Depression and Suicide
Table of Contents
- What Is Depression?
- Signs of Depression
- What Causes Depression?
- What Treatments Are Available?
- How Can I Help a Depressed Person?
What Is Depression?Everyone feels down at times. The breakup of a relationship or a bad grade can lead to low mood. Sometimes sadness comes on for no apparent reason. Is there any difference between these shifting moods and what is called depression? Anyone who has experienced an episode of depression would probably answer yes. Depression, versus ordinary unhappiness, is characterized by longer and deeper feelings of despondency and the presence of certain characteristic symptoms (see below). This distinction is important, because in severe cases, depression can be life threatening, with suicide as a possible outcome. Depressed people may also fail to live up to their potential, doing poorly in school and staying on the social margins. Depression is frequently ignored or untreated; the condition often prevents people from taking steps to help themselves. This is unfortunate, as effective help is available.
Signs of Depression
Anyone who feels down most of the day nearly every day for weeks or months may be clinically depressed. Depressed individuals may experience:
- Loss of pleasure in virtually all activities
- Feelings of fatigue or lack of energy
- Frequent tearfulness
- Difficulty with concentration or memory
- A change in sleep pattern, with either too much or too little sleep; the person may wake up in the night or early morning and not feel rested the next day
- An increase or decrease in appetite, with a corresponding change in weight
- Markedly diminished interest in sex
- Feelings of worthlessness and self-blame or exaggerated feelings of guilt
- Unrealistic ideas and worries (e.g., believing no one like them or that they have a terminal illness when there is no supporting proof)
- Hopelessness about the future
- Thoughts of suicide
There is growing evidence that depression is in part an illness with a biological basis. It is more common in individuals with close relatives who have been depressed. Research on the physiology of the nervous system suggests that the level of activity of neurotransmitters, such as norepinephrine and serotonin, changes in longstanding depression: Antidepressant medicines probably work by correcting a "chemical imbalance" of this kind. One type of imbalance is associated with bipolar disorder (previously called manic depression), characterized by dramatic mood swings from depression to irritability or euphoria and other symptoms. A number of physical illnesses can also lead to depression: An examination by a medical clinician may be helpful to rule out medical causes of depressive symptoms.
While depression does appear to have biological components, it is certain that psychological and social factors also play a vital role. The loss of a loved one or a disappointment may trigger a depression; past losses, perhaps not fully acknowledged, often make someone more vulnerable to depression. For complex reasons, some individuals find themselves enmeshed in negative ways of thinking, which can contribute to depression. Other environmental components are a lack of social support and the absence of avenues for fulfillment.
What Treatments Are Available?
Friends and family may provide all the support that is needed in mild cases of depression. Having someone who is willing to listen and ask concerned questions can make all the difference. However, even the most caring and involved friends or family members may not be enough when depression is more severe. In such cases, it is important to seek professional help.
Mental health professionals who may be consulted include psychiatrists, clinical psychologists, and masters-level therapists. Some may first seek help from a general physician or religious counselor. Each type of professional has their own perspective and expertise, and practitioners of all kinds have experience dealing with depression. The important thing is to seek professional help when symptoms are severe and/or longstanding. In factl, it is wise to seek help even when symptoms are not severe to help prevent depression from getting worse.
Some moderate and most severe depressions respond to antidepressant medications. These are prescribed by a physician, generally a psychiatrist, after a thorough evaluation. A positive effect is usually felt within a few weeks. Some types of mood disorders require specific medications; for example, people with bipolar disorder often do well on lithium. Taking medicine does not preclude other forms of treatment. Individual psychotherapy, alone or in combination with medicine, is often beneficial. Insight-oriented psychotherapy aims to raise insight and awareness of unconscious conflicts, drives, and problems in the hope that increased understanding will lead to more freedom to deal with issues and a better sense of self. Other therapies take a cognitive and/or behavioral approach and attempt to change unhelpful ways of thinking or address isolation by helping the person develop interpersonal skills. Group therapy has been shown to be effective in addressing depressive symptoms and raising insights about the self and relationships to others.
Therapists may help individuals make changes in difficult life situations. With the individual's permission, they can set up meetings with friends or parents to explore ways of resolving a crisis. Depressed individuals who are at high risk of killing themselves may need to be in a hospital temporarily. While this may seem like a drastic measure, it can be life-saving, and it may allow the person to get the treatment and support that they need.
Suicide is the second leading cause of death in young people. A major cause of suicide is mental illness, very commonly depression. People feeling suicidal are overwhelmed by painful emotions and see death as the only way out, losing sight of the fact that suicide is a permanent "solution" to a temporary state—most people who try to kill themselves but live later say they are glad they didn't die. Most people who die by suicide could have been helped. An individual considering suicide frequently confides in a friend, who may be able to convince them to seek treatment. When the risk is high, concerned friends and relatives should seek professional guidance.
Suicidal thoughts may be fleeting or more frequent, passive (e.g., "What if I were dead?") or active (e.g., thinking of ways to kill oneself, making a plan). Preparations for death, such as giving away possessions or acquiring a gun, are cause for great concern. A sudden lift in spirits in a depresed person can be a warning sign that they are planning to kill themselves. Any level of suicidal thinking should be taken seriously.
While suicide is often hard to predict, there are some warning signs:
- Being depressed or having other mental disorders
- Talking directly or indirectly about wanting to die or “not be around”
- Increased social isolation
- Significant changes in appearance and hygiene
- Giving away valued possessions; making other preparations for death
- A sudden change in mood
While anyone can become suicidal, there are certain risk factors that make suicide more likely:
- Previous suicide attempt(s)
- Having a family member or friend who recently killed themselves, multiple suicides in the community
- Other recent losses, such as the loss of a relationship or job
- Cultural and religious beliefs supporting suicide (e.g., belief that suicide is a noble resolution of a personal dilemma)
- Alcohol and drug abuse (as this can lower inhibitions and increase impulsiveness)
- Feelings of hopelessness
- Access to means of suicide (e.g., a gun, a quantity of pills)
- Unwillingness to seek help and/or barriers to accessing mental health treatment
"People who talk about it won't do it."
The truth is that few individuals are single-minded in their decision to kill themselves; many are asking for help even as they contemplate suicide. Suicide threats should always be taken seriously.
"People who really want to kill themselves are beyond help."
Fortunately, this is not the case. Suicidal impulses may be intense but short-lived. The majority of individuals who are suicidal even for extended periods recover and can benefit from treatment.
"Suicide is a purely personal decision."
This argument is sometimes used to justify a "hands-off" attitude. It is a misconception, because suicide doesn't just affect the person who dies; it affects others. This view is unfair to those struggling with suicidal impulses who need help and hope.
"Asking about suicide can put the idea in someone's mind."
Research proves that asking someone about suicide will not "put the idea in their head." In fact, many people having suicidal thoughts often feel relieved when someone asks. Suicidal individuals are engaged in a private struggle with thoughts of death. Talking about the possibility of suicide can alleviate the loneliness of the struggle and can be a first step in obtaining help.
It helps to listen in a way that shows you care and empathize. This does not mean entering into the person's despair; an attitude of careful optimism is appropriate. However, avoid minimizing the person's pain or making comments like "everything's fine" or "Your life is good—you have no reason to feel suicidal!" Try saying something like "I can see how hopeless you feel, but I believe things can get better" or "I hear you; I want to help." Advice should be simple and practical; for example, "Let's go for a walk and talk more," "I know you don't feel like it, but it would probably help to eat something," or "I am here for you, but you need more professional advice; let's look up some numbers together."
Change can be slow. Trying to help someone who is depressed and is not responding to your attempts can be frustrating and anxiety provoking. It's important to take care of yourself and get support, too. If you don't take care of yourself, you may burn out, feel angry, or give up on the person. It is a good idea to seek help and support well before you reach this point.
If a person is expressing that they have suicidal thoughts or you see signs of possible suicidality, it's important to take it seriously. Sometimes, a suicidal person may ask you to keep their situation a secret. It can be tempting to promise to keep this secret and/or to take on the burden of supporting them all on your own; however, these are not good ideas. Consider the possible consequences of failing to get the person professional help. It is a sign of caring to get help for someone who is at risk of killing themselves, even if it makes them angry at you. If you are unsure of what to do, you can call CAPS for advice at (831) 459-2628 or call a suicide hotline (see below).
If a person is threatening to kill themselves in the immediate future, is actively trying to kill themselves, or has just made a suicide attempt, call 911.
Call CAPS at (831) 459-2628, the Student Health Center at (831) 459-2500, or your off-campus therapist or medical clinician to make an appointment and/or get referrals for the treatment of depression.
See our Resources page for information, self-help tools, and links to other resources.
Visit our Crisis page for crisis/emergency resources.