Treatment for people who are at risk for suicide

There are no treatments that specifically stop suicidal thoughts. However, for each individual, identifying and treating any mental illness, and dealing with any stressors can reduce the risk of suicide. Some treatments for mental illness, including major depression and bipolar disorder, have been shown to reduce suicide risk. Certain medications have been shown to reduce the risk of suicide. 

Lithium (Eskalith, Lithobid), a mood-stabilizing medication used for bipolar disorder or major depression, has been shown to decrease suicides associated with depression.

 Similarly, clozapine (Clozaril, FazaClo), an antipsychotic medication, can reduce the risk of suicide in people with schizophrenia. It is not clear if these medications reduce suicide risk when used to treat people with other diagnoses.

In contrast, there have been concerns that antidepressants actually increase the risk of suicidal thoughts. In fact, the U.S. Food and Drug Administration (FDA) has required a warning stating that antidepressants may increase the risk of suicidal thoughts in children, teens, and adults in their 20s. There was no evidence that these medicines increased suicidal behavior in older people. This warning was based on a review of studies that suggested this increase. Some researchers and clinicians disagree with this warning and feel that not prescribing antidepressants has actually increased suicidal thoughts and attempts, since fewer people are treated for depression. Ongoing studies will hopefully answer these questions more clearly. In the meantime, it is important that people taking antidepressants know about this risk and are given information about how to get help if they have suicidal thoughts.

People who frequently have suicidal thoughts may benefit from specific types of psychotherapy ("talk therapy" or counseling). Cognitive behavioral therapy (CBT) addresses negative thoughts and cognitive distortions. Cognitive distortions are ways that the mind reads things around us in an overly negative way (for example, if someone receives a critical comment from one person, they believe everyone thinks badly about them). By repeated practice, people can learn to overcome these thought patterns and reduce depression and suicide risk. CBT has been shown in many research studies to help improve symptoms of depression and anxiety disorders. Similarly, dialectical behavioral therapy (DBT), a type of therapy developed to help people with borderline personality disorder, also can reduce suicidality. DBT uses mindfulness and other coping skills to decrease impulsive and destructive urges that can lead to suicide attempts.

Nonemergency situations

If you have suicidal thoughts, but aren't in a crisis situation, you may need outpatient treatment. This treatment may include:

• Psychotherapy. In psychotherapy, also called psychological counseling or talk therapy, you explore the issues that make you feel suicidal and learn skills to help manage emotions more effectively. You and your therapist can work together to develop a treatment plan and goals.
• Medications. Antidepressants, antipsychotic medications, anti-anxiety medications and other medications for mental illness can help reduce symptoms, which can help you feel less suicidal.
• Addiction treatment. Treatment for drug or alcohol addiction can include detoxification, addiction treatment programs and self-help group meetings.
• Family support and education. Your loved ones can be both a source of support and conflict. Involving them in treatment can help them understand what you're going through, give them better coping skills, and improve family communication and relationships.