Last week, Katherine received the following question from a Warrior Mom:

What is considered a “suicidal” thought, ideation or gesture? I remember being asked by my physician if I was having suicidal thoughts and I honestly didn’t know if I should say yes or no. I wasn’t making plans in my head on killing myself when I was in the deepest of depression, but I was having fleeting weird thoughts about things like “what would it be like to throw myself down the stairs?” and “my family would be so much better off without me here because I cause them so much stress”, etc. There were many days that I know I just kept holding on because my baby needed me and loved me and I couldn’t bear the thought of leaving him. But was this considered being suicidal? I honestly still don’t know. When you look up “suicidal thoughts” on medical websites, there’s no plain mama English description on what this could be, it is focused on the emergent and description of planning and/or acting on these plans to try to kill yourself. I figure other moms out there may be just as clueless as I am and it could be useful to have a plain mama description of this so we know if we should say yes or no to that scary question from our doc.

It is a terrifying place to be when the thought of suicide or harming yourself comes into your head.  Moms who suffer from postpartum depression do not always go to this place even though they may be suffering greatly.  But those who do are usually dealt an additional level of uncertainty and fear: Does this mean that I am really crazy? Will I be locked up for these thoughts that I am having?  Will my baby be taken away?  Will anyone even notice if I am no longer here?  Usually, for these moms, the thought of harm and/or suicide comes from one of two places: either the belief that her family will be better off without her or the feeling that she is in so much pain that she can’t go on.

And, there is of course a spectrum with respect to the nature of these thoughts.  There are the moms who are in such distress that they have fleeting thoughts of wanting to escape it all.  There are the moms who have fleeting thoughts about putting themselves in harm’s way.  There are the moms who know that, despite their thoughts, they would never choose to follow through with these actions.  There are the moms who wonder if they might follow through if things get bad enough.  There are the moms who have a plan about what they would do to hurt themselves.  And there are the moms who have already made a commitment to do so.

So, as for the question above: What, in “plain mama English” is suicidal thinking?

Technically speaking, a mom is having “suicidal thoughts” if and when she begins to think about hurting herself and/or ending her life. These thoughts are, indeed, red flags and a very necessary reason to seek out help.  It is true that not every mom with postpartum depression having these thoughts will act them out, but any time that the thoughts occur, those of us in the field of postpartum depression treatment and mental health will pay attention and note that a mom is really, really suffering.  In my practice, any time a mom talks about having had thoughts like this I put my “medication talk” in a whole new category – medications are a very important part of treatment for moderate to severe cases of postpartum depression and are usually a relatively quick way to reduce symptoms.  My lead towards medication in these instances are NOT because I think these moms are “crazy” or “insane” or “unfit” to be moms, but rather because I know from their thoughts that they are suffering greatly, and I simply don’t want them to have to struggle like that.

Clinically, a “suicide assessment” has to be done any time that a mom discloses that she is having thoughts of hurting herself or ending her life.  When moms, like the one above, disclose these thoughts and then assure me that they have no intention of following through, I will make a verbal commitment with them that they will let me know if they do begin to think seriously about acting upon these thoughts or if these “thoughts” become “urges” (meaning that they are being drawn by an impulse to act upon their thoughts).  And, if they are not already, I will let them know that I think medication treatment is imperative.  For moms who have a plan or who fear that they really may put themselves in harms way, hospitalization is a necessary part of her treatment simply in order to get her immediate relief and to protect her.

The Mayo Clinic lists the following as “warning signs” for suicidal thinking:

• Talking about suicide, including making such statements as “I’m going to kill myself,” “I wish I was dead” or “I wish I hadn’t been born”
• Getting the means to commit suicide, such as getting a gun or stockpiling pills
• Withdrawing from social contact and wanting to be left alone
• Having mood swings, such as being emotionally high one day and deeply discouraged the next
• Being preoccupied with death, dying or violence
• Feeling trapped or hopeless about a situation
• Increased use of alcohol or drugs
• Changing normal routine, including eating or sleeping patterns
• Doing risky or self-destructive things, such as using drugs or driving recklessly
• Giving away belongings or getting affairs in order
• Saying goodbye to people as if they won’t be seen again
• Developing personality changes, such as becoming very outgoing after being shy

Any time a mom with postpartum depression is struggling with the above symptoms, it is absolutely important for her to reach out for appropriate support, even if it is hard to do so.  In fact, acknowledging suicidal thoughts, answering, “yes” to the question “are you having suicidal thoughts” and being honest with yourself and others is usually the hardest part.  But please, please know that you do not need to suffer in this way.  Even if you have gotten very used to doing so.   You owe it to yourself to live your life without these (even fleeting) thoughts or fears.  And your babies and families do need you.

~ Kate Kripke, LCSW