Depression and Suicide

Table of Contents


What Is Depression?

Everyone feels down at times. The breakup of a relationship or a poor evaluation in class can lead to low spirits. 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. The duration and depth of despondency, and the presence of characteristic symptoms, help distinguish depression from ordinary unhappiness. This is important because in severe cases depression can be life threatening. Suicide is a possible outcome. Depressed individuals may also fail to live up to their potential, doing poorly in school and staying on the social margin. 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 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 sleep or too little. Some depressed people wake up often in the night and do 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.
  • Exaggerated feelings of guilt.
  • In some cases, very unrealistic ideas and worries, for instance, the belief that one has a terminal illness or is being pursued for a past crime.
  • Hopelessness about the future.
  • Thoughts of suicide.
    • Those who are seriously depressed are quite likely to have thoughts of suicide.
    • Other emotional illnesses such as severe anxiety or confusion can lead to the idea that "life is not worth living."
    • Anyone who has previously attempted suicide is at increased risk.
    • Recent losses, particularly deaths of close relatives or friends, heighten vulnerability.
    • Alcohol and drugs can dissolve inhibitions against suicide.
    • 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 mean a decision has been reached that will "end the misery."

What Causes Depression?

There is growing evidence that depression is in part an illness with a biological basis. It is known to be more common in individuals with close relatives who have been affected. Research on the physiology of the nervous system suggests that the level of activity of "neurotransmitters" such as norepinephrine and serotonin changes in long standing depressions: antidepressant medicines probably work by correcting a "chemical imbalance" of this kind. One type of imbalance is associated with bipolar or manic-depressive illness, characterized by dramatic mood swings from depression to irritability or euphoria. A number of physical illnesses also lead to depression: an examination by a physician may be in order to look into these possibilities.

Whatever is shown to be true concerning the biology of depression, it is certain that psychological and social factors play a vital role. The loss of a loved one, or a disappointment, may trigger a depression; past losses, perhaps not fully acknowledged, often set the stage. For complex reasons, some individuals find themselves enmeshed in negative ways of thinking. Lack of social supports and the absence of avenues for fulfillment also predispose some to depression.

What Treatments Are Available?

Friends and family may provide all the support that is needed in mild cases of depression. Someone who is willing to listen and ask concerned questions can make all the difference. However, even the most caring and patient companions can find themseves frustrated when depression is more severe. It is important to seek professional help before anything untoward happens.

Mental health professionals who may be consulted include psychiatrists, clinical psychologists, and other psychotherapists. Some turn first to general physicians or religious counselors. While each specialty has its own perspective and expertise, it should be remembered that practitioners of all kinds have experience in dealing with depression, and can refer to others when necessary.

Some moderate and most severe depressions respond to antidepressant medications. These are prescribed by a physician, generally a psychiatrist, after a thorough evaluation. There is usually a positive effect in a few weeks. Some types of depression require special medication: for instance, individuals with manic-depressive illness 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 bring underlying conflicts, drives, and identifications into awareness, in the hope that increased understanding will lead to more options and a better sense of self. Other therapies have the goals of changing negative ways of thinking, or overcoming isolation by developing interpersonal skills. Group therapy has been shown to be effective in helping those who have difficulty forming relationships.

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 is often seen as a drastic measure, it can be life-saving, and it may allow effective treatment to begin.

The Problem of Suicide

Suicide is the second leading cause of death in young people. Each year in the U.S., approximately five thousand individuals between the ages of 15 and 24 take their own life. A major cause of suicide is mental illness, very commonly depression. Others who are not suffering from depression are overwhelmed by painful emotions and see death as the only way out. Most of those who die could have been helped. An individual considering suicide frequently confides in a friend, who may be able to convince the person to seek treatment. When the risk is high, concerned friends and relatives should seek professional guidance.

How Can You Tell if Suicide Is a Possibility?

While suicide is very hard to predict, there are some reliable indicators of risk.

Some Misconceptions About Suicide

"People who talk about it seldom do it."
The truth is that few individuals are single-minded in their decision for death; many are asking for help even as they approach the final act. Suicide threats should always be taken seriously.
"People who really want to kill themseves 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. All 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 always affects others. The dismissal is unfair to those who are struggling with suicidal impulses and need help in choosing to live.
"Asking about suicide can put the idea in someone's mind."
The idea of suicide does not originate this way. 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.

How Can I Help a Depressed or Suicidal Person?

It is useful to listen in a manner that shows appreciation of the person's difficulties. This does not mean entering into the despair; an attitude of careful optimism is appropriate. Depressed individuals are very often wrapped up in their own concerns; advice should be simple and practical, and may have to be repeated. When there is a threat or real possibility of suicide, it is important to stay close to the individual until professional help is obtained.

Change can be slow. Putting out energy and getting no response can be frustrating. People in a helping role should try to make sure their own needs are being met. Too high a level of frustration can lead to anger and a sudden decision to withdraw. It is a good idea to seek assistance well before this point is reached.

Suicidal individuals often try to convince others that the "worst" thing would be to let anyone know of their plight. Friends put in this position should consider the possible consequences of failing to obtain professional help. It is a sign of caring to bring a person to treatment that may alleviate suffering and save a life.