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

The 988 Lifeline offers text and chat in Spanish. It also has help pages for Veterans and service members and for LGBTQI+ callers.

You do not need to be in danger this minute to call. People call for all sorts of reasons, including simply because the week has been too heavy. There is no threshold you have to clear first.

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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. These thoughts are a symptom, and symptoms can be treated. Depression during cancer responds to treatment. So does pain. So does the sleeplessness that makes 3 a.m. feel like proof. Treatment does help many people, though how much and how fast varies from person to person, and finding the right approach can take more than one attempt. That is a reason to start rather than a reason to wait.

Cancer does not make suicide a sensible answer to anything. It makes people exhausted. Exhausted people need help, not a verdict on their life.

NIMH lists warning signs that someone may be at immediate risk. Several come up often in cancer:

• Talking about wanting to die
• Feeling empty, hopeless, or trapped
• Unbearable emotional or physical pain
• Feeling like a burden to others
• Pulling away from family and friends
• Giving away possessions, saying goodbye, or putting affairs in order
• Thinking about death often

Cancer makes that one hard to read. Making a will after a diagnosis is sensible. Saying goodbye is different. If you cannot tell which one you are watching, ask the person directly.

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
• Medicines used in cancer care, such as corticosteroids, procarbazine, interferon alfa, and interleukin-2

NIMH lists chronic pain as a risk factor for suicide, and pain and low mood feed each other. A pain plan that finally works can change how the whole situation feels.

Ask your oncology team to check these things. It is a normal request.

Depression during cancer is treated in more than one way, and the ways combine well.

• Talk therapy. Cognitive behavior therapy, crisis counseling, and one-to-one or 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. Do not judge them in the first few days.
• Movement, if you are able. NCI reports that regular moderate to vigorous exercise was associated with less depression among breast cancer survivors. What is realistic depends entirely on where you are in treatment; ask your team what is safe for you rather than working to a target.

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.

• Tell one person. A partner, a friend, a nurse, a chaplain, a 988 counselor. Saying it out loud takes some of the weight out of it.
• 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.
• Do not drink to get through it. Alcohol lowers the brakes at the worst moment.
• 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. Reducing access to lethal means is one of the most protective things you can do. A 988 counselor or clinician can talk you through what that looks like in their home.

Help them connect. Put 988 in their phone. Offer to sit with them while they call.

Follow up. Check back after the crisis, and again after any hospital discharge. NIMH reports that supportive, ongoing contact plays an important role in 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."

Avoid arguing them out of it. Avoid "you have so much to live for." That usually lands as one more reason to feel guilty. 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. Pain, sleep, medicines, and mood can be treated together. 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 differ by state and by hospital. Anyone who tells you exactly what will happen, without knowing where you live, is guessing.

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. Often the answer is a plan, a follow-up appointment and a phone number. Sometimes, where someone is in immediate danger, more is needed, and that is the system working rather than failing. Nobody can promise you in advance which it will be, but you are allowed to ask what the clinician 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
• Crisis Text Line: text HOME to 741741 — Crisis Text Line