Go to your regular doctor, or one you feel you can trust, and talk to them about a referral for professional counselling.
Confide in a close friend or family member. Know that talking about feeling depressed is not a sign of weakness.
Stay away from non-prescribed drugs and alcohol – you may need your doctor’s help with this – and dispose of any unused medication in the house (especially antidepressants and sedatives). You can take these to your doctor or pharmacist for disposal.
If you are prescribed medication, make sure you are aware of any side effects and arrange for regular follow up.
In some cases, antidepressant medication relieves feelings of anxiety and depression, but in other cases the medication actually increases suicidal thoughts. This risk is greatest in the first few months of medication.
To start feeling better physically, you should sort out any unresolved health problems or manage chronic symptoms, eat a healthy diet and get enough sleep.
You should also seek to reduce or eliminate sources of stress, get out into nature so you can benefit from the sunshine and fresh air, and try to connect in a meaningful way with people who care about you or share common interests.
Set a regular routine with a day plan that includes setting the alarm to get up in the morning, eating breakfast, lunch and dinner at regular times, and making time for exercise and sleep.
Make a list of jobs you need to do each day – even the menial tasks.
Remember the things that you have enjoyed in the past and try to do something that you might enjoy, even for a short period of time, each day.
Make sure you continue with counselling, even after the immediate crisis has passed. You may go through some vulnerable feelings once you are feeling better, and it is important to build preventive strategies for the future. This will also involve developing a short-term and longer term wish list of things you would like to do.
Unfortunately, severe depression can make someone feel so lost, so hopeless for the future that they will end their life. When that happens, those who are left behind always question whether they should have been more aware or done something more.
If you are the go-to person for someone you suspect is suffering from depression, it will probably be unfamiliar territory for you.
There is a common fallacy that if someone is serious about suicide there is nothing you can do to stop it. That is not true – there are strategies for you to follow.
Remember, when someone is so distressed they think about ending their life, or being better off dead, they are wanting to stop the pain.
Recognise the signs: a preoccupation with dying, getting their affairs in order, withdrawing from usual social connections, gathering information or the means to suicide, increasingly using drugs or alcohol, or expressing deep pessimism about the future.
Take any suggestion of suicide seriously: it is a warning sign and a plea for help.
Raise the subject with the person you are concerned about: this gives them the opportunity to talk about how they are feeling and for you to help them get the help they need. You might open the conversation with words such as “I have noticed you seem really down lately – what can I do to help you?”
Encourage them to vent their negative feelings.
Tell them that if they feel like giving up hope, they need to call for help or just get through the next minute or hour.
If the person seems acutely suicidal, do not leave them alone.
Suicide is a tragedy for the person who felt at that moment there was no other solution to their distress, and for the people close to them who are left to wonder what they might have done to prevent it.
If you are thinking about suicide, ask for help. If you are asked for help, know that your actions might save a life.
Dr Kerryn Phelps is conjoint professor in the UNSW Faculty of Medicine, and a past president of the Australian Medical Association and the Australian Integrative Medicine Association.
This opinion piece was first published in The Australian.