DBSA of Memphis

Subtitle

UNDERSTANDING YOUR MOOD We’ve been there. We can help. An Introduction to Depression and Bipolar Disorder

What is a Mood Disorder?
Mood disorders are medical conditions that affect the brain. Their exact cause is not known, but we do know that an imbalance in brain chemicals plays a role. These conditions also have a genetic component, meaning they can run in families. They’re not your fault, and they’re nothing to be ashamed of. Having a mood disorder does not mean you can’t lead a fulfilling life. Everyone, at various times in life, experiences mood swings. It’s normal to feel sad on occasion— just as it’s normal to feel euphoric or on top of the world sometimes. The differences between these normal mood swings and a mood disorder are • Intensity Mood swings that come with a mood disorder are usually more severe than ordinary mood swings. • Length A bad mood is usually gone in a few days, but mania or depression can last weeks or months. Even if moods go quickly from high to low the person does not usually return to a stable mood for a long period of time. • Interference with life Mood disorders can cause serious problems, such as making a person unable to get out of bed, or causing a person to go for days without sleep or spend money he or she does not have. I’ve always had mood swings. I used to throw huge tantrums when I was a kid. As I got older, the highs got higher and the lows got lower. I lost several jobs and ruined a whole bunch of relationships. Finally, I decided nothing could be worse than living like I was, and I went to get some help. It was like my brain played a cruel joke on me. My energy and creativity were the things I relied on and when I became depressed they were completely gone, as was most of my will to live. There was no way I could “snap out of it.” The depression was stronger than I was—that’s the nature of the illness. I’m so grateful that my treatment has helped me get back to living my life.

What is Depression?
Depression is a common and treatable health problem. Depression is both physical (involving chemical changes in the brain) and psychological (involving changes in thoughts, feelings, and behavior). It’s not a character flaw or a sign of personal weakness. Just like you can’t “wish away” diabetes, heart disease, or any other significant illness, you can’t make depression go away by trying to “snap out of it.” While depression sometimes runs in families, many people with the condition have no family history of depression. It can have many causes; genetic or inherited risk, early life traumas, stressful life events, and other illnesses or injuries. Usually, it’s not one factor, but several of them combined. Common Symptoms of Depression: 
Sad, empty, irritable, or tearful mood nearly every day 
No interest in or pleasure from activities once enjoyed 
Major changes in appetite or body weight 
Insomnia or sleeping too much 
Feelings of restlessness or agitation 
Fatigue, exhaustion, or lack of energy 
Feelings of worthlessness or excessive guilt 
Difficulty concentrating or making decisions 
Thoughts of death or suicide 

Types of Depression 
There are many types of depression, but the two most common are unipolar depression and dysthymia. For information on other types of depression visit DBSAlliance.org/Depression.

Unipolar Depression Doctors use this term to describe periods of low or depressed mood that are not accompanied by high or elevated periods. It is also sometimes referred to as major depression. Patterns of depression can vary widely between people or over time. Some people experience periods of complete wellness between bouts of depression. For other people, depression is more chronic or long term.

Persistent Depressive Disorder (Dysthymia) Persistent Depressive Disorder is a long-lasting low-grade state of depressed mood, symptoms of which include poor appetite or overeating, insomnia or oversleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. The depressed state is not as severe as with major depression, but can be just as disabling.

What is Bipolar Disorder?
Bipolar disorder is a treatable illness marked by extreme changes in mood, thought, energy, and behavior. It is not a character flaw or a sign of personal weakness. Most people who live with bipolar disorder experience low or depressed periods as well as mania, or speeded up periods. Everyone can experience changes in mood, but mood episodes in bipolar disorder are severe enough to interfere with daily functioning. For some people, these high or low periods can last weeks or even months. For others, the changes are much faster—lasting just days or even hours. Some people experience feelings of depression and feelings of being speeded up or agitated at the same time.

Common Symptoms of Mania/Hypomania
Feeling overly energetic, high, better than good, or unusually irritable for at least one week 
Very high self-esteem; feeling all powerful 
Decreased need for sleep without feeling tired 
Talking more than usual or feeling pressure to keep talking 
Racing thoughts; many ideas coming all at once 
Distracted easily; thoughts or statements jumping topic-to-topic 
Increase in goal-directed activity; restlessness 
Excessive pursuit of pleasure (e.g. financial or sexual) without thought of consequences

Mixed States
When people experience symptoms of mania and depression at the same time, they’re said to be experiencing a mixed state (or mixed mania). They can have all of the negative feelings that come with depression, but they also feel agitated, restless, and activated. Those who have had a mixed state often describe it as the very worst part of bipolar disorder.

Types of Bipolar Disorder
Patterns and severity of symptoms (or episodes of “highs” and “lows”) determine different types of bipolar disorder. The two most common types are bipolar I disorder and bipolar II disorder.

Bipolar I Disorder 
Bipolar I is characterized by one or more manic episodes or mixed episodes (which is when you experience symptoms of both a mania and a depression). Typically a person will experience periods of depression as well. Bipolar I disorder is marked by extreme manic episodes. 

Bipolar II Disorder 
Bipolar II disorder is diagnosed after one or more major depressive episodes and at least one episode of hypomania, with possible periods of level mood between episodes. The highs in bipolar II, called hypomanias, are not as high as those in bipolar I (manias). Bipolar II disorder is sometimes misdiagnosed as major depression if hypomanic episodes go unrecognized or unreported.

Just Diagnosed? You’re Not Alone.
If you’ve just been diagnosed with a mood disorder, you’re not alone. Mood disorders affect more than 21 million Americans. These disorders are treatable and one of the best things you can do to help yourself in your recovery is learn all you can about your condition.

How are Mood Disorders Treated? 
The most important thing to know is that wellness is possible. There are many different paths to recovery from mood disorders, and you should keep looking until you find the path that’s right for you. A good treatment plan for managing mood disorders often includes several different tools: medication, talk therapy, personal wellness strategies, and support from a peer-run group like DBSA. 

What are the Benefits of Talk Therapy? 
You may need extra help coping with unhealthy relationships or harmful lifestyle choices that contribute to your condition. Talk therapy (psychotherapy) can be very helpful for this. Choose a therapist with whom you feel comfortable, and whose judgment you trust. The goal of therapy is for you to develop skills and behaviors that will help you cope with difficult situations and help you to become aware of, and possibly prevent, episodes of depression or mania.

Do I Need to Take Medication? 
The decision to take medication is entirely up to you and your healthcare team. Many people find medications help to keep their moods stable and prevent episodes of depression or mania. Not everyone choses to use medications and they are only one component of a treatment plan. 

What if My Medication Doesn’t Work? 
No two people will respond the same way to the same medication. Sometimes you and your doctor will need to try several different medications or a combination of medications in order to provide the improvement you need. Finding the right medications can take time. Don’t lose hope! It may also take some time for you to adjust to your medication. Most medications take two to six weeks before a person feels their full effect. So, though it may be difficult, it’s important to be patient and wait for a medication to take effect. Many of the medications that affect the brain may also affect other systems of the body, and cause side effects such as dry mouth, constipation, sleepiness, blurred vision, weight gain, weight loss, dizziness or sexual dysfunction. Some side effects go away as your body adjusts to the medication, while others can be long term. Don’t be discouraged by side effects; there are often ways to reduce or eliminate them. Changing the time you take your medication can help with sleepiness or sleeplessness, and taking it with food can help with nausea. Sometimes another medication can be prescribed to block an unwanted side effect, or your dosage can be adjusted to reduce the side effect. Other times your medication can be changed. Tell your doctor about any side effects you are having. The decision to change or add medication must be made by you and your doctor together. Never stop taking your medication or change your dosage without first talking to your doctor. Talk to your doctor before you begin taking any additional medication, including over the counter medications or natural/herbal supplements. If side effects cause you to become very ill (with symptoms such as fever, sore throat, rash, yellowing of your skin, pain in your abdomen or any other area, breathing or heart problems, or other severe changes that concern you), contact your doctor or a hospital emergency room right away.

Are There Lifestyle Changes I Can Make to Improve the Quality of My Life? 
Adopting healthy lifestyle changes will help you manage or lesson your symptoms and improve the quality of your life. Some key areas to address include 
• Reducing stress Stress can cause or worsen symptoms of mania or depression. It is important to learn what causes your stress, ways to identify and deal with stressors, and ways to minimize your day-to-day stress level. Stress may be caused by a variety of factors, both external and internal, some of which you may not be aware of. Repeated or constant stress can lead to tension, chronic pain, anxiety, and an inability to enjoy life. With the right treatment and therapy, you can learn to anticipate and deal with stress, and with support, you can work on breaking out of stressful patterns or situations. 
• Physical well-being Healthy sleeping, eating, and physical activity habits do not have to be complicated, depriving, or uncomfortable, and can make a big difference in the way you feel. Many people have found that simple changes, such as eliminating caffeine or taking walks regularly, have helped stabilize their moods. Though symptoms of your mood disorder may disrupt sleeping, eating, or physical activity, making things as consistent as possible, especially sleeping, can help keep your symptoms from worsening. Regular habits can also help you spot the beginning of a manic or depressive episode more quickly. 
• Relationships Living with a mood disorder can make it difficult to maintain friendships, family relationships, and intimate partnerships. Relationship trouble may arise from unpredictable or careless behavior during manias or social withdrawal during depressions, and may be made worse by others’ lack of understanding of mood disorders. Though you may feel lonely and isolated at times, you are not alone—almost everyone who has dealt with a mood disorder has been frustrated by interpersonal difficulties. Education, communication, and acknowledgement of feelings are some things to keep in mind when working to build or rebuild relationships. 
• Work Mood disorders can affect people on the job in many ways. Sometimes it may be necessary to reduce work hours or stop working completely in order to deal with depressive or manic symptoms. Other times, work is not a problem, but questions may arise about how open to be about your mood disorder. It is important to be in a work environment that is not uncomfortable or unduly stressful and does not aggravate your symptoms. If you are not employed, volunteer activities can help you maintain a daily routine, provide contact with others, and give you a sense of accomplishment. Whether you are employed part-time, full-time, unemployed, or involved in volunteer work, it can be helpful to consider your stress level and needs for accommodation as well as your unique skills and long-term goals.

What Can I Do to Improve Communication with my Health Care Provider(s)?
Everyone deserves to have open, trusting relationships with health care providers. You should never feel intimidated by your doctor or feel as if you’re wasting his or her time. It’s also important that you share all the information your doctor needs to help you. A complete medical history, including your medication allergies, prior experiences with medication, and any alcohol or drug use, is important to your treatment. Sometimes your doctor will also ask for your family history. Sometimes you’ll need to see one health care provider for psychotherapy or talk therapy (this may be a psychiatrist, psychologist, therapist, social worker, or other professional) and a medical doctor to prescribe medication (this may be your primary care doctor or a psychiatrist). If you have more than one person providing treatment, let them know how they can reach one another. It is best for all of you to work together to find the right treatment plan for you. You deserve to have the best treatment possible. If, after some time has passed, you feel the same way you did before treatment or worse, it is important to let your health care provider know so that they can assist you in changing your treatment plan. If you do not feel comfortable with your provider or they do not seem able to help you, you have the right to ask for a second opinion from another health care professional. Bring a list of questions with you to your doctor. Take notes so you can review them later. 

Questions to Ask Your Doctor  
How can I reach you in an emergency?  
How long will it take for me to feel better? 
What type of improvement should I expect? 
Are there any specific risks I should worry about? How can I prevent them? How can I recognize them?  
What’s the name of my medication and how will it help me?  
What dosage(s) of medication do I need to take?  
At what time(s) of day should I take them? Do I need to take them with food?  
Do I need to avoid any specific foods, medications (over the counter or prescription), supplements (vitamins, herbals) or activities while I am taking this medication? 
What should I do if I forget to take my medication?  
Is there a generic form of my medication available? If so, would it be right for me? 
What side effects might I have? What can I do about them?  
If my medication needs to be stopped for any reason, how should I do it? (Never stop taking your medication without first talking to your doctor.)  
How often will I need to come in for medication management? How long will my appointments take?  
Should I participate in talk therapy? What type do you recommend? Is it possible that I could be treated with talk therapy and no medication?  
Is there anything I can do to help my treatment work better, such as changing my diet, physical activity, sleep patterns, or lifestyle?  
If my current treatment isn’t helpful, what are my alternatives? What is my next step?  
What risks do I need to consider if I want to become pregnant? 
How will other illnesses I have affect my treatment?

How Can I Spot My Warning Signs? 
Each person is different and each person has different triggers or stressors that may cause their symptoms of depression or mania to get worse. A trigger might be an argument, visiting a particular place, having too much to do, or a major life event such as moving. As you learn more about your condition and your triggers, you will be able to spot new episodes and get help before they get out of control. Be sure your family and friends know how to look for signs that you might be having an episode. Being aware of your symptoms is a very good place to start. You may wish to take a moment to look back at the symptoms listed at the beginning of this brochure and circle the ones that apply most to you. Next, it can be very helpful to identify any events or circumstances that might trigger an increase in your symptoms. Be sure to also identify anything you can do to lessen the trigger. Now make a list of your early warning signs (feelings, thoughts, sensations, behaviors) you or others have noticed when you are starting to shift into a depressive or manic episode. Examples may include things like starting to need less sleep or not wanting to go out with friends. Also list what you may do if you notice them occurring. Take action as soon as you notice your warning signs. Don’t wait for an episode to become fullblown and cause a crisis. Call your doctor or therapist. Ask a close friend or family member to stay with you until you are feeling more stable.

What If I Start to Feel Suicidal? 
It’s especially important to have a plan in place to help yourself if you start to feel suicidal and to make a promise to yourself that you’ll use it. You can begin by using the plan on the next page. Make a list of the phone numbers of trusted friends, health care providers, and crisis hotlines you can call if you are having trouble. Your life is important, and as strong as suicidal thoughts may seem, they are a temporary and treatable symptom of your mood disorder. Get help as soon as you start having these thoughts. One national crisis hotline you can use is 1-800-273-8255 (TALK). You can also check your local phone directory or ask your health care providers for a local crisis line number. Make sure you can’t get hold of any weapons, old medications or anything else you could use to hurt yourself. Dispose of all medications you are no longer taking. Have someone else hold onto your car keys. Don’t use alcohol or illegal drugs, because they can make you more likely to act on impulse.

My Plan for Life I promise myself: If I start to think about suicide, or am in any other type of crisis, I will contact these family members or friends: NAME___________________________________________ PHONE__________________________________________ NAME___________________________________________ PHONE__________________________________________ NAME___________________________________________ PHONE__________________________________________ 
I will also:  
call my doctor or a suicide hotline, or go to a hospital if necessary;  
remind myself that my brain is lying to me and making things seem worse than they are. Suicidal thoughts are not based on reality, they are a symptom of my mood disorder;  
remember that my life is valuable and worthwhile, even if it doesn’t feel that way right now;  
stick with my prescribed treatment plan and remember to take my medications;  
remember to call my health provider(s) if I don’t feel safe or if I’m having problems; 
get in contact with other people who have a mood disorder; 
stay away from alcohol and illegal drugs; 
have someone take away anything I could use to hurt myself.  
stay aware of my moods, know my warning signs, and get help early;  
be kind to myself.

What Are Some Things I Can Do to Manage the Cost of Treatment? 
• Talk to your health care provider(s) and try to work out lower fees or a payment plan. 
• Use community or state-provided services, many of which offer a sliding payment scale. 
• Space out your allowable talk therapy visits over time and work on developing skills you can use between visits. 
• Ask your doctor to contact the pharmaceutical company that makes your medication to see if you are eligible to receive free medication. Ask if your doctor has any medication samples to give you.
• Ask your doctor to contact your insurance company and ask if they will allow more treatment for you. 
• Get help before there is a crisis. A brief appointment to talk about how you’re feeling or adjust your medication costs less than a hospital stay.

How Do Support Groups Help? 
When you are newly diagnosed, it’s helpful to have reliable, knowledgeable people around you who know what you are going through. DBSA support group participants are people with mood disorders and their friends and families who share experiences, discuss coping skills, and offer hope to one another in a safe and confidential environment. Visit DBSAlliance.org/FindSupport to find a group in your area. 

People who go to DBSA groups say that the groups 
• provide a safe and welcoming place for mutual acceptance, understanding and self-discovery; 
• give them the opportunity to reach out to others and benefit from the experience of those who have been there; 
• motivate them to follow their treatment plans; 
• help them to understand that mood disorders do not define who they are; 
• help them rediscover their strengths and humor. 
People who had been attending DBSA groups for more than a year were also less likely to have been hospitalized for their mood disorder during that year, according to a DBSA survey

How Do I Talk to Others about My Mood Disorder?
Telling others about your mood disorder is completely your choice. Some of your close friends and family members may have already become concerned about mood swings you’ve had, so they might be glad to hear you’re getting help. Other people in your life might have wrong or hurtful beliefs about mental health conditions and you may choose not to tell them. Sharing that you have a mood disorder with employers or co-workers can also be difficult. Sometimes it may be best to say nothing about your condition, unless you need special accommodations such as reduced hours or extended time off. Some people have a hard time accepting a mood disorder diagnosis. They may believe that a person should be able to control mood swings, or just “snap out of it”. Do your best to educate your family and friends by giving them information about depression and bipolar disorder. Even if they do not change their beliefs, keep reminding yourself that getting treatment is the best thing you can do for yourself. Encourage your loved ones to get help and support if they need it.

There is Help. There is Hope. 
Patience is a great help when adjusting to the effects of a new treatment, getting to know a new group of people, or waiting for your mind and body to feel better. Always remember, you are not alone, there is help, and there is hope. With treatment and support, you can feel better.

Mood Disorder Glossary 
cyclothymia: A milder form of bipolar disorder characterized by alternating hypomanic episodes and less severe episodes of depression. The severity of this illness may change over time. 
depressive episode: A period of prolonged sadness that interferes with life. 
hypomanic episode: Similar to a manic episode, but less severe. It is clearly different from a non-depressed mood with an obvious change in behavior that is unusual or out of character. 
manic episode: The up side of bipolar disorder; a period of high, energetic or irritable mood that interferes with life. 
mixed episode: A period during which symptoms of a manic and a depressive episode are present at the same time. 
persistent depressive disorder (dysthymia): A milder form of depression characterized by changes in eating or sleeping patterns, and a down, irritable, or self-critical mood that is present more of the time than not. People with dysthymia may say they are “just that way,” or “have always been that way.”
rapid cycling: a characteristic of bipolar disorder that occurs when a person has four or more manic, hypomanic, mixed or depressive episodes within a 12-month period. For some people, rapid cycling is temporary.



Suicide Prevention and Mood Disorders: We’ve been there. We can help. Understanding Suicidal Thinking


Don’t give in to suicidal thoughts—you can overcome them.

If depression or bipolar disorder affects you or someone you care about, you know that symptoms may include feelings of hopelessness and thoughts of suicide. If such thoughts occur, it’s important to remember that they can be overcome with the right kind of care, treatment, and support. 


Here are some facts to keep in mind. 

• Mood disorders are not character flaws or signs of personal weakness, nor are they conditions that will just “go away” if a person “thinks positive.” 

• Mood disorders are medical conditions caused by changes in the chemistry of the body and brain. Depression and bipolar disorder may cause symptoms such as intense sadness, hopelessness, low energy, loss of appetite, changes in sleep patterns, inability to concentrate, decreased ability to perform one’s usual tasks, loss of interest in once-enjoyed activities, and thoughts of death or suicide that can be difficult to ignore or overcome. 

• Depression and bipolar disorder are treatable with medication, psychotherapy, support from others, and wellness strategies. With the right treatment, all symptoms can improve, including suicidal thoughts. 

• The act of suicide is often a desperate attempt to relieve symptoms of a mood disorder. During a severe depression or mania, a person has little or no control over painful and disturbing thoughts and feelings. These are symptoms of the illness, not a part of a person’s true self.


About Treatment for Mood Disorders 

There are many different medications and therapies available for successful treatment. Treatment can be effective in reducing and preventing mood disorder symptoms. 

Finding the right treatment may take time. People respond differently to medication and therapy. Medication usually takes two to four weeks to reduce symptoms and may take several more weeks to provide greater relief. Some people need to try more than one medication or combination of medications before they find the one that works best. There are many different types of talk therapy and it may take time to find the right one as well as a therapist that you are comfortable with. Keep this in mind as you work with your health care provider to develop a treatment plan and while you are trying to stick with it. Never stop taking your medication without first discussing it with your doctor. 

Don’t get discouraged if your symptoms come back. Brief, re-occurring episodes of depression should not threaten your recovery if you keep in touch with your health care professional; work to find the right treatment plan and follow that plan.


If You Are Feeling Suicidal 

The belief that there is no hope is not the truth. When you feel this way, it’s your illness talking— your mind is lying to you. Remind yourself that suicidal thoughts are not reality. 

If you are thinking of suicide, it’s important to recognize these thoughts for what they are: expressions of a treatable medical condition. They are not true and they are not your fault. Don’t let fear, shame, or embarrassment stand in the way of communicating with your physician, therapist, family, or friends; tell someone right away. 

• Tell a trusted family member, friend, or other support person—someone you can talk with honestly. Try not to be alone when you feel this way. This may mean sitting quietly with a family member or friend, going to a support group, or going to a hospital or crisis center. 

• Get help. Tell your health care professional. Suicidal thinking can be treated. When suicidal thoughts occur, they are your signal that, more than ever, you need help from a professional. 

• Know that you can get through this. Promise yourself you will hold on for another day, hour, minute—whatever you can manage.


Suicide Prevention 

It’s very helpful to have a plan of action ready before thoughts of suicide occur. 

• Learn to recognize your earliest warning signs of a suicidal episode. There are often subtle warning signs your body will give you when an episode is developing. As you learn to manage your condition, you’ll become sensitive to these signs.They are signals to treat yourself with the utmost care, instead of becoming ashamed or angry. 

• Stay in contact with your doctor. Always have your doctor’s phone number with you—an office number as well as an after-hours number—and a back-up number, such as an emergency room or suicide crisis line like 1-800-273-TALK. 

• Stay in contact with trusted friends. Develop a list with phone numbers of dependable family members and friends who can give you support during a crisis. Keep the list with you. 

• Make a Plan for Life (see brochure end). Promise yourself that you will follow it if you start to have suicidal thoughts. 

• Give a copy of your plan to family and friends. Give them the plan before it’s needed, so they can act quickly if you are in crisis. Be sure to include your list of phone numbers. 

• Recognize symptoms for what they are. With your doctor, therapist (counselor), or trusted friends, identify the symptoms you are likely to experience when your condition is at its worst. Always remember: feelings are not facts. Suicidal feelings are not your fault; they are a symptom of your illness. They may not seem temporary, but they are. As you learn to manage your condition, you will be able to spot your warning signs sooner and get help earlier. 

• Write down your thoughts. Spend a little time each day writing down what things and people you appreciate and value in your life, and your hopes for the future. Read what you’ve written when you need to remind yourself why your life is important.

• Connect with other people socially. When you are feeling suicidal, don’t be alone. Walk around a mall, go to a library or park to be around people who are active and busy. Visit family and friends who are caring and understanding, even if it’s difficult. Attend support group meetings where you can meet others who understand what it’s like to live with a mood disorder. 

• Avoid drugs and alcohol. Many suicides result from sudden, uncontrolled impulses. Since drugs and alcohol can make you more impulsive, it’s important to avoid them. Drugs and alcohol can also make your treatment less effective. 

• Know when it’s best to go to the hospital. There may be times when your condition becomes so severe that hospitalization is the best way to protect your health and safety. Discuss this possibility and your options with your doctor and family before the need arises. 

• Understand your health coverage. Know whether your insurance, HMO, Medicaid, or Medicare plan provides psychiatric hospitalization coverage and how much. Keep copies of policy numbers and important health care information in an easy-to-find place. If you don’t have insurance coverage, find out what other options you have, such as community or state-run facilities. 

• Keep yourself safe. Make sure you do not have access to weapons or anything you could use to hurt yourself. Have someone hold on to your car keys when you are feeling suicidal. Get rid of all medications you are no longer taking. 

• Give yourself time to get better. When you are first treated, or when you have recently had a severe depressive or manic episode, give yourself time to heal. Allow yourself to take life a little more slowly and don’t get discouraged if you aren’t up to your previous activity and lifestyle levels right away. With continued treatment, you can feel better.


If You Are Worried that Someone Is Considering Suicide 

You cannot make someone suicidal by asking straightforward, caring questions. 

If you are prepared and informed, you will be better able to assist friends and family who are dealing with suicidal thoughts. 

It’s extremely important for people with mood disorders to receive early, quality treatment from health care professionals. If you believe someone close to you has depression, help that person find and stick with effective treatment. Be supportive, reassuring, and willing to talk about suicidal feelings and thoughts. 

While not every mention of suicidal thoughts means that a person is in immediate danger, take any mention of death or suicide seriously. If someone you know talks about suicide, asking direct questions about whether they have a plan for how, when, and where they intend to end their life may help you discover the level of crisis and how you can best help. 

It’s natural to fear that a question about suicide may anger or offend someone you care for—or even that it may put the idea of suicide into a person’s mind. However, you cannot make someone suicidal by asking straightforward, caring questions. A person considering suicide may welcome the chance to talk about these thoughts and feelings. 

Many people dealing with suicidal thoughts fear judgement, misunderstanding, and over-reaction. Focus on listening to the person instead of offering advice or countering their thoughts or feelings. It may be very tempting to jump to conclusions or try to cheer the person up by offering all the reasons they have to live, but allowing them to talk about why they’re feeling so down and why they’re considering suicide will show them that you are someone they can truly talk to.


Warning Signs that Someone May Be Considering Suicide 

• Unbearable feelings Depression causes some people to have powerful, extreme feelings of hopelessness, despair, and self-doubt.The more intense these feelings become, and the more often they are described as unbearable, the more likely it is that the idea of suicide may enter the person’s mind. 

• Taking care of affairs Making final plans, preparing wills or life insurance, or arranging for the family’s welfare is another warning sign. The person may give away valued possessions or make reference to what others will do “after I’m gone.” 

• Rehearsing suicide Seriously discussing one or more specific suicide methods, purchasing weapons, and collecting large quantities of medication are all signs that an individual is rehearsing suicide. Even if the person’s suicidal thoughts seem to come and go, it’s important to step in early and help. 

• Substance use Addiction to alcohol and/or drugs is a treatable condition that must be addressed along with the mood disorder in order for treatment to be successful. Substance use may cause impulsive behavior and make a person more likely to act on suicidal thoughts.

• Isolation If a person seems determined to cut off friendships and social connections, there’s a chance that the person might be experiencing serious depression and/or preparing for suicide. 

• Sudden sense of calm A person with a mood disorder may be most likely to attempt suicide just when he or she seems to have passed an episode’s lowest point and be on the way to recovery. If a person who was recently feeling hopeless suddenly seems very calm and settled, it may be a sign that he or she has decided on a plan.


Who Might Be at Risk 

Anyone might have suicidal thoughts at any time, but there are certain groups of people who may be at higher risk. 

• Older adults are at a higher risk because of the many stresses they may be facing, such as loss of loved ones, lifestyle changes, moving to assisted living facilities, loss of physical independence, or other illnesses. Sometimes other illnesses or medications can cause or mimic symptoms of depression, so it’s important for older adults to have complete physical examinations if they seem to have depression or suicidal thoughts. Watch for signs such as preoccupation with death, increased visits or calls, hopeless statements, or refusal to follow doctors’ orders for medication or diet.

• Young people may be at a higher risk because of family and school pressures, major life changes, and hormonal changes. Watch for signs like deliberate self-harm (such as cutting), reckless behavior, frequent “accidents,” talking or joking about death, aggression, rage, impulsive behavior, running away from home, perfectionistic behavior, and other problems, such as eating disorders or alcohol/substance abuse. 

• People who have recently had a major loss or life change. It’s normal to experience grief after a loss or need time to adjust to a major change, but if a person’s mood remains constantly down for several weeks and the person shows other symptoms of depression, there may be a more serious problem. Watch for major changes in attitude, changes in eating or sleeping habits, loss of energy, loss of interest in things once enjoyed, and statements about feeling worthless or wanting to escape. 

• People who are recovering from an episode of depression or have attempted suicide before. If the person has attempted suicide before and seems to be showing signs of depression—like isolating or not finding pleasure in things they used to enjoy—it may mean they are at risk. Studies have shown that people who have been hospitalized for depression are most likely to consider or reconsider suicide 6 to 12 months after hospitalization. 

No matter who the person is or what the signs may be, if you are worried about someone, talk to that person as well as their family or their doctor as soon as you can.


What You Can Do to Help 

Don’t promise confidentiality. Support your loved one in getting professional help. 

• Express understanding and concern. Severe depression usually causes a self-absorbed, uncommunicative, withdrawn state of mind. When you try to help, the person may be unwilling to talk. At such times it is important to let the person know you understand the reality and severity of the painful and hopeless feelings. If the person is not comfortable talking with you, encourage him or her to talk with someone else. 

• Describe specific behaviors and events that worry you. Don’t be afraid to point out particular ways the person’s behavior has changed or things that lead you to think he or she may be considering suicide. 

• Listen more than you talk. Give your loved one plenty of space to share their feelings with you, free of judgement, corrections to their feelings, or your thoughts on immediate solutions. 

• Stay calm. While you may be feeling anything but, keeping calm will help the person feel more comfortable talking with you. 

• Try to help him or her overcome feelings of guilt. Your friend or family member may be unwilling to communicate because of guilt or shame over the depression and suicidal thoughts. Remind the person that he or she is not alone and that guilt is also a treatable symptom of the illness. 

• Stress that the person’s life is important to you and to others. Remind the person in specific terms why his or her life is important to you and makes your own life better. 

• Don’t take responsibility for making the person well. Be supportive and encouraging as you help the person find professional treatment. 

• Support someone during hospitalization by making regular visits or calls and offering to take care of the person’s errands, home, children, or pets.

• Support the person as he or she recovers and help him or her develop a treatment plan, make a Plan for Life, and connect with a support group.


If Someone Is Considering Suicide 

Remind the person there is help and hope. Don’t try to handle the crisis alone. 

• Take the person seriously. Stay calm and let the person know you are willing to listen. 

• Involve other people. Don’t try to handle the crisis alone or put yourself in danger. Get help from a suicide hotline like 1-800-273-TALK, or call 911 if necessary. Ask if the person has a crisis plan. Contact the person’s family, psychiatrist, therapist, or others who are trained to help. 

• Express concern. Ask direct questions and listen.Try to find out if the person has a specific plan for suicide and what it is. It can be helpful to practice asking these questions out loud until you feel more comfortable with them. Be sure to ask in a neutral way without judgement. 

• Be understanding, not judgmental. It’s important to remember if you have not experienced suicidal thoughts, it’s nearly impossible to truly understand how the person is feeling. While the idea of suicide may be unfathomable to you, remember at this time the person likely feels that it would be better than continuing to live. Remind the person that while thoughts of suicide may feel never-ending and unbearable in this moment, they can be overcome and that you and others are here to help. 

• Never promise confidentiality. You may need to speak to the person’s family or doctor in order to protect the person. Secrecy can endanger your loved one’s life. 

• Don’t leave the person alone, if possible. Stay with them until you are sure he or she is in the care of others.


Difficult Situations 

It takes courage to help a person who is considering suicide. If the person is also abusing drugs or alcohol or is verbally or physically abusive, helping may seem impossible. You may have decided that you cannot tolerate this behavior and want to keep your distance. However, even if you keep your distance or live far away, you can still help by informing the person’s doctor, or another friend or family member who lives nearby, of the person’s suicidal thoughts. People experiencing severe depression—no matter how unreasonable or angry they become—need help.


Take Care of Yourself 

When you are helping someone else, it’s also important to take care of yourself. You may be feeling many difficult emotions as you support someone close to you who is considering suicide. Be honest with yourself about your own feelings and be sure to let yourself feel them. Don’t be afraid to ask for help. Even if you are not severely depressed, therapy and support from your family and friends can help


If You Have Lost Someone to Suicide 

• Give yourself time to grieve. You may have overwhelming feelings of anger, guilt, confusion, sadness, and forgetfulness, as well as physical aches and pains or trouble eating or sleeping. Allow yourself to feel these things and know that they are normal reactions.Try not to make any major changes in your life right away. 

• Get support. Talk to other friends and family members about what you are feeling. Find a support group for people who have lost a loved one to suicide. Don’t be afraid to seek professional help to get you through this difficult time. You may even have suicidal thoughts. If you do, get help right away. 

• Don’t blame yourself. You may have thoughts such as “What if I had done this?” or “Why didn’t I say that?” A mood disorder is not the fault of the person who has it or of anyone else, and no one is the sole influence in another person’s life. Know that this was not your fault. Allow yourself to feel angry at the person or at yourself, but work to forgive yourself and the person, too. 

• Reach out to others. When you are honest about how you feel and what you are going through, you can help others who are having similar experiences.


DBSA Support Groups: An Important Step on the Road to Wellness 

DBSA support groups provide the kind of caring and help that is important to lasting recovery. Participants are people who live with depression or bipolar disorder and their loved ones. People attending support groups say that their groups 

• give them the opportunity to reach out to others and benefit from the experience of those who have been there; 

• motivate them to follow their treatment plan; 

• help them understand that a mood disorder does not define who they are; 

• help them rediscover strengths and humor they may have thought they had lost; 

• provide a forum for mutual acceptance, understanding, and self-discovery. 

Visit DBSAlliance.org/FindSupport to find a support group near you or learn more about starting one. Take the next step toward wellness for yourself or someone you love. There is help and there is hope.


Crisis Planning 

Many depression-related suicides occur during someone’s first three depressive episodes—before he or she learns that an episode of suicidal thinking is temporary. As people learn from experience that any given episode will eventually pass, the likelihood that they will actually act on suicidal impulses drops sharply. It’s important to have a course of action ready before thoughts of suicide occur. Some people find it helpful to develop a Plan for Life. This plan lists warning signs you should watch for and actions to take if you feel that you’re slipping into suicidal thoughts.


My Plan for Life 

I promise myself if I start to think about suicide, I will contact these family members or friends:  

I will also 

 call my doctor or a suicide hotline, or go to a hospital or crisis center if necessary. 

 remember that suicidal thoughts are a treatable symptom of my illness. 

 remember that my life is valuable and worthwhile, even if it doesn’t feel that way right now. 

 stick with my treatment plan. 

 take my medications. 

 see my counselor/therapist/psychiatrist. 

 call my doctor if I don’t feel safe or if I’m having problems. 

 get in contact with other people who have a mood disorder. 

 stay away from alcohol and recreational drugs. 

 have someone take away my car keys and anything I could use to hurt myself. 

 stay aware of my moods, know my warning signs and get help early. 

 be kind to myself.