BPDFamily.com

Depression and Suicidal Ideation

This workshop is about depression and the suicidal ideation that may accompany depression.  Specifically we want to talk about depression:

~what it is,

~how it is treated,

~suicidal ideation during depression,

~how to handle it when is you,

~how to handle it when its someone else (how to be responsible and but not over involved / manipulated).

Thanks for participating in this workshop.

The Staff


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Serious depression can occur under many circumstances but most commonly is present in these two situations:

Sudden Severe Loss In this situation, the individual has experienced a sudden, perhaps surprising severe loss. This loss may be the death of a loved one, loss of a job, loss of friendship, or other grief process. In this type of depression, the patient can clearly identify what is creating the depressed mood.

Long-term High Stress Level In this situation, the patient is depressed but can't quite put their finger on the cause. Imagine running a video tape of your life, reviewing the past 18 months. Look at the stress you've been under, the amount of responsibility, the number of pressures, and the number of hassles. In actual clinical practice, this cause of depression is seen more often than sudden loss. This type of depression creeps up on you.

Your Emotional Hurt Can Seriously Alter Your Brain Chemistry

The human brain operates, much like your automobile, on fluids called neurotransmitters. Just as your automobile has brake fluid, antifreeze, transmission fluid, and oil - your brain runs on these neurotransmitters. The brain neurotransmitter often associated with depression is called serotonin. Serotonin is the brain's "oil", a rather slow-acting neurotransmitter that is associated with sleep, appetite, energy, alertness, and mood - just to name a few.  :)uring long-term high stress, the brain burns its' oil, serotonin, at a higher rate than it can replace!  Your neurochemical level of serotonin drops and you become depressed.

In depression, your brain will then turn against you. It will reach in your memory and pull out every bad memory it can find - abuse as a child, failed relationships, etc. - anything to make you feel bad and especially guilty. You will be tortured by your own thoughts. When depressed, your brain begins running a mental "video tape" of your worst hits/experiences.

Treatment for depression frequently involves two programs, one using antidepressant medication and the other repairing the damage done by months of "garbage". In all current research, the best way to recover from a severe depression is using both methods.

Medication Treatment: Remember the automobile example, being several quarts low after running too hot for too long. Depression is treated medically in a similar manner - we add a few quarts of oil until the fluid level (Serotonin) is normal. In depression, we use antidepressant medication to "add" the brain's oil, in most cases, Serotonin. An antidepressant medication slowly increases the Serotonin in the brain. Prozac, Zoloft, and the newest "Paxil" are antidepressants especially made for this purpose.

Psychological Treatment: Psychologists and other therapists work with you to repair the damage done by the "garbage", helping you sort out reality from what your brain has fed you over the past many months. Many people feel going to a psychologist or therapist involves laying on a couch and talking about your toilet training during childhood - Nonsense! Modern psychologists are experts in not only brain chemistry, but how to repair "thinking" damage and rebuild/reconstruct your confidence. The combination of medication and therapy is extremely effective.

Usually, successful treatment for severe depression involves both medication and therapy/counseling.

Suicidal Ideation

Suicidal ideation is not uncommon in clinical depression. The Journal of the American Medical Association has reported that 95% of all suicides occur at the peak of a depressive episode.  All suicidal ideation should be taken seriously, because addressed early, problems may be averted. Often there is a progression over time from harmless ideations all the way to the act. The earlier the progression is intercepted, the more likely harm can be averted.

In such situations it is important to talk openly about the subject.

Conclusion - If Your Hurting, Don't "Tough It Out"

Depression, at some level, will hit every adult eventually. While most depressions are brief, with our serotonin gradually returning as stress decreases, when depression comes and stays you should seek professional treatment to recover. Depression is no longer a mystery and is easily treated. Treatment is usually short-term.

The above was excerpted from the following references:

https://bpdfamily.com/tools/articles11.htm

https://bpdfamily.com/discussions/search-info2.htm

I think it should be pointed out, also, that depression sometimes isn't situational- it's biological.

Some people, like me, have biological depression. And, at least in my case, it can't be treated with medications (Or at least, it hasn't been successfully yet and I've had enough bad reactions to antidepressants to be fairly confident I don't want to give them another chance).

Keep in mind that it is ENTIRELY possible that medication won't help, regardless of if your depression is stemming from biological or situational causes (or both!). If medication doesn't help, it only means that the chemicals the antidepressants are trying to treat (usually Serotonin, as mentioned in the workshop post, but other neurotransmitters can and do effect moods and depression) aren't the problem.

Medication not working for you does NOT mean you are broken, "unfixable" or defective. There are ways of managing depression without the use of medication.

Another version of depression is "dysthymia" which is a low-grade, chronic depression that lasts for years.  Clinical signs of dysthymia may mirror those of depression but of a lower degree of imparement and longer in duration.  An individual with this condition can live a productive life.  However, there is no joy or happiness in the dysthymic's life.  There can be social isolation from not having the energy and desire to engage in various activities.

People with dysthymia can be treated in similar manners to depression with psychotherapy and/or medications.  Like depression, dysthymia may be genetic or situational. 

Bart

This topic has over 800 views but only two responses so far--obviously, it hits home for a number of us.

To add on to what has already been said: Additionally, "double depression" is possible--dysthymia with a concurrent episode of major depression.  For many with dysthymia, a low mood is thought of as normal; it is simply the way one is.  When a person has never known happiness, or does not remember it, understanding what it means to be happy becomes impossible.  Never having much energy, often being tired, neglecting basic tasks, repeated thoughts of death--some or all of these can be part of a normal day for a dysthymic individual who does not recognize him/herself as such.  An episode of depression on top of this may still be recognized by that individual as depression.

Lifestyle changes can also be important to recovering from depression, whether situational, genetic, or a combination.  Exercise, as hard as it is to do while depressed, makes a difference!  The same is true for diet, and for spending time outside (if one is affected by the diminished hours of daylight in winter).

For some of us, I think that depression is brought on when we internalize the BPD's criticisms of us--whether it happens as we are growing up in a dysfunctional household, whether it develops in the course of trying to make a marriage work, etc.  Additionally, it can occur as we realize the futility of anything we do in dealing with the BPD, as a sense of hopelessness and despair sets in.  In these cases, and in others relating to our dealings with BPDs, I think that it's important to remember that the depression may have both a situational and genetic component (regardless of whether or not we are related to someone suffering from mental illness).  Some people are genetically predisposed towards depression, which can be triggered by seemingly relatively minor circumstances (the converse is true as well--for some people, depression is triggered only by very severe situations).  This does NOT mean that these people are "weaker."

(Disclaimer: The above is my generalization based on my own experience and what I have observed of others.  It may or may not resonate with you--please disagree if you wish, or take what you will and ignore the rest.)

I recently saw a presentation in which Perry Hoffman of the NEABPD (National Association for Borderline Personality Disorder) said that 33% of the adolescents who commit suicide have BPD. Both she and very high-ranking psychiatrist Robert Friedel agreed that early detection is a challenge because people don't want to label adolescents with such a devastating illness. This deters recovery," she explained. You can see the video of this on NEABPD.org. Click on the link for the presentation to members of Congress. Randi KregerManager of the Welcome to Oz Online Community for Family Members

That's a very sobering statistic, Randi.

I think the statistic is disturbing too. However, there are certainly some good reasons for letting parents know that the stat exists.It may be scary, but it gives them a heads up and a chance to educate the child's therapist, which is crucial. I know parents who have had hospital administrators push their kids out of the hospital and the parents simply refuse to take them because they were afraid of removing the child out of the protective environment. (The hospital can't just dump the child). Most people don't know who Perry Hoffman is, but she is Marcia Linehan's right hand person. All she does is work with families. She has published more than a handful of studies. In short, she has a great deal of credibility. Plus, she presented this to 50-some members of Congress. If parents can pass this on to providers and refer them to the video, there is a great chance for education.Knowing this also gives parents a heads up so they can plan and prepare and know what to do if their child becomes suicidal. They can read what the signs are and makes SURE that the child's health care provider knows this too. This is how another online parent's group is using the information: educating clinicians who are treating their children.Just some food for thought.

I haven't posted in a long while,but I believe this an appropriate subject to post on .I left my BPD last July after 13 years of "the cycle". He even took the most important thing in my world with him,our children ,but I held strong with the love and support of friends ,family and people I didn't hardly know .Almost four weeks ago ,he took several painkillers in what I believe was his final attempt to get my attention.He was prounced brain dead on Feb. 12,2008 at the age of 45 leaving behind two young children and a slew of people who had tried to help him all his life.He had gone to therapists ,tried medication,been loved to the point of almost total destruction.the only person that can help a BPD is themselves,like any other serious illness.My hope is that he has found the peace he sought on earth in vain.

rib,

Wow, I hope you're OK. Your story touches a point of concern I have; if I leave will w do something harmful. I think about it alot. How have you dealt with this tragedy? I don't know why this has to happen... .I mean do you ever get away? Now after hearing your story I'm thinking you will have to deal with this forever. I wish you all the best.

owdrs

For me when I think back on the final days/months/years of the marriage I had gotten to a more depressed point than I think I have known in my lifetime (which is really saying something considering my story)... .I literally felt as if I were drowning in dispair, an amazingly dark experience.

I know that I do have some PTSD from my childhood and first marriage, but, I had been able to manage it.  Even the panic attacks were something I could get through... .but this marriage really took a toll, on my emotional well being, my heart, my health.  A profound sadness took over my life... .for quite some time.

I've never considered suicide, always been far too responsible for such thoughts, I have kids that depend on me and I could never do anything like that to them... .they (and my own stubborness) have always been the one thing that keeps me strong, motivated, determined to beat whatever obstacles were thrown in my path.

Going to Therapy and having this place to come to over the last two years has been HUGE in my ability to overcome.  I've worked hard in T to understand my own issues, accept responsiblity for those things that I should, and rid myself of the blame I've taken on for everyone else.  My T is fairly impressed with my understanding of self and my resilliance... .but, I still have sleep issues, panic attacks, and a very high stress level in my everyday life... .

I'm a work in progress... .with alot of work ahead, but, everyday the wounds heal over a little bit more... .

Prolonged stress really does take a toll on us... .and it adds one grain of destruction every day... .you don't see it coming.

For me, that last thing I expected was for there to be a "healing" pill for feeling down.  I assumed they were all tranquilizers - numbing drugs.  But these newer classes of anti-depressants are really rehabilitating. 

Many of our members are depressed at one time or another. Suicidal ideation is not uncommon in clinical depression. The Journal of the American Medical Association has reported that 95% of all suicides occur at the peak of a depressive episode.  Often there is a progression over time from harmless ideations all the way to the act.

Whether its us or others, the earlier we intercept this progression, the more likely harm can be averted.

Joe Carver's layman's description (below) is simple and valuable. - I only wished I had been educated about it earlier - it would have saved me many gray days.  Life is too short to waste.

Skippy

I do worry about suicide but mostly for my uBPDw. I don't think she could handle life without me (how's that for affected?). However, after reading many posts I believe that she would be fine and that the helplessness I see is a setup.

Anyway, here's one of my stories to show how affected I am/was by her (nobody knows these things except all of you). In '01 my w found out I had taken out CCs without her knowing. I had debt of 35K in CCs. She blew up and it set off some horrible times in my life (terrible attacks on me in front of my kids... .punching, kicking, spitting, swearing). I had known she would find out and I remember thinking I'll just tell her and say I'm sorry and I'll work to fix things (also note; we had 500K in savings n investments but I had no access to them). When I told her, she slapped me. She would tell me how horrible I was all the time (mind you, she wouldn't leave though), I wouldn't get the kids or any of 'her' money if we divorced. I didn't know anything. I had basically raised the kids myself, and losing them would have killed me. I was scared and I believed what she told me. Plus, I was too embarrassed to get help from others. The money problem was so bad, I thought, that I seriously thought about suicide... .because of those CCs, and really because she had me convinced what a loser I was. I couldn't reach her in any way until there was money involved. Yet, the only problem we had, in her eyes, was the money.

I look back and think, OMG, I was so sure I was the evil one. Now, after years of the same behavior and my kids also noticing things, and this great site, I can't believe I was down that low. You become isolated from others (because of the bp), and your grasp on reality changes. You're beat down constantly and over time you become nothing. I finally opened up to my family and they really helped. But they had no idea what she was really like. Now, 7 years later, they've all seen her 'real' side and she's is an outsider almost. Even friends have seen it too. She doesn't have any girlfriends, and she doesn't like her own family.

Sorry for the diversion. The memories come flooding in. Point is, I thought suicide was an option for me, and somehow I came out of that. There is hope for all nons. It's not easy but it is possible.

owdrs

This is a hard one in my relationship. For a lot of reasons I think including just being borderline suicide is something I worry about with my boyfriend. The post about using up seritonin like oil in a car makes a lot of sense. I think that fits well. When things have been very stressful he crashes emotionally and seems to get stuck in a dark place that is very hard for him to get out of.

Obviously this happens with people with borderline sometimes. The part that is worst  is he stops talking. When he gets to that state of mind he does not say how bad they are until he is "back" sometimes weeks later. 

Though this Workshop is here on a board for people with BPD loved ones, that doesn't mean that depression is an issue only for those with BPD loved ones or with BPD themselves. 

How can we help family members and friends (not with BPD) to see that they are depressed and may need help?  Any ideas anybody?

In a recent poll of 182 bpdfamily members, 74% scored themselves as depressed using a test developed by Standford University.

https://bpdfamily.com/message_board/index.php?topic=79772.

Percent 3% 14% 29% 28% 12% 14%

Level of Depression Extreme depression  Severe depression Moderate depression Mild depression Unhappy (no dep) No depression

Important Note: The site protocol for Suicidal Ideation or Domestic violence can be seen by clicking on the "Emergency" icon at the bottom of every thread.

Suicidal Ideation. All suicidal ideation should be taken seriously. Many of our members are depressed at one time or another. Suicidal ideation is not uncommon in clinical depression. The Journal of the American Medical Association has reported that 95% of all suicides occur at the peak of a depressive episode.

Often there is a progression over time from harmless ideations all the way to the act. The earlier we intercept someone in this progression, the more likely harm can be averted.

Our goal in such situations is to talk openly about the subject (tips on what to say) and to gently guide the member to "live local help" in a calm and non threatening way. Local telephone counselors are best - they can do everything from just answering simple questions and being a friend, to suggesting places to go for immediate / low cost assistance, to dispatching emergency assistance in the rare event that it is needed.

Great thread. I have suffered several major depressive episodes in my life, been on the brink of suicidal ideation once or twice, but because I had the love of wonderful parents, DH and DD, I was able to hang on until I could get some help.

I am going through major stress now with BPDDD17 in crisis and DH in serious depression, anger, and denial and not yet getting help. I also suffer from Seasonal Affective Disorder, and I take St. John's wort seasonally to cope with that. So the holidays are hard for me every year, due to the SAD. And now with DD and DH falling apart, I am amazed that I'm not depressed. I am stressed, anxious, my blood pressure is up, I'm not sleeping well, but I am not depressed. Sad and upset, yes, but not depressed.