Is Suicide Ideation a Big Deal?

trouble solitude manI was on the bus the other day and began thinking how much I miss owning a car, which reminded me that I miss owning a home, which reminded me how much I miss having a job and all the good things (materialistic) that come with it. I became sadder as I thought of how long I’ve been on disability and that lead quickly into self-pity. I began thinking how hard life is and wondered if it’s worth it to continue. I then realized I should write an article about it. The entire incident lasted less than a minute. I was experiencing suicide ideation.

I’ve been depressed a lot lately. This may come as a surprise to friends and family because, on the surface, I’ve been smiling, conversing and generally looking “normal”. It doesn’t mean I haven’t had a good time, enjoyed some laughs and even enjoyed people’s company. I’m not experiencing the traditional, heavy, debilitating type of depression. Instead I have the feelings of depression floating underneath the surface of the skin, which manifests itself via ideation. Frequently, that is my first trigger that I’m feeling depressed.

What is suicide ideation? Well, apparently it depends on who you ask. The Center for Disease Control defines it as thinking about, considering, or planning for suicide. It’s kind of hard to argue with the CDC, but I find that definition unsatisfactory because it doesn’t fit what my understanding of what suicide ideation is. When I experience it, I don’t go into the planning stage.

The World Health Organization describes it as entertaining suicidal thoughts, but never attempting to kill oneself. This one kind of works for me because it’s short and simple, but still doesn’t feel right.

Medical News Today describes suicidal ideation as a feeling people may have when they are no longer able to cope with an overwhelming situation… There may be a feeling of bleakness and an erroneous assumption that taking their own life might be the answer. If the individual’s mental state is heightened enough, suicide may seem to be the only exit.

Still feeling unsatisfied, I decided to delve further and learned that much of my confusion is because there are two types of suicide ideation – active and passive. I found many definitions for these as well, but the most succinct comes from an unlikely source – Their definition is much more in line with my thinking. They say,

Passive ideation is when stressful events in life may drive a person to think, “I wish I were dead.” Fleeting thoughts, including wishful thinking, are considered passive because the thinker hasn’t acted on the thoughts.

This is what I’ve experienced most in my life. Usually too tired to think about taking action to kill myself, but wishing I could quietly curl up and die.

Active ideation as when someone has taken steps to end his own life. Taking action for the depressed person could include writing a suicide note, giving meaningful items away or just planning how to “end it all.”

As I was searching the net for these definitions I began to wonder why. Why was it so important for me to find a definition that suits me? Why was it so important for me to blog about? I gave it some thought and I understood. I was trying to find a way to minimize my suicidal thoughts as no big deal. I was wrong. It is a big deal.

The American Academy of Family Physicians says most patients who voice or admit to suicidal ideation when questioned do not go on to complete suicide. However, some of these patients will go on to commit suicide; thus, suicidal ideation warrants thorough evaluation.

The following passage is from the website of Highland Hospital in Charleston, West Virginia:

Whether suicide ideation is active or passive, the goal is the same—terminating one’s life. Suicidal ideation, such as the wish to die during sleep, to be killed in an accident, or to develop terminal cancer, may seem relatively innocuous, but it can be just as ominous as thoughts of hanging oneself. Although passive suicidal ideation may allow time for interventions, passive ideation can suddenly turn active.

It’s been a very long time since I’ve experienced active ideation, however, I experience passive ideation almost daily. I bring it up with my therapist and pdoc occasionally, but I think it’s time for me to take it more seriously and really have a good conversation about it. Will I have to learn to live with, or is it something I need to work on? Hopefully, they can help me find those answers.

If you, or a loved one, is in a crisis state you should immediately call 911.

An excellent resource during any stage of suicidal tendencies is the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). On their website you can choose to not call and chat with a counselor instead. There is a link on their homepage: Whether you need information for yourself or a loved one, you’ll find a wealth of information on their website.

31 comments on Is Suicide Ideation a Big Deal?

  1. The immediacy of suicidal ideation really depends on the person, I think. As you mentioned, there are two types of suicidal ideation: passive and active. I live daily, and have since I was a kid with the passive type. Not a day goes by that I do not wish that I was dead instead of having to deal with Bipolar disorder mixed with PTSD (to me ADD is just a nuisance and doesn’t require addressing). I live on disability which when broken down into the traditional 40 hour work week, does not pay even minimum wage. I struggle every month to pay rent (always the first bill paid), pay for the Internet I am so dependent upon, pay for food (which doesn’t always happen; my cat comes first), etc. Some days it just seems overwhelming, but I continue to exist in my mixed state world passively considering what death would be like. By the by, mixed states are when most suicide attempts and completions occur.

    However, I have a long history going back to the age of 16 (I am almost 44 now) of suicide attempts. I have actively thought about and made plans to end my life and carried them out. I really do not know how many times I have actively tried to take my own life. i know my first “real” attempt was at 16 when I swallowed a full bottle of aspirin. My first pseudo attempt was at the age of 12.

    My last attempt had me swallowing two full prescriptions: Welbutrin (ironically, an anti-depressant) and Geodon (an anti-psychotic used to stabilize mood). I was so hell-bent on dying that I didn’t even call the ambulance until I felt myself going under, and realized that maybe I didn’t want this after all. I have since run into the ER doctor who saved my life that night, and she told me about ER triage: there are people who can wait, people who need to be seen within a couple of hours, and people who might not pull through (this is all paraphrased). She told me that they were not sure they could pull me back that night due to the levels of medication in my system. I had 8 IV’s flushing my system, I became paralyzed from the neck down and had to be lifted to the portable toilet they had brought in (you pee a lot when you have 8 IV’s in you). I spent an hour just trying to wiggle a toe. I was almost completely conscious the whole time. I prayed (begged) not to be paralyzed for life. That was 6 years ago this past July. I made a pact with the Universe that night that if the Universe saw fit to bring me through this intact, I would never do it again. And, I haven’t although I have been in the active phase more than once since then. One does not break pacts made with the Universe.

    So, the point of this monologue is that I think suicidal ideation has to be handled on a case by case basis. Does the person have a history of suicide attempts, have they tried it once and failed and it was just a one-time thing, do they have a plan, or is it a fleeting thought? If the person has a serious history of attempts, any suicidal talk needs to be taken very seriously. If they have fleeting thoughts but no history of attempts or plans, it still needs to be taken seriously, but not in the same mode as those who have a long history of attempts.

    The main problem I see is that a passive thought can manifest as active planning fairly quickly; it may take days, it may happen in a few minutes. Therefore, I think, in conclusion, any type of suicidal ideation should be taken seriously even if it is just a passing thought. In my case, any talk of suicide is very serious as I proven over the years that it isn’t just talk, I will attempt it, and when I feel myself slipping away, I call for Emergency. One of my biggest fears since I live in mixed episode world is that one of these days, I won’t call the ambulance.

    Sorry I wrote you a book, but this is a subject that I know way too much about.

    1. The book is okay LOL, you gave lots of good feedback. Thank you for sharing your story. I’m glad you’re still with us today.

      1. So am I. It was a close call though. Having been through too many active episodes that all started out as fleeting thoughts, I think suicidal ideation is serious, but as I said it really depends on the person. Some people can handle the depressive phase of this mental interestingness better than others.

        It’s the people in mixed episodes you have to watch. I have literally been manically cleaning my apartment while crying like someone ran over my cat. It is the most mentally uncomfortable feeling. Fortunately, that hasn’t happened in a while. I chalk it up to good docs, the right meds, and a firm Buddhist practice.

  2. i am either in a passive or active state most of the time. sometimes, my active states are so intense, so deep, it is all i can do to not act on them. hopefully getting back on lithium will put me back to a mostly passive state, or even better, no ideation at all.

    i think it is good you have decided to deal with this as a serious thing and to talk about it with your pdoc. it is a big thing. its not a place one should want to be. good luck dealing with this and hope you find tools to help relieve it.

    1. Yes kat, every day I’m in a passive state at one time or another and they’re so fleeting it’s hard to take them seriously. I’ve now promised myself that when they do hit that I need to take a breath and take inventory of what’s going on.

      I hope the lithium works for you. That’s probably the one drug I haven’t tested.

      1. i was on lithium for 7 yr until this july. stupid doc decided i should not be on it any longer and took me off. had psychotic mixed ep and hospital stay and outpatient tx. not good. new doc says it is best idea to get back on lithium, and i agree!

        if you are well managed (maybe need a bit of tweaking) then don’t change, but if tweaking still leaves that passive state, maybe ask about if lithium would be helpful to augment what you are on, or to replace something you are on. its worth asking about.

        1. Oh, it took forever to finally convince my pdoc to up one of my meds and it helped a lot when he finally did. I think I will talk with him about adding some other meds, lithium perhaps, to hopefully give me just a smidge more of a lift. I’m pretty stable so I’m not sure how much I’ll convince him, plus, I’m not sure I want to shake things up a bit right now. We’ll see after I have the ideation chat with him.

        2. I am allergic to lithium even though I took it successfully for several years. I am now on a small cocktail of two anti-psychotics, one anti-anxiety med, and meds for adult ADD. It is probably the least amount of meds I have ever been on, but it works and it manages the highs and the lows.

          My psychologist and psych. both know I think about suicide everyday, and I have an agreement with my psychologist that if I even try to hurt myself, she will no longer see me. Since I have been seeing her for about 10 years, the idea of starting over with someone else just sends chills through me. I do really believe that even brief suicidal ideation is serious because if one is in the right (or wrong) mood, it can become active very fast, and the next thing you know, you’ve done something stupid.

          1. that is so right…it can blow up right away and be totally overwhelming before you have a chance to think about it.

            1. Yep. That is why I really think any talk of suicide should be taken seriously especially if the person has a history of mental health issues, or has attempted it before. People are very unpredictable. Kay Redfield Jamison wrote a very interesting study on suicide called “Night Falls Fast” that I read. I was really surprised by some of the cases mentioned. People seemingly doing fine just kill themselves out of the blue (to everyone else, but not to them.)

  3. This was such an excellent post, Brad. I think that the following paragraph really nailed its essence:

    “As I was searching the net for these definitions I began to wonder why. Why was it so important for me to find a definition that suits me? Why was it so important for me to blog about? I gave it some thought and I understood. I was trying to find a way to minimize my suicidal thoughts as no big deal. I was wrong. It is a big deal.”

    I think this is very important for friends and family members of those with depression. While your posts are always excellent, there are some that feel very relatable to a person who is not bipolar, which help illuminate those behaviors and thoughts in ourselves that others struggle with at a heightened, sustained level (like…at least for me…inattention to minute or mundane tasks or housekeeping, or periods of feeling overwhelmed or down without a clear-cut reason—and sometimes make me go “oh no! me too!”) and then there are those, like this one, that I wouldn’t call alarmist per se, but serious enough that a person who is not bipolar can’t totally relate. It helps us really see a stark difference in those normal idiosyncrasies that we are all subject too vs. that dark place that you constantly get drawn back into and have to deal with. It helps clarify how challenging everyday moments are for a person who is bipolar or depressive, and how difficult it must be to explain it all and to relate to those of us who don’t feel the same.

    I hope that makes sense. I realize that this post may include one of the longest sentences in history, but I am too lazy to go back and revise it for clarity. 😉 My apologies.

    1. Thank you for the excellent flattering comments, Alana. I think I probably sound repetitive to some of my regular readers at times and that’s because I’m always keeping the friends and family members in mind and that this may be the first time they started looking up info about bipolar/depression. Your comments show me I was successful today.

  4. I agree with the first commenter. It depends on the person and their history. My doctor said that suicidal ideation is just part of the disease. The thoughts aren’t deliberate they aren’t conscious they just come. I have them on more days than not even when I am “not depressed.”

    However even on days where I don’t have them if you were to ask me would I rather die than be alive I would choose death because I believe in a peaceful afterlife and look forward to it, because life here is really hard and painful.

    1. What your doctor said is kind of what I’m believing, that it is just part of the disease. I’m almost certain of it actually, but still want to speak with my doctors about it. Maybe I can learn some coping skills that can make them arise less often. Life is hard and painful.

  5. This is a really good and important post, Bradley. I think those of us who put on a happy face, and then disclose things like this about ourselves, make people really step back and listen. No one knows what goes on in all the heads around us, for sure. I don’t think I ever thought about suicide until my brother took his life. 33 years ago and I think about it daily. There have been many times I’ve thought about it in a very serious way, but now, it’s passive. I think if you’ve been touched by it, it will be with you forever, and I think once you make peace with it being an option, it lays ready in the wait. I do notice the farther along in my healing journey I get, I have days that it’s not there at all–and that is very cool. Full Disclosure: I’ve never posted a trigger warning on any of my posts, though i have talked about suicide.Truth be told for me? If you put a trigger warning up I’M GOING TO READ IT! What’s that about? It’s like being told as a kid you can’t watch something on TV cuz it’s going to give you nightmares. Uh huh–I’m watching it! Maybe that’s my problem! 🙂 (Forgive me for sounding like a jokester, I know this is a very serious topic.)

    1. You’re right about the spoiler alert, Mandy. I debated whether to put it on there or not. I was concerned that people would think I was irresponsible if I didn’t.

      I always appreciate your comments especially when you sound like a jokester.

  6. This was probably one of your best posts Brad. Not only was it well researched and insightful but honest and raw. I am glad you can be honest here. It is really hard to be honest about something like this out loud with our family and friends. You don’t want to burden them or scare them, you may feel like you’ve done that enough. I think it is always important to take suicide ideation seriously, even the passive kind. I am glad songtothesirens who posted above made a pact with the Universe. I would like you to make a pact with us here. If you have a thought like this again today, or tomorrow or any day, you can post it here but please also call one of us. Keep dialing until you reach one of us and be honest and don’t worry how it may affect us. If you can’t reach someone you know, do call the suicide prevention hotline. I hope your other readers can make the same pact. None of us knows how our lives may positively impact someone else in the future, just like you have here today. Suicide not only takes your life it robs those who know you of their peace in their life. I know when you are that depressed it is hard to believe that but it is true. If you doubt it, just think about what your life would feel like if someone you cared about took theirs. That is sometimes the only thought that brings me to say no, I can’t do it. I’ve made my pact, to no matter what, tell someone. I’m going to call you now. Glad you are here for me.

  7. Bradley you have touched upon a very important subject in this post. Personally, I have struggled with passive suicidal ideation, which for me included considering and planning (like how I would do it) since the age of 14 and I am now 32. It was not as frequent until my first major breakdown.

    Since I have stopped working (3.5 years and counting), it has become more frequent and is now a daily occurrence or rather an hourly occurrence. For the longest time it didn’t seem something unusual since it has been with me for so long. I kind of just made my peace with it for most of my life and even thought that everyone has these thoughts yet I never asked to check with others. I truly cannot imagine a state of being where suicidal ideation does not exist.

    For me, I have come to the conclusion that stress exacerbates the frequency and severity of suicidal ideation and I worry that a major stress in the future may cause me to become actively suicidal. Also I’ve read many blogs where sufferers talk about the time they first became suicidal and that was a wake up call for them. For me I didn’t wake up since it occurred so early in my life and I feel it insidiously and slowly creeped into my thought processes over time so I just became desensitized to it. I feel like it’s a part of who I am.

    I would be very interested in hearing what your doctor has to say. Is one of the objective of treatments to reach a point where one has no suicidal ideation or a state with reduced frequency/severity.

    I guess my question is, what is the objective here, cause the worse outcome of this disorder does result from suicide although the suicidal me does argue the worse outcome is not suicide and preferable over the impact on quality of life 🙂

    PS – Would like to add, the only time I can recall having zero suicidal ideation was a two year period in my mid 20s when I was hypo-manic and on low dose lithium + an SSRI. It was either the Lithium or the Hypo-Mania, not sure.

    1. PPS – Similar to what Friend said above. The only thing that keeps me from actively acting on my suicidal thoughts is the thought of the impact it would have on my aging parents and my sister. That’s my reason. When they are gone….Don’t wanna thing about that right now.

      1. A friend and I discussed this at length one evening. We both agreed that nearly everyone resists suicide because of the pain of hurting loved ones, but what is it that finally that it doesn’t matter any more. My guess is it happens when a person convinces themselves that everyone would be better off without them. Believing this, I keep that in mind at all times.

      2. Yeah, same here, I would be dead already if it wasn’t for my little sister already have gone through the loss of a close cousin.

    2. I’ll keep people posted on what my doctor says. My personal opinion is that both my pdoc and my therapist will tell me its something I’ll need to get use to.

      Like you I have a hard time imagining life without it.

  8. Hi Bradley,

    First I hug you and second I understand this post all too well! 🙂
    So much so that I’m not going to write about what I deal with as I’m in a good place right now, and don’t won’t to open old wounds.

    What we deal with Bradley is beyond many people’s comprehension. The illness can rob us of all rational thinking when our guards down. It would be hard to not have some of the things you mentioned, but at the end of the day your health is more important than anything money can buy.

    I’m thinking of you. Take care, Bradley. Hugs Paula xxxxx

    1. I’m happy you are in a good place now, it is a battle most people will never understand. Hugs back at you, Pam

  9. Thank you so much for writing this. I had no idea what the distinctions were. or if it was serious, so today I finally looked it up. I realized, “this can’t be normal!” when I thought how I could easily just slip into the bathroom and down a couple bottles of tylenol. I’ve had passive ideation since i was a child. My job as a little kid was to put away clean silverware, and I used to hold the knife to my belly, just wondering how it would feel to push it in. (Ironically I was so scared of needles I could not look at them without flinching). I never made a cut, but what elementary school kid does that? I didn’t think about that at the time. Then came middle school. I would dream up dramatic revenge-like or tragic suicides that would symbolically give those who watched me kill myself a big middle finger. In high school it morphed into traumatic fantasies, like accidents or loved ones dying or tragic betrayals. I wanted to get into an accident. Mostly, I got on just fine; I was just a little more goth than most. Then I became super spiritual, and that seemed to help. Ever since I got married and had kids, I have been riding a quick spiral downhill. Anytime there is too much stress, when husband and I disagree on things, I just want to tap out. Little things that most people can probably deal with set me into a tailspin. It feels like nothing will ever change for the better, ever. But I keep wanting to brush it aside, until this past year. The ideation is more realistic now. The Tylenol incident happened tonight. I keep thinking, “people who are truly in need of help have it way worse than this.” That has stopped me for too long. My story may not be as big or bad as someone else’s, but if i end up taking my life, would that have mattered? You are right. I wanted to minimize my problem. Thank you so much for sharing. I scheduled a “well-patient” visit with my clinic and told them I’d like to talk about possible depression options including meds, but the doc gave me a drive-by gyno visit instead and told me to make an appointment with someone else about depression. I wanted to scream. Why isn’t there a better system in place?

    1. Beka, I’m sorry it was so tough growing up. Your story is sad and yes, even scary. I’m glad you are still with us. I know we need a better system. Our medical system sucks and especially when it involves mental health. It’s changing though. A lot of people have said “enough is enough.” My personal opinion is it will be significantly better within the next 5 years. I hope you find the help you need soon. It’s tough going it alone. Keep us posted. I wish you the best.

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