But there’s got to be a line, right? How do we know that a person’s happier attitude is a sign they plan on hurting themselves, versus just that they’re having a better day? Or versus the “ups” and energy that mania entails in bipolar disorder?
First, consider the context. “If the individual’s sudden happy or carefree behavior increases without explanation, that is an indicator to inquire further and not be afraid to ask about the change, as well as to ask directly about thoughts of suicide,” Marshall said. (More on this in a moment.)
Next, look for other signs of mania and suicidality, and note how they differ. “Manic episodes include other symptoms that would not necessarily be common for a person who is struggling with suicidality to display, such as grandiosity or self-importance,” Dellaquila said. “Those having a manic episode often also seem elated, while an individual who is intent on suicide is more likely to come off as calmer and happier, but not necessarily overjoyed.”
Some other markers of mania include rapid speech, decreased need for sleep and participating in more goal-directed activities, said Dr. Howard Weeks, chief medical officer for Pathlight Mood & Anxiety Center. “Mania is also a concerning psychiatric condition and would warrant a referral to local mental health crisis centers,” he added. In other words, getting professional help can be a smart move regardless.
Signs of suicidality, on the other hand, are talking about suicide (e.g. “I would be better off dead”), seeking lethal means, giving away cherished belongings, and saying goodbye and implying you’ll never see someone again. The signs can also vary from person to person. For example, in Black women with depression, you may notice more self-criticism and physical symptoms, such as headaches, low libido and gastrointestinal issues.
Week said sudden happiness or relief isn’t a sign you’ll commonly see, per se, in people experiencing suicidal thoughts. “Nothing is ever ‘exact,’ and many patients who decide to attempt suicide do not experience this switch in mood,” Weeks said. “However, it can be a warning sign.”
At the same time, the “masking” element Dellaquila mentioned is very real, too. “The key thing to remember is many patients do not exhibit classic severe depression symptoms on the surface,” Weeks noted. “They can be very good at masking their underlying feelings and appear happy and content in discrete social situations.”
Here’s the bottom line, according to Marshall: “Any sudden change in the way one talks, their mood or behavior warrants our attention.”
