How To Stay Alive (When You Really Don’t Want To)

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How To Stay Alive (When You Really Don’t Want To)

A subscriber recently requested:

❝Request: more people need to be aware of suicidal tendencies and what they can do to ward them off❞

…and we said we’d do that one of these Psychology Sundays, so here we are, doing it!

First of all, we’ll mention that we did previously do a main feature on managing depression (in oneself or a loved one); here it is:

The Mental Health First Aid That You’ll Hopefully Never Need

Now, not all depression leads to suicidality, and not all suicide is pre-empted by depression, but there’s a large enough crossover that it seems sensible to put that article here, for anyone who might find it of use, or even just of interest.

Now, onwards, to the specific, and very important, topic of suicide.

This should go without saying, but some of today’s content may be a little heavy.

We invite you to read it anyway if you’re able, because it’s important stuff that we all should know, and not talking about it is part of what allows it to kill people.

So, let’s take a deep breath, and read on…

The risk factors

Top risk factors for suicide include:

  • Not talking about it
  • Having access to a firearm
  • Having a plan of specifically how to commit suicide
  • A lack of social support
  • Being male
  • Being over 40

Now, some of these are interesting sociologically, but aren’t very useful practically; what a convenient world it’d be if we could all simply choose to be under 40, for instance.

Some serve as alarm bells, such as “having a plan of specifically how to commit suicide”.

If someone has a plan, that plan’s never going to disappear entirely, even if it’s set aside!

(this writer is deeply aware of the specifics of how she has wanted to end things before, and has used the advice she gives in this article herself numerous times. So far so good, still alive to write about it!)

Specific advices, therefore, include:

Talk about it / Listen

Depending on whether it’s you or someone else at risk:

  • Talk about it, if it’s you
  • Listen attentively, if it’s someone else

There are two main objections that you might have at this point, so let’s look at those:

“I have nobody to talk to”—it can certainly feel that way, sometimes, but you may be surprised who would listen if you gave them the chance. If you really can’t trust anyone around you, there are of course suicide hotlines (usually per area, so we’ll not try to list them here; a quick Internet search will get you what you need).

If you’re worried it’ll result in bad legal/social consequences, check their confidentiality policy first:

  • Some hotlines can and will call the police, for instance.
  • Others deliberately have a set-up whereby they couldn’t even trace the call if they wanted to.
    • On the one hand, that means they can’t intervene
    • On the other hand, that means they’re a resource for anyone who will only trust a listener who can’t intervene.

“But it is just a cry for help”—then that person deserves help. What some may call “attention-seeking” is, in effect, care-seeking. Listen, without judgement.

Remove access to firearms, if applicable and possible

Ideally, get rid of them (safely and responsibly, please).

If you can’t bring yourself to do that, make them as inconvenient to get at as possible. Stored securely at your local gun club is better than at home, for example.

If your/their plan isn’t firearm-related, but the thing in question can be similarly removed, remove it. You/they do not need that stockpile of pills, for instance.

And of course you/they could get more, but the point is to make it less frictionless. The more necessary stopping points between thinking “I should just kill myself” and being able to actually do it, the better.

Have/give social support

What do the following people have in common?

  • A bullied teenager
  • A divorced 40-something who just lost a job
  • A lonely 70-something with no surviving family, and friends that are hard to visit

Often, at least, the answer is: the absence of a good social support network

So, it’s good to get one, and be part of some sort of community that’s meaningful to us. That could look different to a lot of people, for example:

  • A church, or other religious community, if we be religious
  • The LGBT+ community, or even just a part of it, if that fits for us
  • Any mutual-support oriented, we-have-this-shared-experience community, could be anything from AA to the VA.

Some bonus ideas…

If you can’t live for love, living for spite might suffice. Outlive your enemies; don’t give them the satisfaction.

If you’re going to do it anyway, you might as well take the time to do some “bucket list” items first. After all, what do you have to lose? Feel free to add further bucket list items as they occur to you, of course. Because, why not? Before you know it, you’ve postponed your way into a rich and fulfilling life.

Finally, some gems from Matt Haig’s “The Comfort Book”:
  • “The hardest question I have been asked is: “How do I stay alive for other people if I have no one?” The answer is that you stay alive for other versions of you. For the people you will meet, yes, but also the people you will be.”
  • “Stay for the person you will become”
  • “You are more than a bad day, or week, or month, or year, or even decade”
  • “It is better to let people down than to blow yourself up”
  • “Nothing is stronger than a small hope that doesn’t give up”
  • “You are here. And that is enough.”

You can find Matt Haig’s excellent “The Comfort Book” on Amazon, as well as his more well-known book more specifically on the topic we’ve covered today, “Reasons To Stay Alive“.

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  • Learning to Love Midlife – by Chip Conley

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    While the book is titled about midlife, it could have said: midlife and beyond.

    Some of the benefits discussed in this book really only kick in during one’s 50s, 60s, or 70s, usually. Which, for all but the most optimistic, is generally considered to be stretching beyond what is usually called “midlife”.

    However! Chip Conley makes the argument for midlife being anywhere from one’s early 30s to mid-70s, depending on what (and how) we’re doing in life.

    He talks about (as the subtitle promises) 12 reasons life gets better with age, and those reasons are grouped into 5 categories, thus:

    1. Physical life
    2. Emotional life
    3. Mental life
    4. Vocational life
    5. Spiritual life

    It may surprise some readers that there are physical benefits that come with aging, but we do get two chapters in that category.

    The writing style is very casual, yet with references to science throughout, and a bibliography for such.

    Bottom line: if you’d like to make sure you’re making the most of your midlife and beyond, this a book that offers a lot of guidance on doing so!

    Click here to check out Learning to Love Midlife, and age in style!

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  • Psychedelics and Psychotherapy – Edited by Dr. Tim Read & Maria Papaspyrou

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    A quick note on authorship, first: this book is edited by the psychiatrist and psychotherapist credited above, but after the introductory section, the rest of the chapters are written by experts on the individual topics.As such, the style will vary somewhat, from chapter to chapter.

    What this book isn’t: “try drugs and feel better!”

    Rather, the book explores the various ways in which assorted drugs can help people to—even if just briefly—shed things they didn’t know they were carrying, or otherwise couldn’t put down, and access parts of themselves they otherwise couldn’t.

    We also get to read a lot about the different roles the facilitator can play in guiding the therapeutic process, and what can be expected out of each kind of experience. This varies a lot from one drug to another, so it makes for very worthwhile reading, if that’s something you might consider pursuing. Knowledge makes for much more informed choices!

    Bottom line: if you’re curious about the therapeutic potential of psychedelics, and want a reference that’s more personal than dry clinical studies, but still more “safe and removed” than diving in by yourself, this is the book for you.

    Click here to check out Psychedelics and Psychotherapy, and expand your understanding!

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  • Rebounding Into The Best Of Health

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    “Trampoline” is a brand-name that’s been popularized as a generic name, and “rebounding”, the name used in this video, is the same thing as “trampolining”. With that in mind, let us bounce swiftly onwards:

    Surprising benefits

    It’s easy to think “isn’t that cheating?” to the point that such “cheating” could be useless, since surely the device is doing most of the work?

    The thing is, while indeed it’s doing a lot of the work for you, your muscles are still doing a lot—mostly stabilization work, which is of course a critical thing for our muscles to be able to do. While it’s rare that we need to do a somersault in everyday life, it’s common that we have to keep ourselves from falling over, after all.

    It also represents a kind of gentle resistance exercise, and as such, improves bone density—something first discovered during NASA research for astronauts. Other related benefits pertain to the body’s ability to deal with acceleration and deceleration; it also benefits the lymphatic system, which unlike the blood’s circulatory system, has no pump of its own. Rebounding does also benefit the cardiovascular system, though, as now the heart gets confused (in the healthy way, a little like it gets confused with high-intensity interval training).

    Those are the main evidence-based benefits; anecdotally (but credibly, since these things can be said of most exercise) it’s also claimed that it benefits posture, improves sleep and mood, promotes weight loss and better digestion, reduces bloating, improves skin (the latter being due to improved circulation), and alleviates arthritis (most moderate exercise improves immune response, and thus reduces chronic inflammation, so again, this is reasonable, even if anecdotal).

    For more details on all of these and more, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

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  • Flossing Without Flossing?

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    Flossing Without Flossing?

    You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.

    There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.

    The first part was: Toothpastes & Mouthwashes: Which Help And Which Harm?

    How important is flossing?

    Interdental cleaning is indeed pretty important, even though it may not have the heart health benefits that have been widely advertised:

    Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?

    However! The health of our gums is very important in and of itself, especially as we get older:

    Flossing Is Associated with Improved Oral Health in Older Adults

    But! It helps to avoid periodontal (e.g. gum) disease, not dental caries:

    Flossing for the management of periodontal diseases and dental caries in adults

    And! Most certainly it can help avoid a stack of other diseases:

    Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence

    …so in short, if you’d like to have happy healthy teeth and gums, flossing is an important adjunct, and/but not a one-stop panacea.

    Is it better to floss before or after brushing?

    As you prefer. A team of scientists led by Dr. Claudia Silva studied this, and found that there was “no statistical difference between brush-floss and floss-brush”:

    Does flossing before or after brushing influence the reduction in the plaque index? A systematic review and meta-analysis

    Flossing is tedious. How do we floss without flossing?

    This is (mostly) about water-flossing! Which does for old-style floss what sonic toothbrushes to for old-style manual toothbrushes.

    If you’re unfamiliar, it means using a device that basically power-washes your teeth, but with a very narrow high-pressure jet of water.

    Do they work? Yes:

    Effects of interdental cleaning devices in preventing dental caries and periodontal diseases: a scoping review

    As for how it stacks up against traditional flossing, Liang et al. found:

    ❝In our previous single-outcome analysis, we concluded that interdental brushes and water jet devices rank highest for reducing gingival inflammation while toothpick and flossing rank last.

    In this multioutcome Bayesian network meta-analysis with equal weight on gingival inflammation and bleeding-on-probing, the surface under the cumulative ranking curve was 0.87 for water jet devices and 0.85 for interdental brushes.

    Water jet devices and interdental brushes remained the two best devices across different sets of weightings for the gingival inflammation and bleeding-on-probing.

    ~ Journal of Evidence-Based Dental Practice

    You may be wondering how safe it is if you have had dental work done, and, it appears to be quite safe, for example:

    BDJ | Water-jet flossing: effect on composites

    Want to try water-flossing?

    Here are some examples on Amazon:

    Bonus: if you haven’t tried interdental brushes, here’s an example for that

    Enjoy!

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  • Ozempic’s cousin drug liraglutide is about to get cheaper. But how does it stack up?

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    Fourteen years ago, the older drug cousin of semaglutide (Ozempic and Wegovy) came onto the market. The drug, liraglutide, is sold under the brand names Victoza and Saxenda.

    Patents for Victoza and Saxenda have now expried. So other drug companies are working to develop “generic” versions. These are likely be a fraction of current cost, which is around A$400 a month.

    So how does liraglutide compare with semaglutide?

    Halfpoint/Shutterstock

    How do these drugs work?

    Liraglutide was not originally developed as a weight-loss treatment. Like semaglutide (Ozempic), it originally treated type 2 diabetes.

    The class of drugs liraglutide and semaglutide belong to are known as GLP-1 mimetics, meaning they mimic the natural hormone GLP-1. This hormone is released from your small intestines in response to food and acts in several ways to improve the way your body handles glucose (sugar).

    How do they stop hunger?

    Liraglutide acts in several regions of the unconscious part of your brain, specifically the hypothalamus, which controls metabolism, and parts of the brain stem responsible for communicating your body’s nutrient status to the hypothalamus.

    Its actions here appear to reduce hunger in two different ways. First, it helps you to feel full earlier, making smaller meals more satisfying. Second, it alters your “motivational salience” towards food, meaning it reduces the amount of food you seek out.

    Liraglutide’s original formulation, designed to treat type 2 diabetes, was marketed as Victoza. Its ability to cause weight loss was evident soon after it entered the market.

    Shortly after, a stronger formulation, called Saxenda, was released, which was intended for weight loss in people with obesity.

    How much weight can you lose with liraglutide?

    People respond differently and will lose different amounts of weight. But here, we’ll note the average weight loss users can expect. Some will lose more (sometimes much more), others will lose less, and a small proportion won’t respond.

    The first GLP-1 mimicking drug was exenatide (Bayetta). It’s still available for treating type 2 diabetes, but there are currently no generics. Exenatide does provide some weight loss, but this is quite modest, typically around 3-5% of body weight.

    For liraglutide, those using the drug to treat obesity will use the stronger one (Saxenda), which typically gives about 10% weight loss.

    Semaglutide, with the stronger formulation called Wegovy, typically results in 15% weight loss.

    The newest GLP-1 mimicking drug on the market, tirzepatide (Mounjaro for type 2 diabetes and Zepbound for weight loss), results in weight loss of around 25% of body weight.

    What happens when you stop taking them?

    Despite the effectiveness of these medications in helping with weight loss, they do not appear to change people’s weight set-point.

    So in many cases, when people stop taking them, they experience a rebound toward their original weight.

    Person holds Saxenda pen
    People often regain weight when when they stop taking the drug. Mohammed_Al_Ali/Shutterstock

    What is the dose and how often do you need to take it?

    Liraglutide (Victoza) for type 2 diabetes is exactly the same drug as Saxenda for weight loss, but Saxenda is a higher dose.

    Although the target for each formulation is the same (the GLP-1 receptor), for glucose control in type 2 diabetes, liraglutide has to (mainly) reach the pancreas.

    But to achieve weight loss, it has to reach parts of the brain. This means crossing the blood-brain barrier – and not all of it makes it, meaning more has to be taken.

    All the current formulations of GLP-1 mimicking drug are injectables. This won’t change when liraglutide generics hit the market.

    However, they differ in how frequently they need to be injected. Liraglutide is a once-daily injection, whereas semaglutide and tirzepatide are once-weekly. (That makes semaglutide and tirzepatide much more attractive, but we won’t see semaglutide as a generic until 2033.)

    What are the side effects?

    Because all these medicines have the same target in the body, they mostly have the same side effects.

    The most common are a range of gastrointestinal upsets including nausea, vomiting, bloating, constipation and diarrhoea. These occur, in part, because these medications slow the movement of food out of the stomach, but are generally managed by increasing the dose slowly.

    Recent clinical data suggests the slowing in emptying of the stomach can be problematic for some people, and may increase the risk of of food entering the lungs during operations, so it is important to let your doctor know if you are taking any of these drugs.

    Because these are injectables, they can also lead to injection-site reactions.

    Doctor consults with patient
    Gastrointestinal side effects are most common. Halfpoint/Shutterstock

    During clinical trials, there were some reports of thyroid disease and pancreatitis (inflammation of the pancreas). However, it is not clear that these can be attributed to GLP-1 mimicking drugs.

    In animals, GLP-1 mimicking drugs drugs have been found to negatively alter the growth of the embryo. There is currently no controlled clinical trial data on their use during pregnancy, but based on animal data, these medicines should not be used during pregnancy.

    Who can use them?

    The GLP-1 mimicking drugs for weight loss (Wegovy, Saxenda, Zepbound/Mounjaro) are approved for use by people with obesity and are meant to only be used in conjunction with diet and exercise.

    These drugs must be prescribed by a doctor and for obesity are not covered by the Pharmaceutical Benefits Scheme, which is one of the reasons why they are expensive. But in time, generic versions of liraglutide are likely to be more affordable.

    Sebastian Furness, ARC Future Fellow, School of Biomedical Sciences, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What’s Keeping the US From Allowing Better Sunscreens?

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    When dermatologist Adewole “Ade” Adamson sees people spritzing sunscreen as if it’s cologne at the pool where he lives in Austin, Texas, he wants to intervene. “My wife says I shouldn’t,” he said, “even though most people rarely use enough sunscreen.”

    At issue is not just whether people are using enough sunscreen, but what ingredients are in it.

    The Food and Drug Administration’s ability to approve the chemical filters in sunscreens that are sold in countries such as Japan, South Korea, and France is hamstrung by a 1938 U.S. law that has required sunscreens to be tested on animals and classified as drugs, rather than as cosmetics as they are in much of the world. So Americans are not likely to get those better sunscreens — which block the ultraviolet rays that can cause skin cancer and lead to wrinkles — in time for this summer, or even the next.

    Sunscreen makers say that requirement is unfair because companies including BASF Corp. and L’Oréal, which make the newer sunscreen chemicals, submitted safety data on sunscreen chemicals to the European Union authorities some 20 years ago.

    Steven Goldberg, a retired vice president of BASF, said companies are wary of the FDA process because of the cost and their fear that additional animal testing could ignite a consumer backlash in the European Union, which bans animal testing of cosmetics, including sunscreen. The companies are asking Congress to change the testing requirements before they take steps to enter the U.S. marketplace.

    In a rare example of bipartisanship last summer, Sen. Mike Lee (R-Utah) thanked Rep. Alexandria Ocasio-Cortez (D-N.Y.) for urging the FDA to speed up approvals of new, more effective sunscreen ingredients. Now a bipartisan bill is pending in the House that would require the FDA to allow non-animal testing.

    “It goes back to sunscreens being classified as over-the-counter drugs,” said Carl D’Ruiz, a senior manager at DSM-Firmenich, a Switzerland-based maker of sunscreen chemicals. “It’s really about giving the U.S. consumer something that the rest of the world has. People aren’t dying from using sunscreen. They’re dying from melanoma.”

    Every hour, at least two people die of skin cancer in the United States. Skin cancer is the most common cancer in America, and 6.1 million adults are treated each year for basal cell and squamous cell carcinomas, according to the Centers for Disease Control and Prevention. The nation’s second-most-common cancer, breast cancer, is diagnosed about 300,000 times annually, though it is far more deadly.

    Dermatologists Offer Tips on Keeping Skin Safe and Healthy

    – Stay in the shade during peak sunlight hours, 10 a.m. to 4 p.m. daylight time.– Wear hats and sunglasses.– Use UV-blocking sun umbrellas and clothing.– Reapply sunscreen every two hours.You can order overseas versions of sunscreens from online pharmacies such as Cocooncenter in France. Keep in mind that the same brands may have different ingredients if sold in U.S. stores. But importing your sunscreen may not be affordable or practical. “The best sunscreen is the one that you will use over and over again,” said Jane Yoo, a New York City dermatologist.

    Though skin cancer treatment success rates are excellent, 1 in 5 Americans will develop skin cancer by age 70. The disease costs the health care system $8.9 billion a year, according to CDC researchers. One study found that the annual cost of treating skin cancer in the United States more than doubled from 2002 to 2011, while the average annual cost for all other cancers increased by just 25%. And unlike many other cancers, most forms of skin cancer can largely be prevented — by using sunscreens and taking other precautions.

    But a heavy dose of misinformation has permeated the sunscreen debate, and some people question the safety of sunscreens sold in the United States, which they deride as “chemical” sunscreens. These sunscreen opponents prefer “physical” or “mineral” sunscreens, such as zinc oxide, even though all sunscreen ingredients are chemicals.

    “It’s an artificial categorization,” said E. Dennis Bashaw, a retired FDA official who ran the agency’s clinical pharmacology division that studies sunscreens.

    Still, such concerns were partly fed by the FDA itself after it published a study that said some sunscreen ingredients had been found in trace amounts in human bloodstreams. When the FDA said in 2019, and then again two years later, that older sunscreen ingredients needed to be studied more to see if they were safe, sunscreen opponents saw an opening, said Nadim Shaath, president of Alpha Research & Development, which imports chemicals used in cosmetics.

    “That’s why we have extreme groups and people who aren’t well informed thinking that something penetrating the skin is the end of the world,” Shaath said. “Anything you put on your skin or eat is absorbed.”

    Adamson, the Austin dermatologist, said some sunscreen ingredients have been used for 30 years without any population-level evidence that they have harmed anyone. “The issue for me isn’t the safety of the sunscreens we have,” he said. “It’s that some of the chemical sunscreens aren’t as broad spectrum as they could be, meaning they do not block UVA as well. This could be alleviated by the FDA allowing new ingredients.”

    Ultraviolet radiation falls between X-rays and visible light on the electromagnetic spectrum. Most of the UV rays that people come in contact with are UVA rays that can penetrate the middle layer of the skin and that cause up to 90% of skin aging, along with a smaller amount of UVB rays that are responsible for sunburns.

    The sun protection factor, or SPF, rating on American sunscreen bottles denotes only a sunscreen’s ability to block UVB rays. Although American sunscreens labeled “broad spectrum” should, in theory, block UVA light, some studies have shown they fail to meet the European Union’s higher UVA-blocking standards.

    “It looks like a number of these newer chemicals have a better safety profile in addition to better UVA protection,” said David Andrews, deputy director of Environmental Working Group, a nonprofit that researches the ingredients in consumer products. “We have asked the FDA to consider allowing market access.”

    The FDA defends its review process and its call for tests of the sunscreens sold in American stores as a way to ensure the safety of products that many people use daily, rather than just a few times a year at the beach.

    “Many Americans today rely on sunscreens as a key part of their skin cancer prevention strategy, which makes satisfactory evidence of both safety and effectiveness of these products critical for public health,” Cherie Duvall-Jones, an FDA spokesperson, wrote in an email.

    D’Ruiz’s company, DSM-Firmenich, is the only one currently seeking to have a new over-the-counter sunscreen ingredient approved in the United States. The company has spent the past 20 years trying to gain approval for bemotrizinol, a process D’Ruiz said has cost $18 million and has advanced fitfully, despite attempts by Congress in 2014 and 2020 to speed along applications for new UV filters.

    Bemotrizinol is the bedrock ingredient in nearly all European and Asian sunscreens, including those by the South Korean brand Beauty of Joseon and Bioré, a Japanese brand.

    D’Ruiz said bemotrizinol could secure FDA approval by the end of 2025. If it does, he said, bemotrizinol would be the most vetted and safest sunscreen ingredient on the market, outperforming even the safety profiles of zinc oxide and titanium dioxide.

    As Congress and the FDA debate, many Americans have taken to importing their own sunscreens from Asia or Europe, despite the risk of fake products.

    “The sunscreen issue has gotten people to see that you can be unsafe if you’re too slow,” said Alex Tabarrok, a professor of economics at George Mason University. “The FDA is just incredibly slow. They’ve been looking at this now literally for 40 years. Congress has ordered them to do it, and they still haven’t done it.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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