Managing against Tomorrow--
Suicide Prevention
John McManamy


"Notwithstanding all we have to live
for, the brain in crisis has a perverse way
of having us think the very opposite."

Depression kills.  Simple.  Some fifteen percent of us who suffer from major depression will die by our own hand.  Many more than that will make the attempt.  And many more still will die by "accident" or "slow suicide" through reckless behavior or personal abuse and neglect.

According to the Centers for Disease Control, suicide is the ninth leading cause of death in the US (more than 30,000 a year), well above homicide (at about 20,000 a year).  Women will make the most attempts, but men will be by far more successful, by a margin of four to one.  In teens and young adults, suicide is the third-leading cause of death, after accidents and homicides, more than all natural diseases combined.

Suicidal depression does not discriminate.  It afflicts both the strong and the weak, the rich and the poor.  War heroes have been taken down.  So have survivors of the Nazi death camps.  As have successful business people and artists and mothers and those with everything to live for.

We are talking epidemic numbers.  At any given moment, five percent of the general population is suffering from a major depressive episode.

Over the course of a lifetime, major depression will strike twenty percent of the population, numbers comparable to cancer and heart disease.

We are talking battlefield odds.  Those with major depression have an 85 percent survival rate, but the prospect of finding ourselves in the lucky majority brings us only small relief.  The experience has exposed us to our worst vulnerabilities, and deep inside we no longer trust what tomorrow may bring.  We may still be walking and breathing, but we have been as close inside death as this side of life permits, and our minds will never let us forget it.

We ponder the fates of the unlucky minority, and sometimes we say a prayer.  We contemplate the tortures their brains exposed them to, and know for a fact that no God would ever hold judgment against them.  For the time being we are the lucky ones, but tomorrow that may change.

Still, we do have a certain amount of control in managing tomorrow.  We who have survived know what we are up against, and can plan accordingly.  Following are some common sense guidelines:


Cultivate friends or family members you can call on should you find yourself in crisis.  If you have no friends or family you can trust, then seek out a support group, live or on line.

About posting your cry for help on the Internet: Choose your site or mailing list very carefully.  If you are new and posting to a very busy list, your appeal may be lost in the shuffle.  At the opposite end, your message may go completely unread on bulletin boards with little or no traffic.  It may take a few weeks before you establish a presence on a particular list or board.  By then, you will probably be on email or ICQ terms with some of the members.

Look up the numbers of various local suicide hotlines and keep them where you can find them.  Familiarize yourself with the Internet crisis and suicide sites and bookmark the ones you like.  (See the list of links on this page.)

Establish a close relationship with your doctor or psychiatrist. Ask yourself: is this someone you can call on in the middle of the night?  Or, if not, will someone be there to respond to your call?

Remove all guns and rifles from your home.  According to the Centers for Disease Control, 60 percent of all suicides are committed with a firearm.  This is not an anti-NRA message.  We're just being sensible, that's all.

The same principle that applies to firearms applies in part to medications.  The tricyclic and tetracyclic antidepressants can be fatal in overdose.  You may want to switch to a different antidepressant if you don't trust yourself.  If you must keep certain medicines in the house, it may be advisable to turn them over to a loved one.

Watch your thoughts and feelings very carefully.  You may be able to pick up subtle signals in your mind, before a full-scale crisis overwhelms you.  Actually visualizing the act should set off every warning bell.


All too often, a suicidal depression catches us alone and off-guard.  Notwithstanding all we have to live for and all those who care for us, the brain in crisis has a perverse way of having us think the very opposite.  To those of you who are in this state right now:

Promise yourself another 24 hours.

Now call a trusted friend or loved one or a crisis hotline.  Remember, there is no shame in reaching out.

Finally, take comfort in the fact that help is on the way.  Your brain at the moment may not allow you to think hopeful thoughts.  But it cannot keep out the knowledge that others are hoping on your behalf.  This may be that precious one inch of life you can hold onto at the moment, the one that can eventually lead you to a tomorrow worth living.

Part 2

"...75 percent of all those who commit suicide indicate their deep despair beforehand."

Hey you!  You with the teen-age girl who's driving you nuts.  And you, over there!  The one with the co-worker who's been acting a bit strange lately.  You, too, with the husband who's just made out his will for no good reason.  Yeah, and you with the aging parent who's just come back from the doctor.

Have I got everyone?  Wait, you over there, the guy who keeps telling his wife to snap out of it.

You, all of you - listen up good.

Depression kills. Sure, you may never have suffered from major depressive illness yourself, but chances are it will strike at someone close to you.  Should that happen, the odds are heavily in favor of your friend or loved one making it through, but how you respond can greatly increase or decrease those chances.

Following is some common sense advice:


According to studies, 75 percent of all those who commit suicide indicate their deep despair beforehand.  All but maybe ten percent are sane people who might have responded to help.

Take very seriously any possible signs of major depressive illness.  These may include fatigue, weight gain or loss, and feelings of hopelessness and worthlessness.  A child or teen-ager may feel more hyper or agitated than usual.

Keep in mind that any number of situational events can bring on thoughts of suicide, with or without major depression, events such as: marriage breakup, death in the family, difficult birthdays or anniversaries or holidays, or loss of employment.

Watch out for sudden changes in behavior.  These may include:


  • In your child, declining performance in school.
  • In others: declining interest in previously enjoyed activities, neglect of personal welfare, deteriorating physical appearance.
  • In the elderly, self-starvation, dietary mismanagement, disobeying medical instructions.

Take very seriously any signs of suicidal behavior.  These may include:  explicit statements about suicide, acting-out behavior such as rehearsals or mini-attempts, self-inflicted injuries, reckless behavior, making out a will, giving away possessions, inappropriately saying goodbye, and odd verbal behavior (such as "you won't have to worry about me, anymore").


Five things to say to a severely depressed or possibly suicidal person:

"I hear you."

"I understand."

"I love you."

"You're not alone."

"Would you like me to get help?"

Five things not to say to a severely depressed or possibly suicidal person:

"You'll snap out of it."

"It's just a phase."

"Stop being so selfish."

"You're just trying to get attention."

"You gotta pick yourself up by your own bootstraps."


Advance knowledge is excellent prevention.  Read articles on what a depressed person can do, and think what you can do to help that person.  If your friend or companion needs someone to call on in a crisis you can be that someone.  If you are living at home with a depressed person, you can cooperate in making the house as safe as you can.


Listen.  Do not be judgmental.  Allow the person to vent his or her anger or frustration.

Ask if he or she is planning to commit suicide, or has a plan.  This gives the person another chance to vent his or her concerns and allows you to gauge the nature of his or her intentions.  This question is a fairly standard one, and apparently will not trigger an actual attempt.

Do not leave the person alone, once you have determined he or she is suicidal.

Try to convince the person to seek help. The fact that he or she is talking to you is a start.  Offer to make the necessary arrangements if you think that will get the ball rolling.

Remind the person, if necessary, that seeking help for depression no longer carries the stigma it once did, that going for help is not a sign of weakness, and that the chances for recovery are excellent.


Keep in mind, one day it could be me.

For access to counseling, visit

For several good articles, visit If you are thinking ....

For a directory of local hotlines, visit

John McManamy is a journalist and writer who has obtained his expertise in depression in a most unwanted manner - that of battling the beast most of his life.  He was born in Connecticut, obtained a law degree in New Zealand, worked as a business editor on a number of newspapers and magazines, then moved to Australia, where he published three books on business and finance.  In early 1999, following a series of crippling depressions, he was diagnosed as bipolar.  Soon after, he began writing on depression for Suite 101 as a means of coming to terms with his diagnosis, and not long after that launched the net's only independent weekly depression and bipolar newsletter.


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