If there is one suicide sign you shouldn’t ignore, this is it

Recently, we have heard of two celebrity suicides: Kate Spade and Anthony Bourdain. Information about their lives is being discussed in the media.

The temptation, as always for those in our field, is to make a retrospective diagnosis and assessment to try to make sense of such tragedies. Yet, due in part to the ethical Goldwater Rule, which prohibits such analyzing of public figures not evaluated, that principle should be extended to those who are dead.

Moreover, what makes these two suicides even more concerning is the increase in overall suicides in recent years. This increase is despite attempts at more public education on the topic and risk, as well as more suicide hotlines.

From listening to commentary on the recent suicides, one warning sign seemed missing from the conversation: the apparent improvement in ongoing or intermittent depression and/or anxiety without an apparent, sound reason.

It often seems paradoxical to the public and even some professionals, but if not recognized, we can be led in the wrong direction. This type of improvement, of course, can occur from some temporary street drug use. Another possibility is the initial placebo effect after starting an antidepressant because such medications never kick in right away. However, when this unexplained improved state persists, one also has to wonder if that person has now decided to take their life and is relieved with that decision.

Once, in one of my first patients—the only suicide that I was involved with in my career, but also in so many that I later heard about—suicide seemed like such a surprise. “Oh, he seemed to be doing so much better recently,” the refrain goes.

It’s important to note we have no idea yet if this situation was playing out in the recent celebrity suicides. Still, always keep that possibility in mind with your patients, staff and the public. Always try to talk with the person you suspect of planning suicide even though they seem better, and see if their improvement makes psychiatric or psychological sense.