Advice on controlling suicidal thoughts without mood stabilizers

I was recently asked by a reader, and fellow manic-depressive, for some advice.   How can suicidal thoughts be effectively managed when long term mood stabilizers are not an option for that person? 

Here's my response: 

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Hey,  

This is a really challenging question, and I’m not sure if there is a single answer that would apply in general.  I think the triggers for each person’s manic-depressive episodes are unique and as such, there is no single treatment for a nasty bipolar low b/c its a multilayered health issue. I think it has to be dealt with both medically and psychologically - in my experience.  

Admittedly, I’ve been suicidal twice in my life.  Yet I believe its no coincidence that both those moments were before I fully understood my medical condition, as well as my immediate family members also (e.g. mother & aunt who are very supportive/compassionate).  Since my diagnosis I’ve been better prepared to handle my depressive episodes that could potentially lead to suicidal thoughts or worse...  So broadly, I think understanding the full spectrum of my mental health condition has better prepared me for this life long struggle.  I can identify 2 specific tools which have helped me greatly when I hit bottom:

1. Realizing its not really the end of my usefulness/abilities/happiness.  Both my suicide attempts came before I fully understood my bipolar disorder and its affect on me. I really thought it was the end.  But now I know that it will pass.  And I draw on my moments of clarity after those previous suicide attempts as lifelines to get me through.  I think, not so much about my self-worth at that dark moment, but about what I have left to offer others, or the promises left unfilled to others that I still need to conclude.  I convince myself that until I take care of these things I can’t ‘opt out’.   

I don’t know if you’ll feel the same about this, but for me, personally, others can not guilt me into staying alive, only I can do that. My mothers love was not enough. I actually wrote that in my suicide note.  I’ve found that things left undone and using personal guilt from that was much more effective for some reason.   A good example of what I’m talking about is found in the song ‘Me and a Gun’ by Tori Amos. Her long story short - she dealt with a very traumatic situation by realizing that since she hasn’t seen Barbados yet she had to live through the ordeal. Its a strategy many people struggling with severe emotional problems often use to cope.   I’ve found myself using this strategy as well.  I’ve made a deal with myself (one which I’ve never forgotten or belittled for years now), that I could not ‘off myself’ unless I’ve honestly tried to do all the things that were important to me while I was ‘sane’.  And only if I had completed this list would it be my time to ‘off myself’ - with a clear conscious.  While I prefer to keep my full list private, I’m OK with sharing a little with you because it might actually help you, and thats something I consider important (as I know its not easy talking about this stuff - I know reaching out is difficult). One of the things I have to do before I allow myself the option of suicide again in the future is to take a trip around the world, one that includes an extended stopover in some beautiful South Pacific Island where I can escape the city and get in touch with nature again.  

To those who don’t know me, this may sound superficial but this task runs much deeper than many realize.  The happiest moments of my life have always been recalled in my travels. And unless I complete my travel goals it would be too soon to end my life. Simultaneously, I’ve always felt most peaceful/happy while in touch with nature, especially the ocean.  

So when I get really low, and start thinking dark thoughts, I remind myself that there are a few things that might still make life worth living.  And if after traveling and reconnecting with the ocean and nature again, I still feel nothing than maybe its really time to end it.  The way I figure it, I invest a few grand into staying alive.  Put it all on my visa.  And if it saves me from committing suicide then it was money well spent.  If not, well its not my problem when I’m dead then is it?! 

I don’t know if any of my twisted logic will be of any help to you, but its worth a shot I suppose.  Like I said, its a very personal issue. Just take some time and think about it. Its your life, make your own decisions. I don’t know you at all, so I can’t recommend things that might hold value for you, but I’m sure you can find something you care about.  You wouldn’t have bothered to write me if not.  

Honestly, and sincerely, your message reminds me of the time I finally sought help after my second suicide attempt.  My shrink asked me why I was seeking professional help instead of finishing off the job.  It was an excellent question.  After taking a few moments to seriously consider it I replied, “Well I suppose, for some reason, despite the fact that I researched the lethal dose needed (and actually ingested), and ensuring I would be isolated for what I expected to be 3 days (as I didn’t want a hero to interrupt me in the process), I survived the overdose despite my best intentions, for some reason I don’t honestly understand.  All I could think of was that it just wasn’t my time.   I was still in agony, and since my own methods weren’t working, I thought that seeking medical help might be the only other option to end my suffering. So here I am.” 

I’ve thought alot about that Q & A over the years.  I’ve come to realize that in my personal case (and many many others, but not all), suicide attempts are deeply routed in pain alleviation, after no other options are available.  Its not that they want to stop living, so much as it hurts too much to keep on living.  

To sum this up, while I’m not saying that understanding the nature of the beast, or simply making a bet with oneself, will stop someone from committing suicide (especially if they’re at rock bottom), but its at least one strategy worth considering if you refuse to take long term mood stabilizing medications. 

2. My second recommendation is much less complicated.  While I detest taking long term mood stabilizing psychiatric drugs due to their awful side effects, there are some quite good, very tolerable, anti-anxiety meds that I take on the short term to help take the edge off my episodes.  Benzodiazepines (I like to call them ‘Pammies’) help with anxiety by targeting the neurotransmitter GABA, which is often one of the main factors contributing to bipolar episodes. While pammies (like valium or klonopin) are not mood stabilizing in the traditional sense, they but do seem to work like one at times. At least for me. Here’s a good link to help explain: http://en.wikipedia.org/wiki/Clonazepam . They won’t prevent an episode but they can nip it in the bud.  They’ve helped me tremendously. 

Hope this helps. All the best - BSW