMHNP-BC

Breezy Mental Health, LLC

Disclaimer: This article is for informational purposes only and should not be used as a replacement for medical advice. Always consult with a healthcare professional for accurate information for your situation. 

References

1. Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm: Systematic review. British Journal of Psychiatry, 181, 193-199.

2. Bostwick, M. J., et al. (2016). Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew. American Journal of Psychiatry, 173(11), 1094–1100. doi:10.1176/appi.ajp.2016.15070854 

3. Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021). Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. American Journal of Psychiatry, 178, 611–624. doi:10.1176/appi.ajp.2020.20060864

4. HLS Therapeutics. (2017). Clozapine. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/019758s084lbl.pdf

5. Masdrakis, V. G., & Baldwin, D. S. (2023). Prevention of suicide by clozapine in mental disorders: Systematic review. European Neuropsychopharmacology, 69, 4–23. doi:10.1016/j.euroneuro.2022.12.011

6. Zalsman, G., et al. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3, 646–659. doi:10.1016/j.euroneuro.2022.12.011