Suicidal Thoughts After a Cancer Diagnosis

If you are thinking about suicide, you can get help today. You do not have to explain it well. You do not have to be certain.

• Call or text 988, or chat at chat.988lifeline.org. This reaches the 988 Suicide and Crisis Lifeline. It is free, confidential, and open every hour of every day.
• Call 911 or go to the nearest emergency room if you are in immediate danger.
• Text HOME to 741741. This reaches a trained volunteer Crisis Text Line counselor by text message, from anywhere in the United States.

For Spanish, call 988 and press 2, or text AYUDA to 988. Veterans and service members can call 988 and press 1, or text 838255. The 988 Lifeline also has options for people who are deaf or hard of hearing.

You do not need to be in danger this minute to reach out. The 988 Lifeline says you do not have to be suicidal to contact it. It helps people in emotional distress, and illness is one of the reasons it lists. There is no threshold you have to clear first.

A cancer diagnosis can take everything apart at once. Your body, your work, your money, your sleep, your sense of the future. Thoughts of not wanting to be here can show up in the middle of all that. They frighten people, so most people keep them quiet.

They do not need to stay quiet, and they are not rare. The National Cancer Institute reports that nearly half of people with cancer have a lot of distress. About 2 in 10 people diagnosed with cancer become depressed. NCI also notes that higher rates of suicidal thoughts have been found in people with cancer.

Here is the part that matters most. Help exists, and these feelings can change. Depression during cancer can be treated. NCI lists pain that is not well controlled and poor sleep among the things that can add to depression, and both can be raised with your care team. How much treatment helps, and how fast, varies from person to person, and finding the right approach can take more than one try. That is a reason to start rather than a reason to wait.

Cancer can leave people exhausted. Exhausted people deserve help and support, and asking for it is a strong step.

NIMH lists warning signs of suicide. They include:

• Talking about wanting to die, or about being a burden to others
• Feeling empty, hopeless, or trapped, or having no reason to live
• Unbearable emotional or physical pain
• Withdrawing from friends, saying goodbye, giving away important items, or making a will
• Using drugs or alcohol more often
• Eating or sleeping more or less, or extreme mood swings

Some of these signs are hard to read during cancer. Making a will, or changes in eating and sleep, can come with the illness and its treatment. If you are not sure what you are seeing, ask the person directly. If you see these signs, call or text 988. Call 911 if someone is in immediate danger.

Part of what feels like despair can sometimes have a physical contributor that a doctor can find and address. These are possibilities to raise, not a checklist to request or a promise that something correctable will turn up. NCI lists several worth checking:

• Abnormal blood chemistry, such as calcium, sodium, or potassium
• Low vitamin B12 or folate
• Anemia, meaning a low red blood cell count
• Thyroid problems, or adrenal glands that are not working well
• Pain that is not well controlled, and poor sleep
• Medicines used in cancer care, such as corticosteroids, procarbazine, interferon alfa, and interleukin-2

NIMH also lists chronic pain as a risk factor for suicide. That makes pain worth raising, too.

You can ask your oncology team to check these things.

NCI describes more than one way to treat depression during cancer.

• Talk therapy. Cognitive behavior therapy, crisis intervention, and one-to-one or small-group psychotherapy are all used.
• Antidepressant medicine. Several kinds are used in cancer care. NCI notes that some antidepressants take 3 to 6 weeks to work, so they may not help right away.
• Movement, if you are able. NCI reports that exercise has been shown to reduce depression in breast cancer survivors. What is realistic depends on where you are in treatment, so ask your team what is safe for you.

Ask your cancer center whether it has psycho-oncology, psychiatry, psychology, or social work on site. Psycho-oncology means mental health care built around cancer. Ask for an appointment this week, and say why.

• Call or text 988, or chat at chat.988lifeline.org. A counselor will ask if you are safe, listen, and share resources that may help.
• Tell one person you trust. A partner, a friend, a nurse, a chaplain.
• Ask someone you trust to stay with you, or to check in at a set time.
• Ask that person to help make your home safer for now. A 988 counselor or your care team can talk this through with you.
• Try not to use alcohol or drugs to get through it. NIMH lists using them more often as a warning sign.
• Plan the next 24 hours only. Not the year. Not the scan.

You may be reading this because of someone else. You do not need perfect words.

The National Institute of Mental Health sets out five steps.

Ask. "Are you thinking about suicide?" Ask it plainly. NIMH states that studies show asking people if they are suicidal does not increase suicidal behavior or thoughts. Asking gives them room to answer.

Be there. Listen without judging. NIMH notes that research suggests talking about suicide may reduce suicidal thoughts.

Help keep them safe. NIMH says reducing access to lethal means can help prevent suicide when someone is in crisis. A 988 counselor or clinician can talk you through what that looks like in their home. Call 911 if they are in immediate danger.

Help them connect. Help them call or text 988. Offer to sit with them while they reach out. You can also contact 988 yourself if you are worried about someone.

Follow up. Stay in touch after the crisis, and after any hospital discharge. NIMH reports that supportive, ongoing contact can play an important role in suicide prevention.

Some phrases that help:

• "I am not going anywhere. Tell me what today has been like."
• "I would rather you were angry with me than not here. Can we call 988 together?"
• "What would make tonight easier? I will handle it."

NIMH says listening without judgment is key. Try not to argue or lecture. Do not promise to keep it secret. Say instead that you will help them get help, and then stay close.

Tell the oncology team as well, if you can. Pain, sleep, medicines, and mood are all things the team can look at. The team cannot help with what it does not know.

People often stay silent because they fear what comes next.

Be careful with anything that promises you a specific outcome. Rules on privacy, on when a clinician must act, and on hospital care can differ by state and by hospital.

You can ask first. "If I tell you this, what happens next?" is a fair question to put to a nurse, a therapist, or a 988 counselor before you say more. The 988 Lifeline says a counselor will ask if you are safe, listen, provide support, and share resources that may help. If someone is in immediate danger, more help may be arranged to keep them safe. You are allowed to ask what the person is weighing.

• Depression and Cancer (PDQ) — National Cancer Institute
• Adjustment to Cancer: Anxiety and Distress (PDQ) — National Cancer Institute
• Emotions and Cancer — National Cancer Institute
• 5 Action Steps to Help Someone Having Thoughts of Suicide — National Institute of Mental Health
• Frequently Asked Questions About Suicide — National Institute of Mental Health
• 988 Suicide and Crisis Lifeline — 988 Lifeline
• What to Expect — 988 Lifeline
• Warning Signs of Suicide — National Institute of Mental Health
• Crisis Text Line: text HOME to 741741 — Crisis Text Line