Have you ever thought about suicide? How did you cope?

I have been diagnosed with severe, treatment resistant depression since I was about 14 years old. I self-harmed in my teenage years and while I have had frequent suicidal ideation, I have never made a serious attempt. Generally when I have been in that state, I find myself thinking about the aftermath and about my family and friends. Even when I have felt worthless and hateful towards myself, I could never bring myself to knowingly cause harm and suffering to my loved ones. Instead I would just collapse into despair, being caught between needing to continue to exist for their sake, but wanting so badly to die and end my own suffering.

My most recent depressive spiral happened while I was living in a state where cannabis was legal and I did find cannabis to be a helpful tool for self compassion and as a way to cope with suicidal ideation and severe emotional distress. It didn't make me happy, but it would numb my despair enough that I could breathe again and give me some appetite when I had none.

As for "getting out" and treatments, I've tried dozens of oral medications, genetic testing to guide that process, transcranial magnetic stimulation, and IV ketamine therapy all under medical guidance. I also was in psychotherapy more or less continuously since my diagnosis. A combination of TMS/ketamine helped me to stabilize, but I still felt I wasn't thriving. I also didn't tolerate the ketamine well, it made me extremely nauseous and I found the experience of waking up drugged out of my mind in a clinical setting to be very uncomfortable. I was going for TMS weekly and ketamine monthly.

Outside of medical guidance, I had been keeping up on psychedelic research and found a place nearby where psychedelics were decriminalized. I tried taking psilocybin mushrooms as a tea. A 2g dose of mushrooms and an afternoon on my porch gave me more relief than decades of therapy, medication, and alternative treatments. I actually truly like myself now and have rebuilt my self confidence, which has given me new strength in other areas of my life. I have ceased all other treatment for over a year now and am still not only stable, but thriving.

I would not recommend others to do what I do, necessarily. But if you are like me and have tried literally everything else, psilocybin might be helpful for you.

Yes. I struggled with depression for years, and it grew until I would enjoy the feeling of metal in my mouth while I fell asleep. I bought suicide bags and gas. I had a particularly rough night and called the suicide hotline, which was a humongous mistake. 18 minutes after starting the call, I had 7 officers pointing guns at me. I saw laser dots on my chest. They cuffed me and sent me to a hospital for 48 hours where my doctor talked to me just once. I watched ESPN's top 10 probably a hundred times and at least 10 episodes of Friends. Then I was transported to a facility where I spent 3 days surrounded by people who needed help way more than I did. Folks who were screaming at the walls. It was incredibly eye-opening.

Yes.

Typically, whether or not I've felt suicidal has depended heavily on my circumstances. It's at its worst when I'm in high stress environments where I feel trapped with no good path forward.

For example, I was in a university degree where work terms were mandatory for graduation, but my disability made it very difficult to interview without blanking/panicking. My resume as a student sucked. I was aimless, and didn't know what I wanted out of my degree. The university job board was barren, and the thought of cold calling companies terrified me. As well, I couldn't make it through my courses, and took several medical leaves of absence, and was put on academic probation due to my poor grades. The university also placed a time limit on how long you could spend in the program before they kicked you out. Failure for me meant being jobless with 60k student debt, which felt like a death sentence. I didn't think I was capable of making it through, and I shut down at every thought of job searching or completing schoolwork. I felt incapable of functioning to the degree I needed to to survive in life.

The 'burning building' analogy is really apt. When every exit is on fire, the window starts to look really good. At my lowest, it felt comforting to think of no longer existing. How it would be better than having to fight every single day. I was so tired of fighting.

The only way things improved was through my circumstances changing. Little strokes of luck, little opportunities. My 4-year degree ended up taking 8 years, and there were so many points over the last 3 years of my degree where I could point out "if this small thing hadn't happened, I'd be destitute right now." I feel like I made it through by the skin of my teeth.

Once my circumstances changed, and I no longer felt trapped, and could actually see a path forward for me, then the suicidal ideation went away. So, I guess my advice would be to try to understand why you feel trapped, and why you feel like there's no way forward. And then, find a trusted third party to try and see a way forward that you might not be able to see yourself. Doing so often involves a lot of "outside the box" kind of thinking. That can be hard, though, for so many reasons. Even reading back my story, it feels very "draw the rest of the owl"-like. So much had to happen for things to change. But they did? I don't know...

Yes. Many times. Tried, even. I eventually decided that dying sucks.

The mental images are involuntary and inevitable though, and will always be with me. That sucks too.

The compulsion to die can only be replaced by some kind of entanglement to life. Something you're comitted to do, or someone you'd rather be with. Also, medication. Lithium was life saving for me.

I don't have any advice like "work out and you'll feel better" or anything. I had a couple years where I'd even come up with a plan but there was still a point I would never cross, which meant I was never going to actually do it. I leaned into the darkness, sort of, and just let the thoughts run to see where they went. It always stopped short of picking a time and date to do the deed, and eventually just stopped.

Part of what makes it disturbing is you don't know what's going on and give these thoughts power. What helped me was understanding where these thoughts come from. They're just thoughts, they're not even your thoughts. It's like letting a cold control your life, when all it is, really, is something external making you uncomfortable.

The thoughts come back in periods of intense stress, but I don't worry about them because to me they're noise, and not really anything I'm going to act on.

I've had major depression with almost daily suicidal ideation for approximately 40 years now.

I'm aware that this doesn't work for everyone, but for me ketamine (I've had it prescribed for home use nasally and orally, and had IV infusions) is indistinguishable from magic - it makes any interest in, or tendency towards suicide stop - within minutes. I don't understand it, and I can think of arguments why it shouldn't work that way .. but it does work for me. It doesn't completely eliminate depression, but it changes suicidal ideation from "probably where I'll end up, it's just a question of timing" to "never going to happen, not interested."

Also, if a person is experiencing some level of suicidal ideation or has thoughts of suicide, it can be helpful to know that there are different levels or intensities of that experience - from passing thoughts, or vague ideas about it at particularly difficult moments, all the way to feeling what seems like a biological drive to complete suicide similar to the need to satisfy severe thirst or an urgent need to use the restroom. If you're on the not-especially-intense end of the spectrum, don't freak yourself out with thoughts that you might be very close to death and are probably very sick or broken. It's common to have escape fantasies where we're taken away from our boring or painful or meaningless or disappointing lives - for some people that might be running away to join the circus or live in the woods, for other people it's just an end to suffering.

Also, some mental health professionals (especially newer ones, or ones who don't have their own "lived experience") are very skittish about suicide and suicidal ideation, and may overreact or want to refer you to someone else or retreat into bureaucratic processes like "no harm contracts." They're not all like that - you can approach the topic carefully with a new therapist or psychiatrist and see how they react. Some mental health workers are can talk to you about the thoughts/ideas without freaking out and thinking about how to institutionalize you or otherwise make you go away (because you scare them, not because you don't deserve or need treatment.) I have been impressed with the CAMS (Collaborative Assessment and Management of Suicidality) model, described at https://cams-care.com/ - I like my current therapist, but if I couldn't see her I think I'd look for someone trained in the CAMS methodology.

Yes, but it's not your typical struggle, i took a clinical approach to it. Sorry if i can tell the whole story but i'm in a rush.
Essentially i was going trough a very hard time mentally, i had just come out of high school a messed up man and started going trough college in a foreign country where everything started going wrong. I flunked all my exams, living in that city was too expensive, roomates were hell, but despite all that i didn't give up and slowly started feeling better about myself. Things were far from perfect but i finally had my indipendence and all my mental struggles were being kept at bay.
Until one day, for no reason, i started slowly falling back into the void. I had no idea why but something shifted in me that made me act erratic. I couldn't recognize myself, i'd say things that i never meant to say, act in ways that i never wanted to, i would go under my bed covers in the middle of the day and cry for no reason, i was a mess. This went on for months, almost a year, as i slowly got more and more deranged.

One day i broke a disposable razor, took the blade out of it, and as i was crying and running it trough my arm i snapped out of it and realized that THAT was NOT me. Threw the blade in the trash, took a good look at my life and realized i was not myself anymore. I took action and realized i had an hormone imbalance, something in my diet was messing with my hormones and that's what was driving me crazy. I ended up cutting them out of my diet and my mental health immediately improved. The old me came back, i started getting healthier, my body started putting more muscles, i was fine.
Despite my life having its up and downs

A couple months before the pandemic, I started developing some weird back pain which would give me some electrical shock like pain. I was also getting leg pain, mostly at night preventing me to sleep multiple nights in a row, slowly losing my mind. After a few months of this and getting worse and more frequent I could only think of dying to stop the pain. Going to the doctor and different specialist could not find any problem.
I made my testament, spoke to my wife and close family to let them know I cannot go like this that long but I will try my best to last as long as possible. They understand.

The doctor gave me nerve pain medication and sent me to a psychiatrist where I got anti-depressants.
All that together with cannabis to help me sleep and I feel maybe 70% of the pain now. It also allows me to do some exercises to hopefully have sturdier muscles.

I do have to walk with a cane today to ease the pain but boy those anti-depressant really changed my way to see things. Sucks that it took medication but hey, I guess that's an improvement. Until a doctor can find the root cause...

Yes. I've had depression for as long as I can remember. I thought about death all throughout my pre-teens and teenage years. What stopped me from doing anything was: a) having a cat that needed me; b) feeling stubborn about giving my family something that would make people feel sorry for them; and c) realizing that this terrible moment I've feeling may go away. I fought hard to maintain the idea that one day I would get better. "This is just a moment" was basically my mantra

Now as an adult, I have people who keep me level, and I take an anti-depressant that helps take the edge off things. I realize I will never have a brain that works the same way others do, but I've learned to accept it. I love the small moments in my life, and when things get bad, I focus on these to pull me back out of the abyss. I'm good at detecting the spiral and have learned to ask for help when it starts. In short meds and support have greatly reduced the idealization I used to live in.

Having cats. There have been a lot of times I've really considered it but then I think about what would happen to my cats if I did it and that always makes me change my mind. I've read a lot of other people say the same thing about having pets. Long term therapy and medication as a lot of people have said, but that's a trial and error process and you need to keep your eye on the end of the tunnel. Because I know how permanent that state of mind can feel, but I've always come out of it eventually.

I never planned or tried it, but did go through a period of suicidal ideation a dozen or so years ago, which gradually progressed to a crisis in the form of a hallucination. I was doing dishes and picked up a knife and saw myself chop at my wrist. Dropped the knife back into the suds at that point and ran out of the room. I could see I was uninjured. Before that, it had just been some idle speculation about ways to ensure doing myself in without endangering anyone else. The thoughts had seemed perfectly normal at the time, even comforting; only later did I realize that they might indicate something dangerous going on.

Suicidal impulses can have all kinds of causes. Mine weren't typical maybe; at least, I don't think I was depressed. But I did seek out help after that episode, and a therapist helped me see I was being consumed by work stress while trying to make myself not consciously feel that stress. Although just having that person to talk to was helpful, I didn't feel quite in the clear for several months. There was some enforced vacation time, some more talk therapy, and when it became clear I wasn't just snapping out of it, some anti-anxiety meds got prescribed which I still take as needed but not on a daily basis.

I still work in that same job. Doing much better with it now. The work wasn't the problem per se; I just have never dealt well with certain situations, but I'm improving both in terms of coping ability and in setting reasonable expectations (i.e., recognizing my limitations and sometimes working around them instead of always pushing through).

Talking is always a good first step. And if you get to a place where you feel like an imminent danger to yourself, it's permissible to go into any emergency room and say so.

A very close friend of mine is planning to take his own life within the next few years. In his own words, he doesn't plan to outlive his cats.

His reasons are a mix of tragic circumstances and trauma throughout his life that have left him on antidepressants and antipsychotics, along with hereditary health problem that are going to make him suffer later in life.

Not sure what I could do to convince him to change his mind. He's determined.

I am still suicidal, but i think what has helped me a lot more over the years is understanding what made me suicidal. It can take a long time to completely understand (3-4 years of experience with this and i only recently discovered i had CPTSD, and 2 years ago i found out i had gender dysphoria), but it gives me some hope that i might not be like this forever. But it will be a long time until i recover.
Also, suprisingly religion didnt help much. In fact, it only seems to have made me remember that if i commit suicide i will still be in sukhatvi (one of the buddhist heavens) after i die. Stoicism hasn't helped much either, because i cant control what i stress over due to the nature of cptsd.

The times I most seriously contemplated it was 2002-2007. I started seeking counseling as well as medical help.

They found that I was anemic and started treating that (a six month course of iron supplements and advice to eat more red meat).

The counseling was interesting and even revealing but ultimately -- after 2 years -- the psychologist and psychiatrist concluded that there wasn't anything seriously going on in their areas of expertise. My problems seemed more medical to them than psychological. The SSRIs were worse than without the SSRIs.

The anemia improved and everything emotionally improved except for a few symptoms in the bathroom. Digging into those, they found the cancer that was causing the anemia. It was very large and the outlook was grim: a 15% chance of surviving 5 more years. Turns out, two weeks later, I was in the ER as the cancer grew and blocked the colon entirely. So I had hours left to live but, because of all of that, they knew what was wrong. They went in surgically and got it out. Miraculously, none of it spread beyond the colon. I beat the odds, I had a long recovery not only from the surgery but from those 5 years of declining health, but I'm back and healthy still here long after my up-to-5-year expected demise.

Practically knowing that I was to die soon really changed my view on life and even on suicide. It's an exit but then was not my time to take it, and if you are at that fork, it's probably best to choose life because you could choose death. There's no higher reason to do it if you have higher reason not to do it.

Get the help you need, it's there. DO talk about it, look at the logic of the situation, enlist professionals to help you.

I've been struggling with depression and suicidal thoughts all of my adult life. For about 10 years I got by with a mental pact with myself that I would never actually follow through on any of the intrusive thoughts. My depression got worse a few years ago and I hadn't really noticed. I got to a point last year where I didn't know how long I could continue holding myself accountable and started wondering how long I could hold out against myself. That's when I knew I needed professional help.

I sought out a therapist after talking to my PCP about medication and being prescribed something to help. The combination of medication and therapy have really helped and made my life so much more enjoyable. There is a lot to be said for the therapy I am still attending, but I know the medication is a large part of it too.

As a young kid I did (around 8-10), as an adult only philosophically.

As a kid life was boring. We moved a lot so I didn't have friends, I had ADHD that my parents didn't believe in or tell me about so school was a struggle, I got in fights at school then got in trouble for that at home despite not starting them. I didn't consider it too seriously because I was afraid of the consequences as they had taught me about hell for suicides and I was afraid of how badly they'd beat me if I failed but I did fantasize about it quite a bit.

I found a couple ways of escape around then luckily. Mostly just reading books 24/7 and also just completely detaching myself emotionally from everything else. Probably extremely unhealthy but it's worked for me, though I still find it impossible to care about most things now (e.g. successes in life, the rat race, companionship, etc).

As an adult I've thought about it philosophically. I think about it as the ultimate inalienable right, but also worry that it might not be possible given Quantum/Subjective immortality. I picked up the skill of picking up hobbies and still find a lot of pleasure in reading and my shitty memory means I can reread the same book again and again so I no longer feel any desire to do it right now but if I lost these pleasures and could find nothing to stave off the perpetual boredom I'd probably book an appointment with Dignitas.

It's tough, and I often feel pretty unqualified to comment due to how "lucky" I am to have the support network that I do. But I do (actively, depression is a forever job) struggle with these things, and it was at the peak a few years ago.

To answer your question directly: antidepressants, therapy, and a lot of mental refactoring is what helped me. I was only able to do this given the time and means, but that's what it took for me.
That time of my life was categorized by difficulty justifying my existence, and the solution developed into re learning why I value life, and how I use this gift.
I hope you can put some time into considering your passions, and how they can help drive your reason to fight. And I hope your fight doesn't prove unreasonably difficult.