For more mental health resources, see our National Helpline Database. Preoccupation with death can be a symptom of depression and other mental illnesses. Here’s why having a mental health condition can make you have these feelings and what you can do to address them.
Suicidal Ideation
Having suicidal thoughts (suicidal ideation) is a hallmark symptom of major depression and depressive episodes in bipolar disorder. Suicidal ideation can be passive (thinking about death often but not acting on these thoughts) or active (making plans to act on your suicidal thoughts).
Passive Suicidal Ideation
Passive suicidal ideation involves thinking about death to a marked degree. These thoughts may take the form of imagining yourself dead or wishing you were dead. While passive suicidal ideation may be frequent, intense, and intrusive, you are not taking action or making plans to harm yourself in response to these thoughts. Examples of passive suicidal ideation could include:
Envisioning yourself lying in a casketImagining what would happen at your funeralObsessing or worrying about what you would leave people in your will (though not taking any action, such as filling out paperwork)Wishing you would die your sleep or in a car accident
You may have these thoughts without feeling the urge to act on them. For example, your family, work responsibilities, or your religious/philosophical beliefs may deter you from making suicide plans. “I wish I were dead” is a common “throwaway phrase” people utter without meaning. They may be expressing embarrassment or exasperation in a “joking” manner. However, someone who is depressed may use these words to convey that they are not coping well—and this is no joke. A person’s thoughts usually have elements of both passive and active suicidal ideation—often with no clear separation. Being aware of where you are on the spectrum between passive and active can give you insight into how well you are coping with and managing your mental health.
Active Suicidal Ideation
With active suicidal ideation, “I wish I were dead” progresses to thoughts or plans for following through on those feelings. The progression from thinking to planning can be spurred on by a number of factors, such as stressful life events or the flux of your mental illness symptoms. Suicidal thoughts are most often caused by the culmination of these factors, which leaves you feeling trapped, overwhelmed, and out of control. You may feel guilty and as though you are a burden to others. You may be hopeless and convinced that your life will never get better. Risk factors for completing suicide include:
Access to firearms or other lethal meansPrior suicide attemptsSignificant life stressorsSubstance use disorders
Whether or not you have made a plan for suicide, the thoughts associated with active suicidal ideation must be taken seriously. Research shows that decision-making processes are altered when someone attempts suicide. If you or a loved one is experiencing suicidal thoughts or showing signs of planning suicide, reach out for help immediately.
Major Depression vs. Bipolar Depression
Bipolar depression is similar to major depression. The main difference is that if you have bipolar disorder and are experiencing a depressive episode, you may be more likely than a person with unipolar depression to have “mixed” symptoms. A mixed episode of bipolar disorder can include agitation (both mental and physical), irritability, anger, and anxiety. Single symptoms are rarely present; rather, there are different groups of symptoms that are common. When you are going through a depressive episode in bipolar disorder, you may fall into any or all of the following symptom groups.
Group 1—Changes in Activity Levels
Fatigue Insomnia Lethargy Loss of interest in pleasurable activities Social withdrawal
Group 2—Physical Changes
Psychomotor agitation Sleeping more or less than usual Unexplained aches and pains
Group 3—Emotional Pain
Crying for no apparent reasonDespair and/or hopelessnessFeelings of helplessnessLoss of self-esteemSadness for extended periods of time
Group 4—Difficult Moods
AgitationAngerIrritabilityWorry/anxiety
Group 5—Changes in Thought Patterns
Difficulty concentratingDisorganizationIndecisionLoss of interest in appearance, health, or hygieneMemory problems
The combination of symptoms may be different from one person to the next and doesn’t mean they’re more or less depressed than someone else. It’s also possible to have a combination of symptoms during a mixed or depressive episode that does not include suicidal thoughts.
Managing Suicidal Thoughts
If you or someone you care about is having suicidal thoughts, it’s very important that you seek help. Whether it’s a trusted family member, friend, doctor, or mental health professional, these feelings do not have to be (and shouldn’t have to be) faced alone. Depression, bipolar disorder, and other mental illnesses can be treated. If you are trying to cope with mental illness know that there are resources, such as online and in-person support groups, that may be able to help. If you are helping a loved one who is dealing with mental illness, there are also support groups for caregivers that can offer resources.
Where to Reach Out
If you are having persistent thoughts about death and dying, reach out to someone in your life who is trustworthy and compassionate. If you don’t have someone in your family or group of friends that you can talk to, look to others in your community, such as clergy, counselors, and health care providers. You can also reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 or visit the website to use the online chat feature any time day or night. These resources are available 24 hours a day, 7 days a week. You may be hesitant to talk about suicide openly, as the topic is sometimes considered taboo and there is a pervasive stigma attached to mental illness. However, if someone you love is depressed and you are concerned they are suicidal, it’s important that you ask them directly if they are thinking about harming themselves. Despite popular belief, asking about someone’s intentions does not “plant” the idea of suicide in their head. Rather, it lets the person know that you care about them and are ready to help. If your loved one admits they are feeling suicidal, having thoughts about death, or making plans based on those thoughts, the first thing you need to do is make sure they are safe. From there, you can reach out to the appropriate resources for help.
Avoiding Impulsivity
If you are having thoughts of suicide or feeling that you wish you were dead, avoid making any impulsive decisions or taking drastic actions. While the feelings you are having may be intense and distressing, try to remember that they will pass. If you feel that you are not in control of your life at the moment and that things will never get better, keep in mind that feelings and emotions do not last forever and can change. When you are depressed it can be difficult to recognize that you have an impact on others. The ripple effect of your actions is felt throughout your personal and professional life, your school, and your community. It may not seem or feel like it, but there are people in your life who care about you. If you reach out to them, chances are they will be more than willing to support you. Even if the people in your life aren’t sure how to help, they can be present with you as you work to identify the resources, support, and treatment that you need.
Help is Available
If you are having thoughts of death and dying, but no immediate plans to harm yourself, call your doctor or therapist as soon as possible. These feelings and thoughts may be a sign that you have a mental health disorder that hasn’t been diagnosed yet. If you have already been diagnosed with a mental health condition, feeling suicidal can indicate you need to adjust your treatment. You may need to change or increase your medication, begin psychotherapy, or pursue inpatient/outpatient mental health treatment.
