If You're Thinking About Suicide

emotional intelligence

Suicide is a brain attack, just like a heart attack. If your chest was crushing, you wouldn’t sit alone hoping it clears up. You’d call someone, because it might kill you. Brain attacks are exactly the same. If you’re thinking about suicide, or the thought has even crossed your mind, call someone right now.

Split screen divided by a yellow lightning bolt. On the left, a sad, worried young raccoon in a grey hoodie sits by an open red first-aid kit and holds its phone to his ear. On the right, a raccoon in rainbow glasses with a red felt heart on his green shirt answers his phone, concerned and supportive, listening closely.

If you know me, call me. You’re not a bother.

Here’s the deal. You might think you’d be a bother. That reaching out will make someone feel bad. I’ve got great news for you: I’m like a robot at my core. You can’t hurt me, you won’t upset me, and I won’t feel bad. And if I get to help, I’ll feel absolutely incredible. There’s no greater gift you could give me.

That voice telling you you’re a bother? That’s the brain attack talking, not you. A brain attack is acute: it peaks, and it can pass. But left alone, sometimes it wins. That’s why you don’t ride it out by yourself. Your job is to get through the next hour with someone on the line.

  • If you know me, fricking call me right now. Text me, then call me at the same time.
  • In the US, call or text 988 (the Suicide & Crisis Lifeline), or chat at 988lifeline.org. Free, confidential, 24/7.
  • In Seattle and King County, Crisis Connections answers 24 hours a day at 866-427-4747.
  • Anywhere else, findahelpline.com lists free crisis lines in 175+ countries.
  • If you’re in danger right now, call 911 or your local emergency number.

There are really good treatments

This isn’t “talk about your feelings and hope.” There are therapies built for exactly this, tested in real trials:

  • CBT for suicide prevention: about ten sessions; in a trial it cut repeat attempts roughly in half. The strongest evidence of the bunch.
  • A safety plan: one page, written with a clinician, of what to do when it hits. It lowered suicidal behavior in VA emergency rooms.
  • DBT and CAMS: skills for unbearable moments, and treating what drives the thoughts.
  • Ketamine: a single IV dose eased suicidal thoughts within hours, for up to a week. A nasal form, esketamine, is FDA-approved for depression with acute suicidal thoughts. It’s a fast bridge given in a clinic, not a cure on its own.
  • Medication, when depression, bipolar or another illness is underneath. That’s a psychiatrist’s call.

The first step is the same for all of them: tell a doctor or therapist, “I’ve been having thoughts of suicide.” No one to tell yet? Call 988.

The longer version of the brain attack idea is in a letter I wrote for people grieving someone.