Treatment for suicidal thoughts and/or attempts is best determined by one’s specific situation, level of risk, and possible underlying causes (i.e other mental health diagnoses).
Identifying and treating any underlying causes and/or mental illness and dealing with any stressors can reduce the risk of suicide. Some treatments for mental illness (i.e, major depression and bipolar disorder) may reduce suicide risk. Various medications have also been shown to help reduce the risk of suicide. These medication include: Lithium, a mood-stabilizing medication used for bipolar disorder or major depression, has been shown to decrease suicides. Similarly, clozapine , an antipsychotic medication, may also reduce the risk of suicide in people with mental illness such as schizophrenia. Keep in mind however, it is not clear if these medications reduce suicide risk when used to treat other underlying diagnoses.
In addition to pharmacologic interventions, there are two types of approved psychotherapies for treating those who attempt suicide: cognitive behavior therapy for suicide attempters (CBT for suicide attempters) and dialectical behavioral therapy (DBT) for patients with borderline personality disorder and recurrent suicidal ideation and behaviors.
Treatment for Major Depression
Research also supports that educating and teaching healthcare professionals to identify sign/symptoms of depression can reduce suicide rates. The following sections emphasize various treatment methods for depression focusing on medications and psychotherapies.
Many medications are available to treat depression, the most common of which are antidepressants. There are about twenty-two medications currently approved by the FDA. Because there is no clear match of a person’s symptoms to a medication, it may be necessary to try a few different medications before finding the best one. To ensure the most effective treatment, the person who may be depressed should discuss with their doctor the medication choice and how to take it, as well as the potential side effects.
When the optimal dose with the best medication is achieved, the antidepressant may take from 4–12 weeks to achieve maximum benefit, but it is possible for one or two symptoms to improve in the first few weeks.
When antidepressants are started or when doses are increased, a few patients, especially children, adolescents and young adults, may experience increased anxiety, agitation, restlessness, irritability or anger which may lead to suicidal thoughts or attempts. These should be outlined by the doctor before the treatment begins.
Psychotherapy, also referred to as counseling, encourages you to explore issues that make you feel suicidal and develop skills to help manage emotions more effectively. A treatment plan is developed by you and your therapist to outline achievable goals. Aside from pharmacologic interventions (medications), specific types of psychotherapies have been used to effectively treat mood disorders such as depression. Oftentimes, treatment is short-term (12-16 weeks), formalized and interactive. Sessions may take place one to two times a week with a professional who has been specifically trained and certified in the treatment they are using. However, long-term treatment plans are possible.
The most common types of psychotherapy for depression are cognitive behavior therapy (CBT), interpersonal therapy (IPT), behavioral activation (BH), and cognitive behavioral analysis system of psychotherapy (CBASP). Research supports combining various antidepressant medications with a psychotherapy to promote the best possible outcomes.
If the depression does not respond to treatment due to severity of persistent psychotic symptoms, additional treatments should be explored. One alternative treatment is electroconvulsive therapy, which can be given as an outpatient or inpatient. However, this form of treatment does require anesthesia and the delivery of a small electric current to the brain. It is remarkably effective but can have side effects, which should be considered prior to beginning treatment. Another alternative, similar to ECT, is transmagnetic stimulation (TMS). This treatment method is less intense, but may not be as effective. Lastly, individuals suffering from seasonal depression or seasonal mood disorders may benefit from light therapy in combination with other treatment modalities.
Treatment for Bipolar Disorder
Individuals with Bipolar Disorder are also at high risk of suicide. This disorder is oftentimes characterized as mood swings from manic to depressive, oftentimes with periods of normality in between. Those with Bipolar Disorder are at greatest risk for suicide when they are in a depression state. Treatment consists of a mood stabilizing medication, such as Lithium (noted above), mood stabilizing anticonvulsants, or antipsychotics. The use of antidepressants for the depressive phase may also be one form of treatment.
Treatment for Alcohol and Drug Abuse
When combined with Depression, Bipolar Disorder or any mental disorder, alcohol and drug can greatly contribute to one’s suicide risk. During treatment, it is essential that the patient be completely open about his/her history of drug use to help ensure proper treatment. Treatment for alcohol and drug use comes in many forms, but is oftentimes associated with psychosocial component.
American Foundation for Suicide Prevention. (2017). Treatment. Retrieved from https://afsp.org/about-suicide/preventing-suicide/
WebMD. (2016). Suicidal Thoughts. Retrieved from: http://www.emedicinehealth.com/suicidal_thoughts/page6_em.htm