While the holidays are a happy time for many, others will feel the weight of depression, anxiety and disconnection upon them. Suicides actually peak in the spring and summer, but the ideation that precedes this often begins around this time. What can you do if you suspect a loved one is suicidal? Know the signs, and know when to intervene. Call 911 or a local suicide help line, or go to the nearest hospital.

We asked Edy Nathan, a psychotherapist who specializes in grief and trauma, what to watch for.

SDTC: What are signs that a person is suicidal?

EN: 1. Behaviour: These are observable changes in the person, but assessment on behavioural traits alone can be contradictory. The behaviour displayed can be calm and more peaceful than would be expected after a loss, trauma or depressive episode. Aggression, often combined with sudden, uncontrolled outbursts, is also a signal. Other behavioural traits to observe include general apathy, selling personal items, accruing more credit card debt, a disinterest in sex, and preoccupation with death.

2. Verbal: If you’re listening carefully, the verbal cues are apparent: “I don’t want to live anymore,” “Life is too hard,” “The pain is overwhelming, so it’s better to end it all.” If you’re hearing these kinds of statements, and hearing them more than once or twice, there’s a good chance that suicidal thoughts are prevalent. Though some verbal cues are direct, others may be veiled. Take what you hear seriously and read between the lines, especially if you’ve got personal knowledge of previous depressive episodes. Don’t go blind or deaf or dumb: Believe what is often too hard to hear or conceptualize.

3. Mood: Clinical depression saps energy, focus and desire. Watch for signs of emotional shifts: helplessness, isolation, pessimism, hopelessness, and a deep sadness. This is a short list of some of the emotional hallmarks of depression. Mood is affected also by physical pain, low self-esteem, concern about what others think or feel, and anxiety. When there seems to be an absence of positive options to shift the debilitating struggle, suicide offers a way to stop the pain.

4. Physical Care: Notice differences in self-care and hygiene. Clothes may be unkempt or dirty, and general appearance is often neglected. Sleeping and eating patterns are different than before. Any physical changes lasting more than two weeks may be a call for action. These are non-verbal warning signs.

5. Risk Contributors: Past history of depression, suicidal thoughts and suicide attempts are high-risk factors for a successful suicide. Drug use, family history of mental disorders and suicide, alcoholism, and serious or chronic health issues also contribute to suicide risk.

What should we say or do when we suspect a loved one is suicidal?

A direct approach with a question like, “Are you thinking about ending your life?” is not always the best solution. Reach out to [their] family, or if you’re not comfortable doing that then write your friend a note, or take them for a walk and be curious about what’s going on with them. Never accuse; you will find resistance and even anger. The anger may be a sign of being on the right track. Go gently into this conversation or outreach. If you are correct, the feelings experienced by someone suicidal are alienation, loneliness, and fear. You might notice shifts in behaviour; less involved in social outlets, more drinking, more sleeping, not showing up to work, not taking care of ordinary things like bills, cleanliness (self-care) or even brushing teeth.

If you believe they are in danger of hurting themselves—they’ve shared a plan with you or you’ve seen strange objects in their home, like a rope—or their mood is obviously sad and depressed, call 911.

Don’t do this alone.

How do we cope with the guilt after a loved one has committed suicide?

When someone chooses suicide as a way to end their pain, the guilt and often accompanying shame can paralyze the living loved ones who believe they could have stopped the act. Enmeshed in this thinking is the belief that we have some super-human powers to stop a loved one from suiciding. In an article by Dr. David Burns, he states that our brains actually reward us for feeling guilt. Guilt keeps other emotions silenced. It’s easier to feel guilt than rage, fury and anxiety. Getting to forgiveness of the self and of the loved one who suicided is the first line of defence against the guilt.

What is there to forgive? As humans it is far easier to forgive others than it is to forgive ourselves. We are hard on ourselves. Learn to focus less on the guilt, tap into forgiveness, and you’ll get the chance to engage with other emerging emotions around the loss.

Know who you are by assessing if you are an introvert, extrovert or ambivert (a little of both). Guilt can be pretty loud in our minds, and quieting it requires outlets, such as exercise, writing, giving service to others and laughter. These are just a few tools to help move out of the guilt. Knowing which outlets are best for you will depend on knowing this about yourself.

Be alive. Guilt is deadening and keeps you stuck. Make a date with your guilt motif once a day, give it thirty minutes of your time, then put it back until the next day. Move from a daily date with guilt to every other day and then twice a week and once a week. You are teaching your brain to release it slowly.

Edy Nathan, MA, LCSWR, is a licensed therapist, AASECT certified sex therapist, hypnotherapist and certified EMDR practitioner with more than twenty years of experience. She has degrees from New York University and Fordham University, with post-graduate training at the Ackerman Institute for Family Therapy. For two seasons in 2010, she was the psychotherapist on the A&E series Psychic Kids: Children of the Paranormal.