Health professionals refer to the wish to be dead as suicidal ideation. Suicidal ideation can be passive or active. Passive suicidal ideation is the desire to die, without any intent to act on it and actually hurt yourself, such as wishing a rock would fall on your head or that the plane you were traveling on would crash. Before adolescence, suicidal ideation is usually passive – children may wish they were dead but not actually try to hurt themselves. However, starting at adolescence, people with depression may develop active suicidal ideation. A person with active suicidal ideation not only wishes to be dead, but has a plan to kill himself or herself. Active suicidal ideation is a medical emergency, akin to a heart attack, and requires immediate treatment.

It can be hard for a non-depressed person to understand the mindset of people who want to kill themselves. Depression can cloud judgement and stop the brain from thinking rationally. Depression can feel like being in a deep hole surrounded by darkness, with no way to climb out. Depressed people can forget what it feels like to be happy, like people who forget they are wearing sunglasses, and believe that the world is dark.

Have you ever had a bad case of flu, where you felt nauseous, tired, and achy? When you were in the throes of it, was it hard to remember how it felt to be healthy? Did it feel as if you would never get better? That’s what depression can feel like- an emotional flu.

I use this metaphor for my depressed patients when they start to lose hope. Just like any other medical condition, depression responds to treatment. Patients can be hospitalized with depression so severe that they are barely able to move. However, within a few weeks of appropriate treatment, their mood and activity levels are normal, and they look back with disbelief at how depressed they were.

Depressed patients need to be reminded that suicide is never a good option. You would not hurt yourself because you were in the throes of a bad flu, and you should not hurt yourself in the throes of depression. Your depression will get better just as the flu does. You will climb out of the hole, take off the dark glasses, and see that there is hope. Most people who try suicide don’t really want to die; they want to escape the pain they are feeling.

Unfortunately, teenagers are particularly prone to “copycat” suicides of acquaintances or celebrities. Even suicide prevention programs or TV shows about teenagers committing suicide may create copycat suicides. This is a tremendous waste- teenagers have the potential to be creative and caring and have so much to contribute to the world. One impulsive action destroys this forever and cuts off what would have been a fulfilling and productive life.

A drawing of a tree can illustrate the potential paths of a depressed patient’s life. Following a healthy path (branch), the patient faces their problems and gets treatment for depression. They lead a fulfilling and productive life. The branch bears fruit (accomplishments, children, etc.) which fall on the ground. The fruit seeds grow into new trees, eventually leading to an orchard. (The person leaves a legacy of family and/or good works.) If the tree is chopped down by suicide, the orchard never grows and the ground remains desolate and empty.

Of course, suicide hurts many more than the person who dies- it is devastating to families, who never get over their sorrow and confusion. It creates a bad ripple effect, making family and friends more susceptible to copycat suicides. (Support groups for family and friends of suicide victims can be helpful in alleviating this.)

Suicidal thoughts must always be taken seriously and never dismissed as “manipulative.” Thoughts and actions are two different things- having suicidal thoughts is not the same as acting on them. However, it is impossible for even the most experienced clinician to predict with 100% accuracy whether a person will commit suicide. Studies have shown that the severity of depression and hopelessness are strongly associated with suicide. Using alcohol or recreational drugs is extremely dangerous, since they may remove a person’s inhibitions against self-harm. A person who begins giving away their possessions, discussing the afterlife or funeral arrangements, saying their friends or family would be better off without them, or saying “goodbyes” is obviously in need of immediate intervention.

If you are a young person who suspects that a family member or friend is considering suicide, what should you do? Tell a trusted adult! This is a secret you do not want to keep. The person will thank you later, even if they are angry now. Tell a parent, teacher, guidance counselor, pastor, or police officer. Just like you would get help if you saw someone hit by a car, get help for your friend who is in emotional pain.

Adults should ensure that a suicidal minor gets immediate medical attention, whether from the treating clinician or a hospital emergency room. All guns, rifles, and/or other weapons should be removed from the home of a child or adolescent with suicidal or violent thoughts, and from the homes they have access to. Even if you keep the weapon locked in one place and the ammunition hidden in another place, and are sure that you are the only person who has access to the key, you are putting your child at risk if you allow the weapon to remain in the house. Do not turn it in to grandparents or neighbors next door whose house your child visits daily-make sure it is far away from where it could ever be used impulsively.

If you are having suicidal thoughts, what should you do? Tell an adult! Tell a parent, teacher, guidance counselor, pastor, or family friend. If you don’t get the help you need, tell another adult. You deserve to have a bright future. Draw your own “tree” of how you want your life to turn out. Copy it onto an index card that you keep in your pocket. When you’re feeling down, pull it out and remind yourself of the future that you can have after you work though this depression.

Remember that the brain is still developing during childhood and adolescence. It does not completely mature until early adulthood. As a result, younger people don’t have the ability to step back and see things in perspective that they will have as adults. The things that seem excruciatingly painful now-being bullied by kids at school, arguing with your parents, getting a bad grade, breaking up with a boyfriend or girlfriend-won’t seem important when you are an adult.