Michelle: My moods are somewhat stable but the thoughts that happened last summer before the hospitalization have resurfaced.

I can only presume that you were depressed last summer and your depression contributed to your suicide attempt. If I were you, I think what I'd do would be to try and conduct an informal assessment on myself. I'd ask myself, did my depression have an actual cause or was life going along fantastically, in spite of which, I was still terribly depressed.

If my depression was related to life circumstances, I'd pursue psychotherapy. Maybe it was back because I hadn't actually dealt with the life challenges that contributed to my depression in the first place. I don't know what kind of therapy you had but there are different kinds; maybe you would benefit more from a different kind.

If my depression was seemingly totally unrelated to life circumstances and I found medication to be helpful, I might consider a change to my medication. However, I'd also look at non-medicinal approaches since medication can only do so much on its own.

No matter what, I'd also want to ensure at least one person in my daily, face-to-face reality was aware I felt I was slipping so if I quickly went down, there'd already be someone there to provide a hand-up.

I’m afraid to go back to my counselor, as he released me as saying I was fine about 5 months ago and didn’t need any more help.

If you found that individual and their form of therapeutic treatment to be helpful, give them a call. Maybe you were fine five months ago. That doesn't mean you have to feel fine now. If you didn't find them helpful, see if you can connect with another therapist. It's probably best to do this sooner rather than later.

Does anyone have any kind of ideas on how to get through this for a second time without having to be hospitalized again?

- One issue to consider is what sort of care might you require if you stayed home as opposed to going to the hospital? Some form of caregiver support will likely become necessary. Do you have a spouse or family member who can provide care in the home should you require it? If not, you could also attempt to create a care team by drawing on friends and family members.

- Another alternative might be to consider a day-program. Depending on your community resources you might be able to find something that you attend throughout the day but return home at night. As another possibility, your community might offer a professional nurse or social worker that will visit you in your home on a daily basis.

- You can also research now to see if there are any alternatives to psychiatric hospitalization in your area, such as residences, hostels or private clinics. Local support groups, mental health clinics or mental health hotlines might be able to offer you some information in that regard.

- It would also likely be helpful to develop a plan, such as an advanced directive, in case hospitalizaion becomes unavoidable. In all cases, it's probably best that you enter the hospital on a voluntary basis as opposed to allowing the situation to escalate to the degree that forced treatment could be imposed. Discuss this matter with your caregivers so they have some idea of what you consider critical enough to require immediate hospitalization.

Best of luck to you.

~ Namaste