The first time I saw my psychiatrist, I told her about my self-harming (suicidal) thoughts. She didn't bombard me with meds or tell me to go to the ER or anything like that. But she was clearly concerned, and took it into account over time when figuring out which meds might work.

I don't *think* I'll actually harm myself, but you never know...the feelings can descend very fast. It's good to talk about it with your psychiatrist.