The Unexpected Sign Someone Is Having Suicidal Thoughts

When you first picture someone experiencing suicidal thoughts, you might imagine them crying, lying in bed, alone or in pain. Suicidal ideation — and the depression that can accompany it — often makes people deeply sad or apathetic, which can lead to any number of these scenarios.

But there’s another indicator of suicidal thoughts that may be unexpected or confusing at first: someone with a mental health condition suddenly acting very happy or carefree. While this may seem like a good sign, it can actually be concerning.

Here’s the gist: If someone with a mental health condition suddenly seems joyful and relaxed, it may be because they’ve made the decision to die by suicide. As a result, they feel relieved by two things: the idea that they won’t be in pain much longer, and the fact they can stop debating that decision with themselves. At this point and to this person, dying is the only answer.

Ultimately, we have to look at suicide as a health issue, and one that entails a lot of pain, said Doreen Marshall, vice president of mission engagement at the American Foundation for Suicide Prevention.

“Despite this pain, those with thoughts of suicide may also be ambivalent about wanting to live or die,” she explained. “Thoughts of ending their pain can be met with relief, much like the relief we feel when physical pain is alleviated.”

There’s also another reason that may be at play. “It is also possible that even if they are struggling with the decision internally, they mask how they really feel inside in an attempt to keep loved ones and mental health providers from finding out about their intention to die,” said Danielle Dellaquila, a therapist in New York City. “This is why it is extremely important that we do not stop assessing for suicide when we see sudden improvement in mental health symptoms.”

People who are suicidal are dealing with different brain chemistry that puts them in a dark place with tunnel vision. Plus, that intense level of emotional pain can be blinding.

“For example, their brain functions differently in terms of judgment, concentration, how they see the world, problem-solving, etc.,” Marshall said.

But there’s got to be a line, right? How do we know that a person’s happier attitude is a sign they plan on hurting themselves, versus just that they’re having a better day? Or versus the “ups” and energy that mania entails in bipolar disorder?

First, consider the context. “If the individual’s sudden happy or carefree behavior increases without explanation, that is an indicator to inquire further and not be afraid to ask about the change, as well as to ask directly about thoughts of suicide,” Marshall said. (More on this in a moment.)

Next, look for other signs of mania and suicidality, and note how they differ. “Manic episodes include other symptoms that would not necessarily be common for a person who is struggling with suicidality to display, such as grandiosity or self-importance,” Dellaquila said. “Those having a manic episode often also seem elated, while an individual who is intent on suicide is more likely to come off as calmer and happier, but not necessarily overjoyed.”

Some other markers of mania include rapid speech, decreased need for sleep and participating in more goal-directed activities, said Dr. Howard Weeks, chief medical officer at Behavioral Health Solutions. “Mania is also a concerning psychiatric condition and would warrant a referral to local mental health crisis centers,” he added. In other words, getting professional help can be a smart move regardless.

Signs of suicidality, on the other hand, are talking about suicide (e.g. “I would be better off dead”), seeking lethal means, giving away cherished belongings, and saying goodbye and implying you’ll never see someone again. The signs can also vary from person to person. For example, in Black women with depression, you may notice more self-criticism and physical symptoms, such as headaches, low libido and gastrointestinal issues.

Week said sudden happiness or relief isn’t a sign you’ll commonly see, per se, in people experiencing suicidal thoughts. “Nothing is ever ‘exact,’ and many patients who decide to attempt suicide do not experience this switch in mood,” Weeks said. “However, it can be a warning sign.”

At the same time, the “masking” element Dellaquila mentioned is very real, too. “The key thing to remember is many patients do not exhibit classic severe depression symptoms on the surface,” Weeks noted. “They can be very good at masking their underlying feelings and appear happy and content in discrete social situations.”

Here’s the bottom line, according to Marshall: “Any sudden change in the way one talks, their mood or behavior warrants our attention.”

You can ― and should ― ask if someone has plans to die by suicide. As uncomfortable as that question is to verbalize, it’s crucial. And it won’t “give the person ideas” like you may (understandably) worry it would, according to a study in Psychological Medicine.

“Often, they’ll be relieved someone cares enough to hear about their experience with suicidal thoughts,” Marshall explained.

It’s vital to note that the person may not always say they are planning on hurting themselves, but that doesn’t mean they don’t need support.

“Even if they say no, if you are concerned, you can still encourage them to reach out for help with their own treatment team (therapist, psychiatrist, nurse practitioner, primary care physician) or encourage them to call 988,” Weeks said. (ICYMI, 988 is the new number for the suicide hotline, which you can call or text.)

Other than directly asking, Marshall recommended staying calm, trusting your gut feelings, reminding them you love them, and reassuring them that you hear what they’re saying and aren’t judging or belittling it. She also advised reminding them they’re not alone in what they’re going through, normalizing mental health talk and offering to help connect them with other resources.

“Take the time to calmly listen to what they have to say, and ask some follow-up questions, like how often they are having suicidal thoughts or what they need to do to feel safe,” she added. “Also, reassure them that help is available, and that these feelings are a signal that it’s time to talk to a mental health professional.” (Open Path Collective has a database with more affordable therapists.) Then, she urged taking this person to an emergency room and staying with them to ensure they’re taken care of and safe.

While you aren’t this person’s medical provider, your role as a friend, family member or other loved one is important, too, Weeks said: “You are not their mental health expert, but you can help them access care.”

The original version of this story was published on HuffPost at an earlier date.