two codirectors of the suicide prevention working group at the johns hopkins suicide prevention school of health, holly wilcox and paul nestadt. dr. wilcox is a researcher and dr. nestadt is a suicide -- sorry, a psychiatry professor. welcome to both of you. guest: thank you for having us. host: dr. wilcox, if you can talk about the working group, what are its missions and goals? guest: sure, so we have a multidisciplinary suicide working group that has been getting together in the school of public health at johns hopkins now for a while, and we focus on creating, developing, and implementing community-based, as well as hospital suicide prevention efforts. we work to influence local and national policy as well. host: can you tell us about your background and research focus? guest: sure. i am a public health professional, and i have spent the last 30 years focusing on implementing evidence-based programs in the community. i work in schools. i'm doing some work with social media. and also working in our hospital and other hospitals. i serve as the director of the center, but i serve in various other roles. i am on the school board in maryland and i am the acting director of the suicide commission in the state of maryland as well. host: dr. nestadt, a little bit about your background and what you focus on? guest: sure. i a psychiatrist. but my research is in suicide, and specifically the epidemiology of suicide, the access to lethal means and how that plays a role. also the role of opioids. i am the codirector of the anxiety and clinical treatment and depression -- treatment of depression. i have been looking at suicide for quite some time now and i have been noticing some of these disturbing trends. host: let's talk about those trends, dr. nestadt, because according to the cdc there has been a record number of people in the u.s. who have died of suicide last year. the country's suicide rate has reached the highest level it has ever been in 80 years. what is the reason behind that, or what are the reasons? guest: it is first worth noting this is not a new trend. suicide rates have been climbing relatively steadily throughout the 21st century. they have gone up about 35% since 2001. this most recent year was the single highest jump we have seen in one year since that time. yes, they are now higher rates since we have seen since world war ii. suicide is multifactorial. i think it is worth noting that the pandemic left a lot of people with mental health issues a little bit more vulnerable, and created stresses for people who had not previously experienced mental health issues. it is worth noting that psychiatric illness is one of the most important risk factors for suicide. it is also worth noting that during the pandemic there was a dramatic increase in firearm purchases. firearms are the number one method used in suicide in the united states. in firearm access has been clearly tied to suicide risk. more firearm buys then we have ever seen. it is not surprising to see an increase in suicide, especially by firearms. host: i will invite our callers to call in and join the conversation. we are dividing those lines up by region this time. if you are in the easterners central time zones you can call (202) 748-8000. if you are in mountain or pacific, (202) 748-8001. we also have a line set aside for those who have experienced suicide or been impacted by it in any way. you can call (202) 748-8002. of course, you can also text and post on social media. dr. wilcox, let's talk a little bit about -- on a more granular level about those trends and the numbers. i have a chart here from axios, working down the change in the suicide rate by age. it shows that all of the numbers went down over the course of last year for all of those that were, essentially under 35 years old. so, up to age 34, but they increased for all of those over age 35. what can you tell us about that? guest: i think we can't pay too much attention to the yearly. what we really look at our trends in the data. the suicide mortality rates change, fluctuate not majorly, but minorly, year by year. what we look for our trends in different groups that may be becoming at higher risk. for adults, they are typically harder to reach. young people we can reach in schools or other programming they are involved in. older adults can be seen by primary care doctors more frequently, but for a long time we have had difficulty reaching adults. no, kind of middle-aged adults the bulk of suicides occur in italy aged adults. and so, efforts to reach people at work, where they work, and through community-based efforts, i think, the way we should be going with trying to reach adults. host: dr. nestadt, you did mention that the highest-risk community, are those with psychiatric illness. could you tell us more about risk factors and if those communities are getting the help they need? guest: that is a good question. there are several risk factors important to think about with suicide. i mentioned psychiatric illness. about 90% of people who do die by suicide had a psychiatric illness as a precipitating factor. other risk factors include substance use, things like alcohol or opioids. there are demographic populations higher at risk. suicide tends to be more common in men. although women do attempt suicide much more frequently than men. men die by suicide very often. racially there is a higher suicide rate in white americans, as well as indigenous people. although it should be pointed out that the suicide rate in black americans has been climbing faster than in other populations, especially since around 2017. other risk factors include having access to a we lethal -- a lethal weapon. also divorce, chronic pain, terminal illness. there are many risk factors. because of that it can be hard to predict suicide in an individual. of these risk factors add up. there are none that are standouts, except perhaps a history of a suicide attempt or suicide attempt in the family. host: dr. wilcox, on the policy side the biden administration has said that they want to impose new requirements on insurers. that would reduce out-of-pocket costs for mental health care, also substance abuse care. but the insurance industry is saying that is going to drive up costs for everybody. what do you think of that? guest: i think anything we can do to try to get people ready access to mental health care is ideal. we have to work to fight stigma, but we also have to increase access and availability of services. and services that are engaging to people, that they will want to dissipate in, and also evidence-based mental health care. we know what works to prevent suicide. part of the problem has been that many of these evidence-based practices never reach somebody at risk or thinking about suicide. and so as a field we have to be a bit more proactive and try to get more upstream. any effort we can do to try to get ahead of somebody ideating and making an attempt our efforts we are thinking about in the public health field. rather than being reactive and waiting for somebody to make an attempt and then engaging them, we want to get upstream, we want to get more to prevention rather than treatment. and so that has been the mission of our center and group, and i think nationally we have to get to that point where we are going to have more of an integrated public health approach, like paul was saying. to a site is a complicated issue. it is multi-determined, so we have to treat it like that. have to have a multi-determined, multifaceted approach that is integrated. and we have not been able to build an infrastructure to make such a national impact like we need to make. so that is the situation, unfortunately, we are in. we have to do a better job of focusing more on prevention and fighting stigma, and some of these other factors that can be barriers to people seeking the help they need. guest: we talk about the economic costs of providing mental health care it is worth noting that suicide, because they will strike people in the younger years sometimes, the economic costs to the u.s., losing those people in their working years is tremendous. the estimates have been from economic organizations that each suicide can cost the u.s. millions of dollars. not just in the cost of taking care of brief meant for those left behind, in years of working life lost. every dollar we invest in providing better mental health care for the people of the united states not only benefits those people and a leaves suffering, it improves our economic outlook as well because of how common suicide is. suicide is thought of as a rare event, but it is worth noting as we talk about these numbers that suicide is the second or third-leading cause of death each year among americans. it has always been one of the top 10 causes of death in the u.s. this is a tremendous public health crisis that allowed -- that demands we take it seriously. host: even if there was lower cost accessing care, are there enough mental health practitioners available to help all of the people that are in need or crisis? guest: that is a really good point. there are several barriers to accessing care aside from money. stigma prevents people from accessing care sometimes. folks are worried about identifying themselves as having a problem. in some ways the pandemic help that. during the pandemic people started to recognize that it was ok to admit they were not doing ok. there was a focus on mental health wellness. there is a shortage of mental health providers. there is a shortage of psychiatrists. it is my hope that that will improve. i think we are seeing in medical schools a shift to more people going into psychiatry then we have seen before. psychiatry is becoming competitive as a specialty. at the end of the day this country has not reimbursed for psychiatric care at the levels they do for things like surgery or internal medicine. so, there are these disincentives to becoming a psychiatrist. hopefully that will change. host: want to redo this, dr. nestadt, and have you comment on it. this is from therican psychological association, who did a survey. not only did more than half of psychologists say they were seeing an increase in severity of symptoms among patients, but 41% said they w seeing an increase in the number of session spent treating each patient, which may reducehe capacity to accept new patients. the miller lite, or than half said they had no openings new patients, and more than two thirds of psychologists who maintained a waitlist said the average wait time is up to three months for a first appointment, while 31% said average wait times were longer than three months. you can't take somebody having a mental health crisis or that is contemplating harming themselves and say, my next available appointment is in three months. guest: you are absolutely right. i have seen those numbers. they are not surprising numbers. it is hard to get an appointment. we find ourselves relying more on more on crisis services, when people are in a very serious crisis, going to the emergency room, calling 988 is always a good option. there is a shortage to those waitlist. we in psychiatry work on triage as best we can. there is different levels of psychiatric stress. when someone is acutely suicidal, that is an emergency, and they are usually able to get care right away in an emergency room setting, although it is not the most comfortable setting. the bottom line is, yes, there is a shortage of providers. thankfully people are seeking help, but when they do sometimes there is a wait. it is best not to wait too long. when you are starting to become worried about your mental health, not waiting until it becomes a crisis, but working to find help. it might be that getting things early prevents you from having extensive care later on that can be hard to attain. host: let's talk to college. carrie is up first in milwaukee, wisconsin. good morning. caller: good morning. i may need a full minute. i have a very different viewpoint and i would love if both of the doctors would like to comment on it. i am 63 years old. i have suffered from severe depression and anxiety since i was 30. so, for half of my life. i am actually on disability for my severe mental illness. i have a suicidal fantasy that i have promised family members i will never carry out. but my point is, there are severely mentally ill people out there that have treatment-resistant depression, like myself, who feel that we treat some animals in this country better than we do people , with illnesses like mine. and bringing up the fact that in parts of canada now i no longer would have to go overseas to get physician-assisted suicide or even euthanasia for a severe mental illness, for someone like myself who very often does not want to be here. it is almost torturous. the government and all of you folks who pay taxes -- and i did for most of my life -- you are supporting me, but i don't want to be here. so, just a viewpoint. i know what you are doing is very noble, but i doubt that most of the folks who work for suicide prevention have ever really wanted to not be alive and can understand that viewpoint. i think canada has it right. if you have someone who truly is so ill -- and it may not be physically terminally ill, but someone who has difficulty living and being alive, there is something to be said about showing compassion for folks. again, we show more mercy to animals in this country as far as euthanasia. host: i'm sorry you are struggling. it's get a response. dr. wilcox, do you want to go first? guest: think you so much for calling. thank you so much for sharing your viewpoint. paul, do you? guest: i can address this as a clinician. first of all, i'm very sorry you are suffering. as you know, you are not alone. many people suffer from treatment-resistant depression. i mentioned earlier the specific focus of our clinic is treatment-resistant depression. most of the time depression does respond to the first treatment use. however, for many people that is not the case. many treatments can be tried and not found to be effective. we have found is that it is very, very rare that no treatment works. and we tried different combination of things in the rum of cognitive behavioral therapy, also meditation. use a relatively new drug which is given specifically for people who have not responded to multiple other treatments, including electroconvulsive therapy. it can be demoralizing to go through those treatments and not see a result. i encourage you to keep trying, because we almost always do find a treatment that works for each individual. when you are depressed one of the symptoms of depression is feeling that hopelessness. that is something the illness does. it makes it seems like nothing is going to work. that is not the case. decades of psychiatric research have shown that we can find treatments in most cases. and it is distressing when somebody is feeling depressed and feeling like nothing has worked, because that is what the illness makes you feel like. i encourage you to continue working with doctors, pursuing new treatments. generally we will find something that works. it is heartbreaking sometimes to hear about some of the cases in canada where euthanasia has been performed for someone suffering from mental illness, because those of us in the field that treat the severely ill have found great improvements in people that for years have said there is no hope for me. to hear about people who have died before they have a chance to get back to their lives, back to their families, is heartbreaking for me. i really hope you are able to find something that works for you. there are many treatments. i'm sure you have tried many of them. sometimes we wait too long to try some of our most effective treatments because of stigma, something like electroconvulsive therapy, things like ketamine and other sorts of treatments, combining psychotherapies can be very effective. but there are many things to do before taking about dying. and what we do know about suicide is that it is often people who have had suicidal thoughts for some time, the actual action can come on very suddenly. it can be very impulsive in some cases. that ambivalence resolving and then seeking death. people who have made a serious suicide attempt and do not die almost universally report tremendous regret that it was attempted. interestingly, only about 6% of people that survive a suicide attempt ever go on to die by suicide later. it is generally the case that once one makes a serious attempt they regret that immediately as long as they do not die. which is why the method used is it so important. if the method used is something that is not likely to be fatal, the chance to survive is high. i wonder if a firearm, with a fatality rate around 90%, they never get a chance to get help. i'm sorry you are suffering. there are many things to be done and i hope the best for you. host: dorothy is calling from opal, virginia. good morning. caller: good morning. i am calling because i have sort of a different viewpoint on suicide and how to prevent it. i had heard earlier talking about the stigma. in 2023i don't think it is the stigma of getting help that is preventing somebody people from receiving any treatment. i think it is more about the lack of a bit -- the lack of availability of any treatment. i personally have been suffering from anxiety and situational depression. since a move i made back in 2022. since then i have been trying to get help. i have become more depressed and more anxious over the actual trying to get help. it makes it worse, because i keep trying and there is never any appointment available. i have transportation issues, so i would need to do it online, and online appointments. and i have seriously become more depressed and more anxious because i have not been able to receive the help. i have insurance that will pay for the help. i call, they tell you, yes, you go online to try to get the help, and they say, no appointments available. so, in my opinion, it is not stigma that is causing it. what is causing the actual suicides is because people, when they know they need help, they cannot receive it. host: all right, dorothy. that goes back to our point about there is not enough practitioners. guest: absolutely. as mentioned before, it is 2023, and during the pandemic they did to see -- they did seem to be a decrease in stigma, but there remains accessibility problems. one thing i encourage people to do is call 988. aside from helping people in the moment, talking them down, the real strength of 988 is to help people find care. you will be put in touch with a center near you geographically. they use your cell phone number to find out where you are, and they use that to see who might be available to help you in your area. if you are calling from virginia what i recommend people do when they're in a state that has a strong state hospital -- sorry, university system -- is to call the local academic center, because they will often take just about every insurance, including public insurance. and often are equipped to do things like zoom appointments. it can be difficult to find help if you are in a more rural area. places like montana, wyoming which are very sparsely populated. unsurprisingly they have some of the highest suicide rates in the country. what ends up being the most effective is continuing to call, friends and loved ones, to find out who can get that appointment soon as. and if it is an emergency going to the emergency room. often practitioners take referrals from the emergency room. guest: we need to be thinking about ways to incentivize people going into the mental health profession. whether that be scholarships, fellowships, or outreach and engagement of people to build the pipeline of mental health professionals do it but, you are right. i had a meeting not too long ago with some members of congress, and this was a big issue for them, and trying to think of ways to expand and build the mental health workforce. and we definitely need to do that. host: and mentioning 988, i have that website. it is simply 988 on a cell phone. i understand that is not just phone, that is also text? host: yes. that has been very important, especially for reaching younger populations. you can text, you can call, online chat. 988 is a very good first step. host: this is a post we got from ajika, who says, is there a high suicide rate ong people in chronic pain? has there been any change since pain medication has become harder to get? guest: there is chronic pain as a major risk factor r suicide. chronic pain is in some wa an epidemic of its own. it is a little bit complicated in terms of the medication treatments, because opioids, which as you know have been part of a public health crisis, have become harder to get as we have recognized how dangerous they can be and how addicting they can be. opioid use has been a risk factor for suicide for quite some time. opioid use tends to increase rates of depression. it is a depressant, so that is a double-edged sword. it can treat pain, but create more depression. also because opioids are such an -- such a dangerous thing to overdose on, it can increase the risk of suicide directly. we need to shift to things that are not opioids. but also cognitive behavioral therapy focused on pain, mindfulness-oriented therapy that can be very helpful for chronic pain without the risks that opioids pose. we continue to seek chronic pain as a major life stressor that does contribute to suicide risk. ultimately dean with that pain can be difficult, but something that can be accomplished. host: we have a text from bric in texas who says, do you feel as thougopids are utilized as vehicles for suicide in any significant way? accidental overdoses seem much more likely. another question. do you believe people have the "right" to commit suicide? guest: just to address the first question, yes, opioids are used as a vehicle or method for suicide. especially as opioids became much more prevalent in the united states. the vast majority of suicide attempts are undergone with overdose of some sort. most suicide attempts. fortunately, it tends overdose are only fatal 2% of the time. 98% survive. the exception being when the overdose method is opioids. it is also difficult to tell when somebody dies of an opioid overdose whether it was intentional. if someone leaves a note that it was a suicide, that makes it easy to tell, but that is the minority of people that leave notes. tickle examiners across the country are left trying to figure that out. in maryland of all of the opioid deaths in maryland -- and we have many -- maryland as many as 75% of those deaths are left as undetermined manner, or we are not sure if it was an accident. those deaths do not even count in our suicide statistics. actually, that is where a lot of my research is in. i interview families who have lost folks to overdose deaths to get a sense if there was any level of intention to it. i believe the second question was about whether anybody has the right to die by suicide, which is a very good question. it relates to the first question we had on the show from wisconsin. it is a complicated ethical question. it is not my area of expertise. it worries me when people die by suicide when they are suffering from depression, because the actual condition of depression is that hopelessness. is that they're or the illness? if we can treat the illness, with the desire to be dead go away? generally, yes. when someone dies before depression has been treated it is heartbreaking. i think a lot about ernest hemingway, who suffered from depression. it was fairly severe depression, throughout most of his adult life. near the end of his life he finally decided to undergo electroconvulsive therapy, but no one had explained to him that it does take eight to 12 sessions. you should do it about three times a week for several weeks. after the first two sessions he just assumed it would not be effective and that hopelessness came forward, and he did die by firearm suicide. it is those kind of images i have in my head when i think about someone seeking suicide, not knowing that the likelihood of getting better is there. i think it is a complicated ethical question, the right to die. as a psychologist i think about how depression plays a role in that. host: al is in annapolis, maryland. good morning. are you there? caller: yes, can you hear me? host: yes, go right ahead. caller: thank you for taking my call this morning. i probably want to take issue with a couple of your comments. that is, number one, is, shall we say, not being able to determine the cause of suicide, or suicide attempts. but let me start with the first premises you have, and that is you are trying to treat the patient, and i would have to say through a silo perspective. when a patient meets with a therapist, a doctor, a hospital, they are all connected with pain medication. now, my wife, she was diagnosed bipolar two. she also had pain medication, so she was on morphine, gabapentin, and i could go on and on. hydrocodone. she attempted suicide twice. the last attempt was on hydrocodone acetaminophen, which you have to have about 7000 milligrams to overdose. her daily prescription was 1300. so she is fully aware that she was wolfing down additional pills to meet that threshold. i grievance is i'm in a house with a wife and daughter that were both suicidal and attempting suicide and cutting, but i was never informed. i was totally left out because the doctors and therapists and hospitals protect the patient from communicating even to the husband. so, my final point is, when a therapist has a patient, at least the people that live in the same house with that patient should be part of the intervention and communication. you could probably appreciate my conundrum when i have a daughter . host: let's go ahead and get a response for you. caller: yeah. but i had no knowledge of. guest: so, patient privacy is important for a couple of reasons, but the most important one is that those patients feel comfortable sharing their struggles with their therapist. they know there is a chance what they reveal to the therapist will be conveyed to their spouse or father, they might be much less willing to discuss those things. however, one of the first things any good therapist or mental health worker does when meeting with the new patient is work on figuring out who is going to be the network of support that they are in touch with to get to lateral information to be their eyes and ears inside the home, so to speak. to get early warnings when things are going bad. at johns hopkins we train our psychology residents to get in touch with family if they are allowed to. if the patient says, no, there is very little we can do unless it is life-threatening. or if there is child abuse involved. because of that it is come to get it. one of the more heartbreaking examples of where that comes into play is when someone ends up in a psychiatric union and their family doesn't know where they are. they call police stations and hospitals. if they call the unit that person is in, we cannot even confirm that they are there because of patient privacy issues. there are subtleties where we can get things that are not in the best interests of the patient. it is legislated that we are not allowed to reveal things, even to close family members, if the patient will not permit it. now, if there is a situation where someone is likely to attempt suicide, there are ways we can sort of go around those confidentiality agreements, and we always explain that to the patient early on in the sessions. but it can be very frustrating for family members. and of the best things family members can do, even with those restrictions, is provide information to therapists and psychiatrists, even if it is a one-directional you can always say, i don't know if you have my son there in the hospital, but let me tell you what i have seen. because we are always allowed to accept information. and be very helpful in treating them. your wife or your daughter, in any situation where you are at home with someone who is suffering and think their mental health worker might not know the extent, let them know. they are always allowed to listen. it is different than giving out information. i always encourage that. people often don't realize that. it generally is very helpful. guest: and there have been major efforts to think about ways to better integrate the family. often times with the child it is the parents taking care of that child, and subduing some level of education, giving them information about psychiatric conditions and disorders, and providing support to them to support their own child. so, there have been multiple efforts we are trying to work on that are in that front of engaging the family to the extent we can and getting them were activated in the care of their family members that are struggling. host: dr. wilcox, you work with children and in schools. i wonder what the trends you have been seen, as far as the mental health of children? has there been a rebound after the dip of the pandemic? guest: yeah, in talking with principals and others working in schools, what they are seeing recently after the pandemic -- and this phase of the pandemic is kids being a little more reactive than they had been in the past. and, you know, increases in depression and anxiety. but also, you know, being quicker from thought to action, in fighting and saying mean things to other students. that is something they are grappling with, figuring out how best to support students and how best to support families in general, and how to do it on their terms. and so, yes, it has been a big challenge. and even in schools where there are mental health professionals and lots of programs, they are always sort of struggling to figure out the best ways to support young people in schools. so, yeah, it is a constant challenge, but it is something i feel like we can really make impact on. host: lonnie is calling from sturgis, south dakota. good morning. caller: good morning. i sure appreciate your efforts. i am a disabled veteran. i was in vietnam when i was 19. and i got severe ptsd. and i have been in mental institutions. i have been in v.a. hospitals. you got to dig down deep, you know? i just lost my wife about a year go to cancer. and i'm really depressed, myself, but a lot of these veterans here in sturgis, we have for me to hear, they are afraid to call out there because they send the police over. and then it makes you feel like you are doing something wrong, you know? and then they take you out to the v.a., and then they lock you up in the side room or whatever. i have been to that too -- through that too, so i kind of just give it to god, you know? that's about all i can do. it is really depressing a lot of times, but i go out and try to help other people and try to do the best i can. but i have been on the streets too, and i have been on drugs. i tried to self-medicaid. i have been to different programs, and back in the 1990's there was a program that was christian-based that was a seminar concept, where it was like attack therapy. and that was about the best program i have ever been to, you know? they see you on a bench and everybody gives you feedback. i think we need more groups. even a chatline would be good, you know? anyway. host: i'm sorry to hear that you are struggling. go ahead, doctor. guest: what you're going through, again, when i listed suicide risk factors i had not mentioned all of them, but being a veteran is a risk factor for suicide we take seriously. as well as losing a loved one. and chronic disability. these things are all risk factors. for ptsd, i agree with you. i think there is a role for medication. the most effective treatments are psychotherapeutic. cbt that is oriented toward your trauma is generally very effective. we are treating ptsd. and what you mentioned about going to groups, has been life-changing for many people. you also mentioned that you focused on helping other people. and sometimes we forget that that is one of the most effective treatments we have some of these struggles. it is turning to helping other people. it is a very adaptive coping mechanism that makes the sufferer feel good as well. turning to something that helps others can be uplifting to give yourself something to be doing that you feel like it is making a difference and is making a difference. that can be hard, especially for people on disability. that tends to be not as many options to fill your life if you are not working. volunteering to help others is tremendously effective. it is also worth noting that bereavement, grief is a risk factor that is just addressed in my opinion through group work. so, finding those groups to organizations like nami. in your area there is often good support. but, yes, pursuing group, pursuing psychotherapy is effective. host: johnny in granite falls, washington. good morning. caller: yes, hello. i had a specific question about antidepressants, but i did want to make a comment after listening to the callers. i had not planned to share this, but in 1988i did make a suicide attempt. and i had an excellent therapist at the time. and i have since found another excellent therapist. both of them have helped me work through the issues i had. and i regret so much, you know, that i made the attempt, because i had so many good things happen since then that i guess i just kind of encourage the people feeling so down right now to hang in there if you can. i know how difficult it is and how sometimes you just give up. but there is hope out there, and i just wanted to say that. i do have a specific question about antidepressants, and i'm wondering if there has been any correlation between suicide and the prevalence of antidepressants? guest: it is a great question. i'm so glad you are doing much better. it is more common that people get better than that they don't. i keep a drawer in my office with letters from patients. sometimes they will write years later, saying, doing so about, here is a picture of my grandkids. i always think of that drawer when i hear about people struggling. about antidepressants. strongest correlation with antidepressants is a reduction in suicide rates. there are great studies that looked at as there was increasing prescription of antidepressants in individual zip codes suicide rates would go down. however, there were reports around the turn-of-the-century of people having increased suicidal thoughts when put on antidepressants. particularly young people. that led to their being a black box warning on antidepressants for young people put on those medicines. i will say that when we treat depression we tend to see people get better first in terms of their energy before even their mood gets better. so, depression can be characterized as people feeling very tired sometimes. everyone is different, but generally people will have low energy, they do not enjoy anything, there is what churchill called the black dog of depression. and they start to get better first the energy comes back before even the mood comes back. so, people look better before they feel better. the problem with that is, then all of a sudden they have the energy they didn't have before two maybe act on the suicidal thoughts they frankly could not handle before. so, those suicidal thoughts are reported more readily, because they are talking more. the things inside their head are coming out more often. then also sometimes that energy can lead people to have the ability to act on it. however, ssri's and antidepressants are very effective for treating depression, which is a major driver of suicide. so, excepting your doctor's advice and taking these medications when you are suffering from clinical depression is much more likely to prevent suicide than to increase suicide. these are very effective treatments. host: just a reminder for everybody, the number of 988 is the suicide and crisis lifeline. that number can be called or texted. holly wilcox, paul nestadt, codirectors of the suicide prevention working group at johns hopkins bloomberg school of public health. announcer: on thursday, the assistant deputy director of the fbi's criminal division testifies on foster children as part of a bipartisan investigation into neglect of children in foster care. watch the senate judiciary subcommittee live at 1:00 p.m. eastern on c-span3, on the free c-span now app, or online at c-span.org. ♪ announcer: c-span is your unfiltered view of government. we are sponsored by these television companies and more, including comcast. >> you think this is just a community center?
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