Should I Tell My Therapist I’m Thinking About Giving Up on Life?

Reader’s Question

How do I tell my therapist that I am worried about passing thoughts of completely giving up on life, without her wanting me to go to the hospital?

Our Consulting Clinical Psychologist’s Reply

Thoughts of giving up on life, that you would be better dead, that you are a burden to your family, that you are a failure, that it would be alright if you died, and that you should kill yourself are all symptoms of depression. Every depressed person gets the same “garbage truck” full of these thoughts. It’s very important that your therapist knows you are experiencing these thoughts. You tell your therapist the same way you have asked this question — “I’m worried about passing thoughts…”.

Depression can be experienced at several levels. Mild depression might be considered a cognitive/thinking and feeling experience involving disappointment, sadness, etc. With moderate depression we experience changes in our basic functions such as sleep, appetite, energy level, concentration, sexual drive, etc. Changes in these functions are created by a decrease in the neurotransmitter Serotonin, according to the current theory.

Depression signs/symptoms are very predictable and when we experience fleeting thoughts of giving up, helplessness, hopelessness, self-harm, and suicide — you’ve moved into severe depression. The severe symptoms tell us that your Serotonin level is a major concern and would benefit from the use of an antidepressant medication. Honestly reporting your symptoms allows a clinician to accurately evaluate the level of your depression and the need for additional treatment.

Now for the good news. Fleeting/passing thoughts as you describe, while serious, can be treated without psychiatric hospitalization. Hospitalization is typically used when the individual is considered at-risk for immediate self-harm or suicide. You can report your thoughts to your therapist without fear of being hospitalized.

One last issue however. If you are experiencing the severe symptoms of depression, you should be receiving or being referred for an antidepressant medication. Meds and therapy are the most effective way of getting out of a depression. If you are not receiving an antidepressant medication, you should consult your family physician and discuss your depression. Additional information on depression, as well as some depression screening instruments, are available on this website. I mention this because therapists vary in their training regarding the use of medications in psychiatric treatment.