What’s The Difference Between Suicidal Thoughts & Ideations?

What’s The Difference Between Suicidal Thoughts & Ideations?

The Albany Clinic • July 1, 2022

Millions of people contemplate suicide yearly, far fewer plan it, and even less take their own lives. But suicide is still a leading cause of death in America, resulting in almost 46,000 deaths in 2020 . In all cases, thoughts of ending their life are the beginning of a potentially dangerous, life-altering journey.

When Suicidal Thoughts Become Worrisome

There is no difference between suicidal thoughts and ideations, but it’s essential to know when they’re dangerous, and when you or someone else may need professional help. Many people contemplate suicide, briefly thinking of it before dealing with the feelings complicating their lives. Others go further, actively looking into ways to end their life and planning for that outcome.

In the first case, that’s an example of what healthcare professionals label passive suicidal ideation . In the second example, planning your suicide means you’re contemplating what’s known as active suicidal ideation .

What puts you at risk of suicidal thoughts?

Many factors can trigger suicidal thoughts and ideations, but they’re different for everyone and have various severity levels:

  • Mental health illnesses like anxiety, depression, posttraumatic stress disorder, and bipolar disorder
  • Ongoing pain due to an injury or medical problem
  • Heavy stress brought on by difficulties at home, work, or school
  • A family history of suicide amongst biological relatives
  • Using or misusing illegal substances
  • Surviving traumatic situations or episodes of physical or psychological abuse
  • A recent misfortune or death of a loved one

What is passive suicidal ideation?

Passive suicidal ideation​ (or Passive SI) happens when you wish you were dead or could die, but without having plans to harm yourself or attempt suicide. Passive SI means you’re indifferent to an accidental death which would happen if you didn’t take steps to maintain your life. This form of ideation gets “ less attention from clinicians and researchers than active suicidal ideation .”

What is active suicidal ideation?

Active suicidal ideation (Active SI) is more serious, indicating the presence of daily, explicitly suicidal thoughts. Active SI is characterized by a mindful desire to cause self-harm, and the person harbors any measure of desire, greater than zero, for death to happen consequently. The possible deadliness of their actions, based on the method employed for the suicide attempt, isn’t the focus. Instead, the person’s expectation that such an attempt could be fatal is the primary consideration.

Warning signs to watch for

Whether you or someone else has active or passive suicidal ideation can be quickly identified by assessing potential symptoms. Some are more obvious than others and include:

  • Intense feelings of emptiness, hopelessness, guilt, or shame
  • A sense of being trapped or no longer having options to improve life
  • A constant presence of severe mental or physical pain
  • Feelings of being a drain on loved ones
  • Aggressive actions
  • Self-isolation from family and friends
  • Frequent and extreme changes in mood 
  • Reckless, impulsive, or dangerous behavior
  • Buying a weapon
  • Collecting or saving pills
  • Giving away personal belongings because they’re no longer needed or valued
  • Saying goodbye to friends and family
  • Online search history includes methods for taking their own life
  • Draw up a will or get personal affairs in order

What causes suicidal thoughts & ideation?

There are many reasons for suicidal thoughts and ideation . Most often, they’re caused by feeling like you can’t deal with life when encountering what appears to be an overwhelming, unwinnable situation. If you think there’s no hope for the future, suicide can mistakenly appear to be a viable solution. You could have tunnel vision, where you believe suicide is the only option during a crisis.

Diagnosis & Treatment

Suicidal ideation, whether passive or active, signals that you need professional help to understand what’s happening and how your problems can be resolved. There are numerous professional resources to consider. You can also reach out to a trusted family member, friend, co-worker, spiritual advisor, healthcare professional, or local support group.

In nearly all cases, thinking of suicide means you need to talk with a healthcare provider for diagnosis and treatment options. A medical doctor may uncover a condition or illness and treat it to lessen your emotional distress. A psychiatric professional will investigate your emotions, thoughts, and behaviors as potential triggers, and help you develop coping skills to manage stress better and reduce the risks of suicidal thoughts and ideation.

Treatment options may include ongoing psychotherapy, antidepressants, or medicine like ketamine. Stellate Ganglion Block has also been shown to alleviate suicidal ideation especially in those who also suffer from PTSD.   Ask your healthcare provider which option is right for you.

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In-Clinic vs. At-Home Ketamine Therapy: What’s Best for Your Mental Health?

By Kimberly Mercille • July 9, 2025
As ketamine therapy becomes increasingly popular for treating mental health conditions like depression and PTSD, more people are exploring their options. At-home ketamine therapy gained traction during the pandemic for its convenience, but without medical supervision, this approach may come with elevated risks. In this article, we’ll explore some of the key differences and pros and cons of in-clinic versus at-home ketamine therapy. What Is In-Clinic Ketamine Therapy? IV Ketamine Treatment In-clinic ketamine therapy involves receiving treatment at a licensed medical facility, such as The Albany Clinic , where professionals monitor and administer the medication under strict protocols. This ensures your safety, especially during your initial sessions. At The Albany Clinic, we specialize in intravenous (IV) ketamine infusion therapy , which has been most well-researched when it comes to treating mental health disorders. IV ketamine bypasses the digestive system, delivering the medication directly into the bloodstream. IV ketamine can help relieve symptoms of various mental health disorders, including depression , anxiety , post-traumatic stress disorder (PTSD) , and more. During an infusion at our clinic, you’ll rest in a calm, controlled environment while ketamine is delivered into a vein through a catheter. Our trained staff will closely monitor your vital signs and mental state throughout the session, adjusting the dose of ketamine if needed. We’ll observe you after treatment to ensure any side effects are managed promptly and effectively. Spravato We also offer Spravato (esketamine) at our clinic, a nasal spray based on ketamine. Unlike other forms of ketamine treatment, Spravato is approved by the FDA and is specifically for adults with treatment-resistant depression or major depressive disorder with suicidal thoughts . Spravato is only approved for in-clinic use under professional supervision and cannot be administered at home, making clinical oversight a legal and medical necessity for this treatment option. During a Spravato session, you’ll self-administer the medication under the supervision of our medical staff. We’ll then closely monitor you for a couple of hours to ensure you’re safe and all side effects have subsided before leaving. What Is At-Home Ketamine Therapy? At-home ketamine therapy allows patients to self-administer the ketamine, typically in the form of lozenges or nasal sprays, delivered via mail. While this option offers flexibility, it usually involves minimal supervision , often limited to virtual check-ins with healthcare providers. Some at-home providers offer optional video support during sessions, but this is not always the case. Patients are largely responsible for monitoring their own physical and emotional reactions, without the benefit of immediate medical intervention if adverse effects occur. At-home treatment often includes supplementary materials , such as guided meditations or journaling tools. However, the lack of real-time clinical oversight makes this option less ideal for those with complex or severe mental health needs. Safety Considerations: In-Clinic vs. At-Home While ketamine therapy is considered safe for most patients, it does come with potential physical and psychological side effects , including: Physical Risks: Elevated blood pressure or heart rate Nausea or vomiting Sedation or dizziness Impaired coordination Rare allergic reactions Psychological Risks: Hallucinations or dissociation Temporary confusion or anxiety Emotional vulnerability during treatment Risk of misuse or dependency The FDA has issued warnings about at-home ketamine use due to its potential for abuse and lack of medical supervision . Without proper monitoring, the risk of addiction and long-term complications, such as bladder damage and cognitive decline, may increase. Key Differences Between In-Clinic and At-Home Ketamine Therapy

A Guide to IV Ketamine

By Matt Rodriguez • July 8, 2025
Intravenous (IV) ketamine has emerged as a promising option for individuals struggling with treatment-resistant depression and other hard-to-treat mental health conditions. Ketamine was originally developed as an anesthetic, but is now being used in controlled medical settings to deliver rapid relief when traditional therapies fall short. This guide explores the history, science, benefits, and practical considerations of IV ketamine therapy and what you can expect from treatment at The Albany Clinic.

Stellate Ganglion Block (SGB) for Depression

By Kimberly Mercille • May 27, 2025
Stellate Ganglion Block (SGB) is an emerging mental health treatment that targets key mechanisms linked to depression. In this article, we’ll discuss the science behind SGB and its potential benefits. If you or someone you know is struggling with depression, this information can help you make an informed decision about whether SGB might be the right option. What is a Stellate Ganglion Block (SGB)? What is the Stellate Ganglion? The stellate ganglion is a cluster of sympathetic nerves located on each side of the neck near the first rib. These nerves are part of the autonomic nervous system, which controls automatic body functions like heart rate, blood pressure, and digestion. The term "stellate" means "star-shaped" because the ganglion often looks like a star under a microscope. It helps regulate the body's stress response by controlling norepinephrine, a chemical that triggers the fight-or-flight reaction. When this system becomes overactive, it can cause various physical and psychological problems, including depression. Stellate ganglion block (SGB) therapy may help by reducing the activity of the stellate ganglion, calming the fight-or-flight response, and lessening the damaging effects of prolonged nervous system stress. How Does Stellate Ganglion Block Work? Stellate Ganglion block (SGB) is when a local anesthetic is injected near the stellate ganglion. These drugs inhibit transmission between nerve cells, dampening activity in the ganglion. They typically include lidocaine, bupivacaine, or mepivacaine, which are sometimes combined with a steroid medication. Patients may also receive another medication to relax them before treatment. SGB is typically performed using ultrasound guidance . The injection process lasts no more than 10 minutes, but patients will motinoted for another 30-45 minutes after treatment to ensure their safety. How Does Stellate Ganglion Block Work for Depression? Chronic stress is a major contributor to depression and is often linked to an overactive sympathetic nervous system. People with depression commonly show high levels of cortisol, a hormone that plays a key role in the body's stress response, in their blood stream. Cortisol is helpful in small doses, but when chronically elevated, it can disrupt neural circuits in the brain. Excessive cortisol can lead to: Neurotoxicity - Cortisol can be toxic to nerve cells, especially in the hippocampus, which is crucial for memory and emotional regulation. Overinflammation - Cortisol increases the activity of the body’s natural defense system, resulting in the system causing damage to nerve cells. Impaired synaptic plasticity - Cortisol inhibits the capacity for the brain to “re-wire” itself. This makes it harder for people to adapt to stressful situations and learn new patterns of behaviour. Disrupted sleep - High cortisol can prevent people from sleeping well. During sleep, restorative biological processes occur in the brain, and excess cortisol can prevent these from happening. SGB decreases sympathetic nervous system activity, which can reduce cortisol levels. This can help restore function in brain areas and pathways associated with positive mood, emotional regulation, and stress resilience. Evidence Supporting SGB for Depression To date, there’s very limited evidence supporting the use of SGB for depression. One pilot study found that SGP significantly reduced depression symptoms in people with treatment-resistant depression (TRD) and was well-tolerated. However, there was no significant difference to the placebo group and the sample size was very small. Nonetheless, multiple lines of research show that SGB can alleviate symptoms of post-traumatic stress disorder (PTSD), which shares similarities with depression. In a trial of SGB for PTSD , participants reported significantly lower scores of depression following treatment. Who May Benefit from SGB for Depression? SGB is primarily utilized for treating PTSD, so individuals with PTSD who also experience depression may find SGB beneficial. Additionally, SGB has shown potential in alleviating anxiety symptoms, suggesting it may be advantageous for those dealing with both depression and anxiety. Because SGB isn’t approved by the FDA, it is typically only used when standard treatments like antidepressants and psychotherapy haven’t worked. SGB is an “off-label” treatment, much like ketamine therapy or brain stimulation therapies. Importantly, SGB may not be suitable for everyone because of medical reasons. Contraindications include: Recent myocardial infarction Coagulopathy or anticoagulant therapy Glaucoma Pre-existing contralateral phrenic nerve palsy Severe emphysema Cardiac conduction block Potential Risks and Side Effects of SGB Common Side Effects Most side effects of SGB are temporary and resolve as the anesthetic wears off. These may include: Hoarseness or Voice Changes: The proximity of the stellate ganglion to nerves controlling the voice box can lead to temporary hoarseness. Drooping Eyelid (Ptosis): Temporary drooping of the eyelid on the side of the injection may occur. Red or Bloodshot Eyes: Some individuals may notice redness in the eyes following the procedure. Watery Eyes and Nasal Congestion: Increased tearing and nasal stuffiness are possible but typically short-lived. Sensation of a Lump in the Throat and Difficulty Swallowing: Some individuals may experience a sensation of a lump in the throat and have difficulty swallowing after the procedure. Warmth or Tingling in the Arm or Hand: A warm or tingling sensation in the affected limb may be experienced temporarily. Although uncommon, some individuals may experience more serious complications, such as nerve damage, seizures, and allergic reactions. Given the potential risks, patients interested in SGB at the Albany Clinic will have an in-depth consultation with one of our qualified healthcare professionals before undergoing treatment. They can assess your medical history, current health status, and the potential benefits and risks of the procedure in your specific case. SGB for Depression in Illinois If you're in the Carbondale area and interested in the potential benefits of SGB for depression, the Albany Clinic is here to help. We specialize in innovative mental health treatments, including SGB, which has been shown to provide rapid relief from mental health symptoms, with effects lasting several weeks. Our experienced team offers personalized support, guiding you through every step—from determining if SGB is the right option for you to exploring alternative treatments and financial considerations. Contact us today to learn more about how we can support your mental health journey.