If you recognize warning signs in yourself or believe that you are suffering from symptoms of a mental health disorder, professional help is needed. During a mental health assessment, your clinician will ask you a series of questions to get a better sense of how you are feeling emotionally. They may ask questions about situations that are causing you stress or emotional pain, if you have had any current or past thoughts of suicide, and your mental health history.
After talking with you and assessing your mental health, your clinician will work with you to develop a personal treatment plan. Each evaluation is unique, and will depend upon your unique situation and the information that you share with the healthcare provider.
Ongoing Treatment and Support
Mental health treatment is an ongoing process that is crucial to supporting people during intense times of crisis. Mental health treatment is also be very beneficial to help maintain good mental health over time. Your recovery plan may include counseling, medications, support groups, education programs and other strategies that work for you.
If you are at risk for suicide, your treatment will be targeted toward the clinical condition that puts you at risk for taking your life. Studies show that 9 out of 10 patients who die by suicide have a mental health condition, and that recognizing and treating mental health conditions, such as depression and bipolar illness, can reduce suicide rates.
Potentially helpful treatments for reducing suicide risk include medication (e.g., antidepressants, lithium maintenance treatment, clozapine, low-dose ketamine), psychotherapy (e.g., CBT, DBT, MBCT), and brain stimulation techniques (e.g., ECT, rTMS, MST). Some of these newer treatments can be very helpful for those who have been struggling with depression that has not responded to other treatments or who need quicker intervention.
In addition, alcohol and substance abuse increases suicide risk, especially in patients who have another mental health disorder, such as depression or bipolar disorder. If you are struggling with a substance abuse problem, your treatment will also likely include treatment for addiction.
Find Help & Treatment
You can contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). The Lifeline is national network of local crisis centers that provides free and confidential support to people in a suicidal crisis. The Lifeline is available 24 hours a day, 7 days a week.
Antidepressants can reduce suicidal thoughts in patients with depression, but require time to take effect. Most people experience improvement within 3 months of antidepressant use.
The currently most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).
Antidepressant use requires carefully clinical monitoring. This is not only to detect early clinical changes that may lead to increased suicidal risk, but also because antidepressants can unmask a previously undiagnosed bipolar disorder, which requires a different treatment approach.
Important Warnings about Medicines for Depression
Call a doctor right away if you notice these changes in yourself or someone else taking medicines for depression.
- Think about dying or killing yourself
- Try to injure or kill yourself
- Feel depressed or your depression is getting worse
- Feel anxious or your anxiety is getting worse
- Have panic attacks
- Become preoccupied with exaggerated fears about health, finances or other vulnerabilities
- Have trouble sleeping (insomnia)
- Feel very agitated or restless
- Feel or act irritable, angry, aggressive, or violent
- Act on potentially dangerous impulses, such as erratic or aggressive driving
- Talk more or become more active than is normal for you (possible hypomania)
- Notice other things in your behavior or mood that are not typical for you
Lithium Maintenance Treatment
Another medication that is used for patients who are at risk for suicide is lithium maintenance treatment. Long-term maintenance treatment with lithium reduces the risk of suicide in patients with bipolar I disorder, bipolar II disorder, and possibly also unipolar depressive disorder (Tondo & Baldessarini., 2009). Youth who had been treated with lithium had half as many suicide attempts, improved depressive symptoms, less psychosocial impairment, and less aggression (Hafeman et al., 2019).
Clozapine is the only medication approved by the FDA for suicide prevention in patients with schizophrenia. It is used for patients with schizophrenia who have tried to kill themselves and are likely to try again. It is also used to treat severe schizophrenia symptoms in those who have not been helped by other medications. Clozapine is available from your medical provider through a restricted distribution and monitoring program.
Another treatment option for those with treatment-resistant depression (i.e., depression that has not responded to standard treatments) is ketamine, which is administered through an IV. Recent studies have found that low intravenous doses of ketamine can rapidly reduce suicidal thoughts, even in patients with otherwise treatment-resistant depression (Gruenebaum et al., 2019; Wilkinson et al., 2017). Ketamine is administered must be administered in a hospital setting under the medical supervision of a physician.
Cognitive Behavioral Therapy (CBT)
A recent review article found that CBT can reduce suicidal ideation, attempts, and hopelessness, based on efforts to change thinking and behavioral patterns (D’Anci et al., 2019). The therapist and patient work together to understand the problems identified and to develop a treatment strategy. The goal is to build skills to better cope with distress. CBT appears to be especially effective in reducing suicidal behavior when the treatment specifically targets suicidal thoughts and behaviors (as opposed to depression or mental illness in general).
Dialectical Behavioral Therapy (DBT)
DBT combines methods of CBT with skills-training and mindfulness meditation techniques to improve emotion regulation, interpersonal relationships, and ability to tolerate distress. DBT was developed in the early 1990s by Dr. Marsha Linehan as a treatment for suicidal behavior in women with borderline personality disorder (BPD), but has since shown effectiveness for other disorders, including mood, eating, substance misuse, and PTSD.
Several recent studies have found DBT to be an effective treatment for reducing repeat suicide attempts in highly suicidal patients, including adolescents (McCauley et al., 2018). A cornerstone of DBT is the idea that the patient must build a life worth living, even when the patient has many problems and wishes to die.
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT is a form of psychotherapy which integrates mindfulness meditation practices and cognitive therapy techniques. A growing body of evidence indicates that training in mindfulness can help to break down the link between depressive symptoms and suicidal thinking. In addition, MBCT can protect against the depressive relapses that are common in those with a history of suicidal ideation and behaviors (Barnhofer et al., 2015).
Brain Stimulation Techniques
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is one of the most effective treatments for patients with treatment-resistant depression or severe depression with psychotic features. It involves applying a brief electrical stimulation to the brain, while a patient is under anesthesia and given a muscle-relaxant to avoid injury. In the United States, most ECT is now given on an outpatient basis. ECT is used for severe cases when other treatments (including medication and psychotherapy) have failed to yield adequate responses.
ECT is also used for suicidal patients who require a rapid treatment intervention. ECT can rapidly reduce suicidal ideation, though most people treated with ECT will require some form of maintenance treatment (e.g., psychotherapy, medication, additional ECT). This is not surprising for lifelong, recurring illnesses.
Repeated Transcranial Magnetic Stimulation (rTMS)
Repeated Transcranial Magnetic Stimulation (rTMS) is sometimes used to treat patients with major depressive disorder who do not respond to one or more adequate trials of antidepressants. rTMS uses magnetic stimulation to activate selective brain sites, as opposed to ECT where electrical stimulation induces generalized epileptic seizures. Studies find that rTMS can resolve suicidal ideation in some patients with treatment-resistant depression (Weissman et al., 2018). Although rTMS does not seem to be as effective as ECT, it does not require anesthesia and has far less adverse effects on memory and cognition. Bilateral rTMS may be a useful alternative treatment for suicidal ideation when ECT is declined, not tolerated, or not readily available.
Magnetic Seizure Therapy (MST)
In this relatively new intervention for patients with treatment-resistant depression, a therapeutic seizure is induced by magnetic stimulation of the brain at higher frequencies than are used in rTMS. Patients given MST are anesthetized and given a muscle-relaxant to avoid injury similar to the protocol for ECT. MST can reduce suicidal ideation in some patients with treatment-resistant depression: in one study 44.4% of patients treated with MST experienced resolution of suicidal ideation (Sun et al., 2018).
The sources for this website come from academic journals and books and organizations, such as the CDC, NIMH, WHO, APA, AAP, ACOG, AFSP, MHA, and NAMI. See our complete list of references.
Stop A Suicide Today provides suicide risk questions, connection to and identification of crisis resources, and information about suicide and its treatment for the public and clinicians. The Stop A Suicide Today program is not itself a health care provider. Scoring positive on the suicide risk questions is not synonymous with a clinical assessment of suicide risk. Suicide risk can be determined only by a complete evaluation performed by a health care clinician. It is recommended that anyone who either scores positive on the suicide risk questions or continues to have concerns about suicide in themselves or a loved one contact the National Suicide Prevention Lifeline 1-800-273-8255, go to a health care clinician or local emergency department for an evaluation, or call 911 for emergency assistance.