A suicide crisis, suicidal crisis, attempted suicide or potential suicide, is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when there is an emotional problem or predicament that the individual cannot solve and suicide seems like a solution. Clinicians should reframe suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems
Most cases of potential suicide have warning signs. Attempting to kill oneself or harming oneself, talking about or planning suicide, writing a suicide note, talking or thinking frequently about death, exhibiting a death wish by expressing it verbally or by taking potentially deadly risks, or taking steps towards attempting suicide (e.g., obtaining rope and tying it to a ligature point to attempt a hanging or stockpiling pills for an attempted overdose) are all indicators of a suicide crisis. More subtle clues include preparing for death for no apparent reason (such as putting affairs in order, changing a will, etc.), writing goodbye letters, and visiting or calling family members or friends to say farewell. The person may also start giving away previously valued items (because they "no longer need them"). In other cases, the person who seemed depressed and suicidal may become normal or filled with energy or calmness again; these people particularly need to be watched because the return to normalcy could be because they have come to terms with whatever act is next (e.g., a plan to attempt suicide and "escape" from their problems).
Depression is a major causative factor of suicide, and individuals suffering from depression are considered a high-risk group for suicidal behavior. However, suicidal behaviour is not just restricted to patients diagnosed with some form of depression. More than 90% of all suicides are related to a mood disorder, such as bipolar disorder, or other psychiatric illnesses, such as schizophrenia. The deeper the depression, the greater the risk, often manifested in feelings or expressions of apathy, helplessness, hopelessness, or worthlessness.
Suicide is often committed in response to a cause of depression, such as the cessation of a romantic relationship, serious illness or injury (like the loss of a limb or blindness), the death of a loved one, financial problems or poverty, guilt or fear of getting caught for something the person did, drug abuse, old age, concerns with gender identity, among others.
In 2006, WHO conducted a study on suicide around the world. The results in Canada showed that 80-90% of attempts failed (an estimation, due to the complications of predicting attempted suicide). 90% of failed suicides investigated led to hospitalizations. 12% of attempts were in hospitals.
Ketamine has been clinically tested for treatment-resistant bipolar depression, major depressive disorder, and people in a suicidal crisis in emergency rooms, and is being used this way off-label. The drug is given by a single intravenous infusion at doses less than those used in anesthesia, and preliminary data have indicated it produces a rapid (within 2 hours) and relatively sustained (about 1–2 weeks long) significant reduction in symptoms in some patients. Initial studies with ketamine have sparked scientific and clinical interest due to its rapid onset, and because it appears to work by blocking NMDA receptors for glutamate, a different mechanism from most modern antidepressants that operate on other targets. Some studies have shown that Lithium can reduce suicidal ideation within 48 hours of administration.
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- *Gary Stix for Scientific American. September 11, 2013 From Club to Clinic: Physicians Push Off-Label Ketamine as Rapid Depression Treatment, Part 1
- Gary Stix for Scientific American. September 12, 2013 Is Ketamine Right for You? Off-Label Prescriptions for Depression Pick Up in Small Clinics, Part 2
- Gary Stix for Scientific American. September 13, 2013 Ketamine, a Darling of the Club Scene, Inspires Development of Next-Generation Antidepressants, Part 3
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National Institute of Mental Health director Thomas Insel said, "To my knowledge, this is the first report of any medication or other treatment that results in such a pronounced, rapid, prolonged response with a single dose. These were very treatment-resistant patients."
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