Stopping suicidal ideation?
January 12, 2011 7:07 PM   Subscribe

If you've been a suffer of depression (especially of multiple instances) and dealt with constant chronic suicidal ideation how did you stop it?

This is silly and I should know the answer to this already since I've been dealing with depression for near on 23 years now. However it escapes me and my therapist is out of town for two weeks and his service only refers to the e.r. (and this is *not* an emergency situation).

I thought I was coming out of my life long depression but these last two weeks the thoughts of suicide and ideation have increased greatly. What were once fleeting now become chronic obsession. My mindful meditation practice is now taken up with 20 minutes of how/when/where/what of death.

Needless to say this is annoying. I know I am not going to kill myself as I know too well the effect of that on those left behind but still the thoughts arise and twirl endlessly in the mind.

So what exactly did you do to get rid of those thoughts? Was there a specific sort of therapy that helped? Practices? Also, when you are in the middle of spinning how do you calm yourself down and see that these are indeed just useless thoughts and not the be-all, end-all? Is this a sign that medication is no longer working? (I've been struggling with medication regimes for 10 years).
posted by kanata to Health & Fitness (29 answers total) 38 users marked this as a favorite
Honestly, one of the things that has helped me most in years was reading this thread.
posted by honeydew at 7:14 PM on January 12, 2011 [2 favorites]

If you are having suicidal ideations, this is an ER issue. Please call someone who is close to you to come over and be with you.
posted by TheBones at 7:14 PM on January 12, 2011 [1 favorite]

My mindful meditation practice is now taken up with 20 minutes of how/when/where/what of death.

What happens in your practice when you gently and kindly remind yourself that you're thinking and return instead to your breath? Since your therapist is on vacation, your only job right now is to tolerate the thoughts and be safe, not to necessarily get rid of them.
posted by liketitanic at 7:14 PM on January 12, 2011 [6 favorites]

I never realized how much I used suicidal ideation as a security blanket until I caught myself practically using "It's okay, you can always just off yourself" as a mantra one night when I was feeling particularly anxious and stressed after a super bad day. This happened well after my three suicide attempts, and as a result I started marking off the times at which I was defaulting to ideation to show myself how often I was using it.

Each time I caught (and still catch) myself defaulting to planning, I stop what I'm doing and pick an alternative form of self-soothing from a list that I've compiled to help me get beyond my anxiety whenever it strikes. Now I exercise, I pray, I get creative, I volunteer. Each and every time, without fail. I channel the destructive energy into something positive, even if I have to guilt myself into doing it by saying, "You dumb schmuck, get your act together because you know you can do this."

Maybe something similar will work for you.
posted by patronuscharms at 7:30 PM on January 12, 2011 [14 favorites]

Please consider going to the ER, because this absolutely is an emergency. "Intrusive thoughts of suicide" are pretty much the definition of psychiatric emergency.

Medication adjustments might help, yeah. Stress reduction techniques might help. Working through the thoughts with a therapist might help.

Have you read How I Stayed Alive When My Brain Was Trying to Kill Me by Susan Rose Blauner? I really dig this book.

If you're not going to go to the ER, think about skipping meditation until your therapist is back in town. I'm very serious about this--20 minutes of free-floating suicidal ideation is not something to indulge in without appropriate support. Better to skip it and do something to distract yourself for now; you can get back to your mindfulness practices after this crisis has passed.

Seriously, this is an emergency. Even if you don't go to the emergency room, please don't feel like you have to do everything in your routine (including the meditation)--the most important thing is to keep yourself safe right now.
posted by Sidhedevil at 7:31 PM on January 12, 2011 [4 favorites]

What works for me is accepting that I'm having those thoughts and not trying to fight the fact that I'm thinking those things, but continuing to remind myself of the reasons why I won't act on them. Taking your post at face value (that you're not in crisis right now), what you're going through is something that I go through often. Keep up with the mindful meditation, it will help to get you through.

My personal perspective - suicide ideation is something similar to fantasising about winning the lottery - it won't ever happen, but it provides me with an escapist fantasy that takes me away from day-to-day problems, albeit temporarily.

As you know, depression comes and goes. Remind yourself that this too will pass. It may not make it pass any quicker, but reminding yourself of the fact that it will pass may make it easier to deal with until that time.

(I am not a doctor, therapist, psychiatrist etc)
posted by finding.perdita at 7:32 PM on January 12, 2011 [1 favorite]

Medication. Not being flippant. It is impossible to understate how much it has changed my life.
posted by schroedinger at 7:41 PM on January 12, 2011

It feels to me like this is counterproductive advice:

Keep up with the mindful meditation, it will help to get you through

but I think that you and I differ on this because this is your experience:

My personal perspective - suicide ideation is something similar to fantasising about winning the lottery - it won't ever happen, but it provides me with an escapist fantasy that takes me away from day-to-day problems, albeit temporarily.

So if the OP's experience is like yours, the meditation absolutely might help.

If the OP's experience is like mine, with a history of active suicide attempts and/or self-injury, I think it's risky to take the chance of clearing a space for suicidal thoughts during a time when they have only the ER as a support system. OP, if it's at all likely for you to act on your thoughts--if you have in the past--I really encourage you to think about taking a break from meditation for now. I am a giant fan of meditation, and of sitting with uncomfortable thoughts in general, but I don't think that doing it in a crisis when you don't have a key element of your support network in place is wise.

You can take a break from meditation during a crisis and then go back to it. You can't kill yourself during a crisis and then go back to meditation. Suicidal ideation isn't something to try and tough it out through.
posted by Sidhedevil at 7:48 PM on January 12, 2011

I understand exactly what you mean about the ideation. It's not a matter of you desiring to kill yourself, it's more a matter of intrusive thoughts.

One thing I used to do is journal particularly when things got rough.

Another thing is to anthropomorphize (sp?) the depression. I called mine the Dragon. I knew it would like to try to kill me, but instead I would envision it as a trophy head over my fireplace.

Another thing, is exercise.

By the way, maybe it's okay to ditch the meditation for now, and do something mindless. Rent a cheesy comedy, or play a fun computer game, or write a story. Or, even, pray. Talk to God about anything at all. Even something silly.

We all know that the worst way to stop thinking about something is to TRY to not think about it, so don't go that route.

And if this is a little more than just intrusive thoughts, don't hesitate to get a friend to babysit you or just hang out and play a board game or something. Or for that matter let Metafilter do it-hang out here and yack.

Ideation is freaking annoying and definitely something you want to bring up to your doc, and I agree it might mean time to up or change meds, but it isn't necessarily an emergency.


IF YOU ARE IN ANY DOUBT AT ALL GO TO THE ER. Better safe than sorry.
posted by St. Alia of the Bunnies at 8:01 PM on January 12, 2011 [1 favorite]

Sidhedevil - I completely agree. I certainly wasn't trying to suggest that if the OP is in crisis, that they should ignore that and try and get through on meditation alone - that would be stupid. I was taking the OP's post on face value - "I know I am not going to kill myself"and "this is *not* an emergency situation" - and just providing my experience as someone who has often been in a situation which sounds similar.
posted by finding.perdita at 8:01 PM on January 12, 2011

I'm not sure if I use suicidal ideation as a fantasy or stress relieving mechanism but I wouldn't be surprised.

I have just started meditation about a month ago so haven't really mastered (if you ever do) the ability to go back to the breath as easily as I like. In my recent meditations it I can only seem to do it once or twice during the 20 minutes of suicidal thoughts. Otherwise my thoughts go right back to it. Or I get taken over by intense physical sensations.

Will it do long term harm to a meditation practice to take a two week break? I have only just made it so it is a habit and not something I put off each day.

Again, there is no way I will act on these thoughts though they tell me I may so. It really is just another form of all the mindless thinking we do. Mine just take a supremely negative form.
posted by kanata at 8:06 PM on January 12, 2011

i could be writing this question. distraction distraction distraction till the therapist gets back. anything that involves activity and attention on your part. it is super annoying, i agree with you, and something i have bee dealing with for years. i KNOW i'm not going to act on the thoughts, but i can't get the damn things out of my head! so...walking around a garden. the mall. handing out with friends. cooking a tasty recipe. going to a food/wine tasting. look for a group on (i actually just found a free depression support group which i'm super excited about. and a harry potter group, which i'm equally excited about). knitting is awesome. just enough activity so you can't think too deeply about stuff, but still adequately mindless. driving around with the music blasting, singing along. volunteering. go look at the cats for adoption at the pet supply store.

point is, keeping trying different stuff till you find things that work as a distraction to *you*

memail me if you'd like, i TOTALLY get what you're talking about. and it's super frustrating.
posted by assasinatdbeauty at 8:14 PM on January 12, 2011 [1 favorite]

What worked for me: think of all the pain you'd cause if you did act upon those thoughts. The grief and sadness I'd cause others far out-weighed the importance, to me, of the sadness I was feeling.
Imagine if a parent, sibling, cousin, coworker, neighbor, or random face you saw on the street decided to off themselves - what would be the chain reaction? How would their sadness or shock affect the people around them? And worst of all: imagine the impact on the poor soul who'd find you.
posted by Neekee at 8:18 PM on January 12, 2011

oh, and eat healthy and work out. Do not underestimate the power of endorphins!
posted by Neekee at 8:19 PM on January 12, 2011

Will it do long term harm to a meditation practice to take a two week break?

I think no. And even if it did, you can always start over, especially after a month, yes?

I was taking the OP's post on face value - "I know I am not going to kill myself"and "this is *not* an emergency situation" - and just providing my experience as someone who has often been in a situation which sounds similar.

Thanks so much for taking my comment in the spirit I intended, finding.perdita. Obviously, I am filtering this through my own experience; I have said "this is not an emergency situation" about myself, and been wrong, hence my concern about the "my meditation is 20 minutes of thinking about suicide" bit, because I know that my own psyche is too fragile for that without my best support network in place.
posted by Sidhedevil at 8:28 PM on January 12, 2011 [1 favorite]

Whenever I get the suicidal ideation, that's my wakeup call that my depression is worsening (I often don't realize my mood is spiraling downward until I'm pretty far in.) When I catch myself thinking about suicide I know it's time to kick the self-care back into high gear: make sure I'm taking all my meds and supplements every day, that I'm eating reasonably well, exercising, getting dressed at some point every day, getting a few chores done, etc.

What I do in the moment to stop the thoughts: first, I remind myself that I could never do such an awful thing to my family. No matter how worthless and shitty I feel when I'm depressed, there are people who love me and would be devastated if I died... as devastated as I would be if something happened to one of them. I wouldn't want to go through a bereavement, so it would be horribly wrong of me to voluntarily put my loved ones through that terrible experience.

That usually works to stop the suicidal fantasies in the moment, and then I'll try to find something else to keep my mind occupied. The Serenity Prayer can be good... it gets my mind busy sorting my problems into categories: this one I have to accept, nothing I can do about it so I have to let it go as best I can; but that one I could probably change, so better get busy brainstorming what actions I can take.

Other things I use to keep my mind occupied in healthy ways: Humorous books, websites, TV. Journaling... sometimes just getting my thoughts onto a page will help me let go of them for awhile. Sometimes when I feel empty and pointless it's just because I don't have any goals or anything to look forward to at the moment, so planning a small fun project helps give me something interesting to think about.

Sometimes just cleaning my apartment makes me feel better... a lot of my depression and anxiety comes from worrying about things I can't control or do anything about, so being able to do something about something that is bothering me helps get rid of that antsy feeling of needing to fix something, when the real issues are things I can't really fix.
posted by Serene Empress Dork at 8:56 PM on January 12, 2011

I've dealt with suicidal thoughts all my life. Some of my earliest memories are of wanting to kill myself.
It all reached a peak in my mid-twenties, where I was fighting active suicidal thoughts every week (in my world active = actually making plans, buying pills/fresh knives etc., as opposed to passive which is wanting to die but not putting any practical work into it).
I was avoiding professional help at the time - I'd been forcibly committed as a child and had strong paranoid fears of being committed again against my will. It was then that I somehow came up with the tactic that almost certainly saved my life.

When you want to die you're completely focused on the negative, on all the pain that you want to end, all the badness in yourself. One day, as I was fighting yet another strong impulse, I found myself thinking of the last time I'd been wanting to kill myself that badly, a couple of weeks ago. And found myself thinking, "It's a good thing it didn't work last time, because I really enjoyed that movie I saw last week."
And that got me thinking, what other good things had I experienced after previous attempted suicides? What good experiences would I have lost if I had succeeded each time? They weren't huge exciting things, but in a dark life moments of happiness really shine, and when I started collecting these moments - "if I'd died that time I wouldn't have met that really interesting woman, If I'd died the time before that I would never have read that fantastic book or bought the nice silver ring..." and suddenly I had a heap of good things that, while they didn't balance out the darkness and the pain, were precious - good things that I would never have had, had I succeeded all those other times. And from there I managed to talk myself into putting off today's attempt, in the name of the next good thing that I would miss.

After that, every time I was gripped by the need to kill myself, I'd stop to think of the good things I had experienced since the last time I wanted to kill myself, things and experiences I'd never have had. A delicious meal, a cat that purred against me, an impressive lightning storm - I'd add them to the stuff-I'd-have-missed list in my head. And that would be enough to get me to put it off again.
Eventually, it became a reflex: want to kill myself > think of good things I'd have missed if I'd killed myself the last time > put aside killing myself for now. After a while I didn't even have to list the stuff, because the existence of the list became a "yeah, yeah, okay, I know" thing that automatically sapped the strength of the suicidal need.

I still fight with passive suicidal ideation. It's no exaggeration to say I think of killing myself at least once a day, but now there's so much less power in it, because the good-things list is always there to counter it. It seriously cured me of active suicidal tendencies and the passive ones are things that I can shrug off after the initial burst, because I'm used to them and I know that I'm not going to follow through.
posted by L'Estrange Fruit at 8:58 PM on January 12, 2011 [11 favorites]

You might also consider that this is a habit left over from depression. When I was depressed I would often say to myself "I want to die." At the time I actually thought it was somewhat comforting, like I was recognizing how I felt and that was better than pretending to feel good. Sometimes I would be out with friends and laughing. There would be a lull in the conversation and I would tell myself out of nowhere "I want to die." But of course that's nonsense. It wasn't comforting. It would set me spinning for the whole day thinking about it. It would ruin the best days and make me want to crawl in a whole. Just as I was feeling better, it would pull me back in. I couldn't get away from it. In every situation I was in that phrase would intrude.

After recovering from depression this phrase still, to this day, comes out of nowhere into my mind occasionally. I'll be walking somewhere, or looking in the mirror, and some part of my brain will say "I want to die." I've learned to accept that this self-talk is just a leftover habit from my depression. It's something I did so often when I was depressed that I can't just make it disappear. It has become less frequent though, the more time passes.

I understand where you're coming from. When you're trying to recover from depression, there are so many old habits that you have to break. Suicidal ideation is one of those. It's insidious and terrifying, but it's just another bad habit on some level. Recognizing this has helped me a lot. Now, whenever some part of my brain says "I want to die," I always respond back, as if making a promise. "In a hundred years," I say. "In a hundred years." Then I smile and remember how lucky I am that I survived depression.
posted by smokingmonkey at 9:12 PM on January 12, 2011 [5 favorites]

While I think your long-term practice will be just fine if you choose to set it to the side for a few weeks until you can see your doctor and get some help with the intrusive thoughts, if you're interested in an awareness-practice-based approach I can't say enough good things about The Depression Book: Depression as an Opportunity for Spiritual Growth by American Zen teacher Cheri Huber.

I truly believe this book helped save my life. I post about Cheri's work rather a lot because it's made such a huge difference for me. Although an appropriate antidepressant and some work with a good therapist helped, I think it's primarily Cheri's awareness practice teachings that have helped me go from telling my partner to pack up and remove all the medications from the house because I was afraid of what I might do with access to them, to being basically content much of the time and quite often actively happy. It's amazing. When I was deep in the Pit, I don't think I could imagine that it was possible to feel like this. The depression still jumps up and grabs me sometimes, and I still have periods of pulling the covers over my head and wishing I could die — but these days those periods are generally over within half an hour.

My own experience with suicidal thoughts makes me think I understand what you mean about being in a place of wanting to kill yourself but knowing that you're not going to, which is why I'm recommending Cheri's books. If that shifts at all, though, please do call in help. Counting your breaths can only help if you're still breathing, you know?

My very best wishes. It can get better, hard as that can be to believe when the darkness has a grip on you.
posted by Lexica at 9:24 PM on January 12, 2011

Oh, and this is sort of morbid, but it does help me get some perspective - I ask myself, and try to really imagine: "What if I were diagnosed with a terminal illness tomorrow... would I be happy about it?" Invariably the answer is no. If I found out I only had a few weeks to live I'd immediately begin lamenting all the people I'd be leaving behind and all the things I'd never get to do.

At that point, entertaining suicidal fantasies begins to seem like rather a foolish waste of time.
posted by Serene Empress Dork at 9:34 PM on January 12, 2011

Thanks for the responses. I think I will stop the meditation sessions since they are making it more intense. I have lost a brother to suicide so I know the effects on a family so that is one thing that keeps me from that edge which I can always recall.

I have done that morbid thing of wondering if I had a terminal illness what would I do. My response of late has always been one of happiness as that would mean it would be a get-out-of-life card that I could play without having to leave the guilt behind. Which is probably a sign that my depression is worsening again and it is time to call the psychiatrist for another go-around at medication adjustments.

It looks like distraction is the key element here. Hard to do when I'm not sleeping well again and house-sitting but its a wide internet out there so hopefully it will work. Thanks again for everyone's input and suggestions.
posted by kanata at 10:16 PM on January 12, 2011

I was suicidally depressed for 23 years. Two things helped me.

The first was standing at a corner minding my own business, waiting for a light to change, when a car ran the red light, slammed on the brakes, squealed through the intersection, bumped up over the curb, and stopped about a foot in front of me. The driver looked horrified but I thought I felt okay. Then a few minutes later my leg started trembling so badly I couldn't walk. I had to sit awhile for the shaking to stop, and I realized that I didn't really want to die at all. So, since two decades of off-and-on therapy alone hadn't helped, I decided that I was going to get a prescription for antidepressants.

The second was the antidepressants.

Since then, when I get depressed I just remind myself that most of the time I'm not depressed, and that the depression is temporary, and that there's a good chance I've just missed my meds sometime within the last few days. And with very few exceptions that's been the case. The important thing, though, is reminding myself that what I'm feeling is only what I'm feeling right now, and that things will get better.

And then I treat myself with something I enjoy: going to a favorite restaurant, or watching a comedy or some silly poppy fun film, etc.
posted by johnofjack at 8:04 AM on January 13, 2011 [1 favorite]

The only thing that has reliably quieted my "I-want-to-die" voice (aside from medication, which tends to have intolerable side effects for me) has been a combination of regular, intense aerobic exercise coupled with meditation. Exercise has the immediate effect of making your body work too hard for you to think, and long-term exercise has the long-term effect of improving your mood (and, for me, making my inner monologue a good deal more pleasant). When you get more experienced at meditating, you'll be better able to identify and switch off the horrible thoughtstream.

And I would say that it won't harm your practice long-term to take two weeks off until your therapist is back in town, as long as you mentally commit to starting again. Whether or not your suicidal ideation during mindfulness meditation is actually an emergency is up to you to decide, but I don't think it's necessarily healthy or kind to yourself to force yourself to sit through 20 minutes of that every day. And that's what it's about in the end, right? Being healthy and kind to yourself?

Random thought: Maybe switch it up for a couple weeks and try a yoga class instead of your regular meditation practice? Most of the yoga classes I've taken have basically been a combination of mindfulness meditation and exercise. Plus if you're in an asana that you find challenging (which for me, at least, is all of them), parts of your body will be speaking to you fairly loudly and it tends (for me at least) to drown out any negative head-chatter.
posted by kataclysm at 8:17 AM on January 13, 2011 [1 favorite]

In all honesty? My son who is 2. I know that suicide would absolutely ruin his life in so many ways that I couldn't do that to him. It doesn't stop the idealization completely but makes a firmer stance that I won't do it. I've been suffering from depression now for 39 years. It sucks. I'm sick of it. But talk therapy/meds are out there and ignoring those things would mean that I felt that my own selfishness was more important than watching him grow up to be happy.

So I guess look to that one person who would absolutely be ruined by you being gone. And if you don't think you have someone--trust me, you do.

I'm so sorry for how you feel. I hate being depressed. It ruins my job, my marriage, my relationships with friends, but I refused to let it ruin me being a mom--so I went on Prozac. Now the Prozac is starting to fail (I'm on a ridiculously low doese) and need to up it. And yes, I hate that part of it too. But I know I have to for my son.

MeFi email me if you want to talk.
posted by stormpooper at 8:57 AM on January 13, 2011

Seconding Sidhedevil's book suggestion above.
posted by oldtimey at 2:28 PM on January 13, 2011

I don't mean to minimise a complex question but my best answer is pretty simple - I remind myself "This too shall pass." Along the lines of what L'Estrange Fruit said, once you've been down this road before, you know it's just a swing in the cycle and you won't always feel this way. It has always struck me as silly and embarassing to kill myself over what I know to be a passing fancy. So I haven't.

The obsessive thoughts are indeed obsessive but you can choose to look at them in a variety of ways. They can be seductive and compelling visions you entertain, or you can decide you've played this game so many times it's now boring. Personally, I go with "boring and predictable" and try to find something new and more interesting to occupy my mind, my time or my hands. Work is my default but cooking, knitting and meetups are all good.
posted by DarlingBri at 2:47 PM on January 13, 2011

Otherwise: I've a nice printed list that I made for myself some time ago, but can't find a link to it on the interwebs again -- curses!!!! I may have saved it in a Word document somewhere . . . memail me if you'd like it . . . But a long-ass list of alternative and grounding techniques -- originally found at either an eating-disorder website or an SI (self-injury) website, or both -- even though I don't have an eating disorder or specific self-injury component to my situation, I've found that pages with info like this or this (both from same site) addressed my suicidality situations pretty well.

And like the emergency box example from the first link above, I made myself a little emergency kit that has easy distract-y things in it (example: coloring book and markers, squeezy foam thing for my hands to fidget with, nice soft handkerchiefs for crying, gummybears, whatever). Manohman does it totally suck to, like, color in a coloring book all frickin' night long, bleary-eyed, headachy, dizzy, shaky and exhausted, until the sun comes up. But it works in the sense that I keep myself safe.
posted by oldtimey at 3:01 PM on January 13, 2011

My 2 cents: If you think of this as a compulsion, more like hand washing or checking the locks, maybe that can point you in a good direction for stopping these thoughts. I have dealt with mild-moderate depression with some meds, some talk therapy, and some cognitive-behavioral therapy. It was the last one that helped the most with my negative interior monologue, including the "I want to die" rut. Also, it was helpful for me to have an outsider - the therapist - point out that although the words were "I want to die" what I was really expressing was wanting to get out of an intolerable situation, which is completely normal.
Plus lolcats, lots and lots of lolcats.
posted by anotherkate at 3:26 PM on January 15, 2011 [1 favorite]

I marked a lot as best answers because there were bits and pieces of each person's advice that really helped me. Thank you.

I see now that my question should have been about how to get over the current bit of ideation til my therapist came back and I ended up focusing on advice in that way. Distraction helped the most.

However the people that said that this was just a routine and hold over from depression, another form of automatic thinking, an escape really proved to be true as I saw when I discussed this with my therapist.

I think the key from here out is just to acknowledge it in a "yeah, yeah suicidal thought..big deal, let's move on" and get some space between it and me with awareness and breathing will prove to be the greatest thing I can do. Thank you for confirming that others feel this way too.
posted by kanata at 12:22 PM on February 12, 2011 [1 favorite]

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