Depression and Suicide
Language conveys a great deal about values and judgments, and people are becoming increasingly sensitive to the way we talk about suicide. Although we still often hear of someone who has “committed suicide,” most mental health professionals who work closely with suicide, as well as most people who have been affected by the suicide of a loved one, feel the phrase “died by suicide” is more objective and less judgmental.
They also prefer to use the term “suicide” to describe only the act, not the person who died in this way since that may convey that the totality of the person has been reduced to his or her manner of death. The person who died can be referred to as a “suicide decedent.” The term “suicide death” is preferable to “successful” or “completed” suicide.
In the year 2010, 38,364 lives were lost to suicide. A person dies by suicide about every 14 minutes in the U.S. It is estimated that over 500,000 suicide attempts occur in the U.S. each year, with one attempt made every minute.
It is estimated that at least 90 percent of all people who die by suicide are suffering from mental illness, most commonly depression. Among people who are depressed, intense emotional states such as desperation, hopelessness, anxiety or rage increase the risk of suicide. Personality characteristics such as impulsivity also increase suicide risk, as does the excessive use of alcohol and drugs.
In all age groups in the U.S., a considerably larger proportion of people who die by suicide are male. Females, however, generally have higher rates of suicide attempts. About 75 percent to 80 percent of college students who die by suicide are male, although, as in other age groups, more female college students make suicide attempts. These patterns are generally consistent with findings that aggressive behavior by men is more likely to cause injury than is similar behavior by women.
In the U.S. population overall, firearms are the most frequent method of suicide for men and women of all ages. Sixty percent of all people who take their own live do so with a firearm, accounting for more than 18,000 deaths each year. In the college population, however, the most frequent methods are hanging and jumping.
No, suicides are not more frequent around holidays, and particularly not during the winter holidays. Suicide rates overall tend to be above average in the spring months, peaking in April, and are below average during the winter months, with the lowest rate in December. Youth suicide rates are also high during the summer months, June and July, while rates for persons aged 35 and older tend to peak again in the fall. Although the reasons for this seasonal variation have not been definitely established, it likely results from an interplay of psychosocial and neurobiological factors.
Genetic factors are involved in depressive illness, and there is evidence that genetic factors predispose some depressed individuals to suicide. This does not mean that one is “destined” to die by suicide if these family influences are present.
To date studies have not produced definitive findings on the relationship between sexual orientation and suicide, in large part because national suicide data does not include information about sexual orientation. In particular, there is no research evidence to support recent claims that gay, lesbian or bisexual youth are much more likely than heterosexual youth to die by suicide.
A number of reliable studies have reported that individuals who identify as homosexual or bisexual have somewhat higher rates of suicidal ideation and suicide attempts. Among youth, this may be linked to conflicts relate to sexual identity, but the overwhelming proportion of gay, lesbian and bisexual youth do not show any evidence of suicidal behavior.
Suicidal thoughts and behaviors are not the natural consequences of serious stressors or even life-threatening illnesses. People who have such difficult and painful experiences may feel intense sadness or loss, anxiety, anger or a sense of abandonment, and may occasionally have the thought that they would be better off dead.
In most people, however, these experiences do not trigger persistent ruminations of death or a genuine desire or plan to die. If such feelings are present, it suggests the person is suffering from depression or some other mental illness and should seek professional treatment.
Depression has a fairly consistent set of symptoms that last for at least two weeks. These include having little interest or pleasure in doing things, feeling down, having trouble falling or staying asleep or sleeping too much, feeling tired or having little energy, poor appetite or overeating, feeling like a failure or that you’ve let yourself or others down, having trouble concentrating, feeling that you’re moving very slowly or the opposite – being fidgety or restless, and having thoughts that you’d be better off dead.
Depression screening questionnaires, often found on the Internet, are convenient and user-friendly, can help people to identify their symptoms as depression and may encourage them to seek treatment. Some people find the computer-generated responses too impersonal, however.
Also, because the answers to the questionnaire items are evaluate by computer rather than by an actual trained counselor or therapist, problems other than depression are likely to be missed. If someone suspects he or she has a mental health problem, it is always best to get a face-to-face evaluation by a mental health professional.
Both depression (or depressive disorder) and bipolar disorder (sometimes referred to as “manic-depression”) are mood disorders. In contrast to the relatively consistent “down” affect that is characteristic of people who suffer from “unipolar” depression, the moods of people with bipolar disorder alternate between episodes of depression and mania.
During a manic episode, the person experiences an abnormally elevated, expansive and/or irritated mood, as well as such symptoms as grandiosity (inflated self-esteem), distractibility, psychomotor agitation and a decreased need for sleep. Being more talkative than usual, working at a fever pitch and excessive or impulsive behaviors such as going on buying sprees are additional symptoms associated with manic episodes.
The mood disturbance seen during a full manic episode is generally severe enough to markedly interfere with work, school or relationships, although some people with bipolar disorder experience less severe or “hypomanic” symptoms. Untreated bipolar disorder is a clear risk factor for suicide.
Asking about what someone is feeling doesn’t create suicidal thoughts. Someone who is thinking about suicide may not respond honestly because they don’t want to be stopped. But there is no evidence that people start thinking about suicide because someone has brought up the subject.
If you suspect a friend or loved one is suicidal, take the initiative to ask what is troubling the person. Tell him or her that you are worried and that you want to help in any way possible. Don’t be afraid to ask whether the person is considering suicide, or even if he or she has a particular plan or method in mind. Encourage the person to talk to a mental health professional.
Most people who die by suicide have communicated their intention to someone. Someone who talks about suicide gives others the opportunity to intervene before it’s too late.
Most people who think or talk about suicide are ambivalent about dying. Since suicidal ideas most frequently result from mental conditions and disorders that are treatable, encouraging the person to get professional help is essential. There is strong evidence that treatment with medications or talk therapy, or a combination of the two approaches, can save lives.
Sometimes the idea of going to a mental health professional may seem overwhelming to a depressed person. Helping your friend locate information about your school’s counseling center or a mental health professional in the community may be an important support. Offering to go with your friend to the first visit may also be helpful. If your friend appears to be in a crisis and is unwilling to get treatment, talk to a mental health professional or someone who is in a position to help.
If someone tells you they’re thinking about suicide, don’t attempt to argue the person out of it. Avoid the temptation to say, “You have so much to live for,” or “Think about how that will hurt your family.” You might say, “Things must really be awful for you to be feeling that way,” and encourage your friend to talk to you about what he or she is feeling.
Let the person know that he or she can be helped and that you will support them in finding help. If someone talks about an actual suicide plan and seems intent on carrying it out, do not leave the person alone. Call for assistance from a resident advisor, counselor or campus police.
Remove any firearms, drugs or sharp objects that could be used in a suicide attempt. If you are unable to get assistance, take your friend to a counselor, clinic or emergency room, or call 911 or 1-800-SUICIDE for help.
Some people who are seriously depressed and suicidal work hard at hiding their feelings while continuing to function socially and academically. Making the decision to die may sometimes help the person to appear calm and behave normally. Each year, suicide claims the lives of college students who appeared to their friends and families to be happy, well-liked and successful. If you suspect that someone may be depressed or thinking about suicide, the fact that the person’s life looks fine from the outside may not matter.
Some young people engage in cutting or other forms of self-mutilation as a way of handling difficult or stressful feelings. Although many such people do not have suicidal intent and do not go on to more lethal behaviors, for some self-mutilating behavior can be a prelude to suicide. Evaluation by a professional is the best way to determine the degree of risk.
While people do have a right to privacy regarding their mental health, this does not apply when the person’s life may be at stake. Saving a life is more important than violating a confidence, even if it means the loss of a friendship. Seek help from a counselor or other professional.
Mental health treatment, like treatment for physical illnesses, is confidential and patients’ rights are protected by the Americans with Disabilities Act and other laws governing privacy. School policies differ, however, in regard to notification of parents in the case of students under the age of 18.
Are you considering medication for depression?
Perhaps your counselor or psychiatrist has mentioned this option to you, or you've wondered whether an antidepressant medication might be helpful based on what you've "heard" or the experiences of friends or family members.
If you decide to explore the option of medication further, you will want to meet with a psychiatrist. A psychiatrist is a medical doctor whose specialty is the diagnosis and treatment of emotional and mental health problems. A psychiatrist is specially trained in the use of medication to treat depression.
Most of us feel temporarily discouraged or "down" at times. This brochure is about treatment for a very different kind of depression. If you are experiencing this kind of depression, you may have been feeling sad, irritable or depressed most of every day for weeks, if not months. Activities or people you used to enjoy might not seem interesting anymore.
You might stop attending class and feel tired all the time. You might find you have increased or decreased appetite, or you might find that you have lost or gained weight. A couple of days of insomnia, sleeping all day, or wanting to "just stay in bed" occasionally happen for us all. But when this happens consistently over a period of weeks it suggests a more serious problem.
If you're depressed, you may have difficulty concentrating or making decisions. Friends may comment that you're extra "sensitive" or crying a lot. When you are this depressed, it is not unusual to feel hopeless and helpless, as if you're "stuck in a dark hole" and can't get out. Other people may notice you no longer seem to care about your responsibilities or your appearance. You may think about death a lot and even consider killing yourself.
These are all signs of a serious depression:
No. As with any serious illness, coping with depression takes great personal strength. Nonetheless, you may be exposed to negative attitudes about anti-depressant medications, which vary among individuals and cultures. Many students have found it helpful to take the perspective that medication is one form of treatment for depression, just as medication may be used to treat asthma, allergies, infections, or diabetes.
Although no one welcomes the presence of illness in their life, treatment such as medication can serve to limit or eliminate the impact of illness, freeing you to direct your energy more fully toward your personal goals. Depression is one of the most common concerns of students coming to the Counseling Center. It's not a condition that you can will or wish away. People suffering from depression cannot merely expect to "pull themselves together" and get better. Without treatment, symptoms of depression may persist or get worse. With treatment, you may begin to experience significant relief within four to six weeks.
You're not alone. Many university students experience depression.
Eventually, some people will feel better, even without treatment. Unfortunately, "feeling better" can take a year or more, and if untreated, depression can get worse and seriously interfere with your ability to study, work and enjoy relationships. Depression can also be a life-threatening illness when there is a risk of suicide. Medication will not "fix" everything, but it may help lighten your mood and help you to function so that you can begin working through other problems.
Depression is an illness in which factors such as genetics, chemical changes in the body and external events may play an important role. Research suggests that depression may be linked to changes in the functioning of brain chemicals called neurotransmitters. Current research focuses on the serotonin, norepinephrine and dopamine systems.
Certain genetic factors and changes in body hormones have also been implicated in some depressive conditions. These complex biological changes can produce profound changes in your mood and behavior. Antidepressants are thought to correct some of the chemical imbalances present in a depressive illness.
The diagnosis of depression is based on the recognition of certain characteristic signs and symptoms affecting your mood state, thinking patterns and physical well-being. At present, there is no blood test that can confirm or eliminate the diagnosis of depression.
You and your treatment professional(s) will meet regularly after medication is prescribed to assess any changes and/or concerns and to evaluate how the medication is working for you. Typically, people take antidepressant medications for eight to twelve months or longer. While it is often tempting to stop taking the medication when you feel better, it is important to continue until you and your doctor agree your depression is treated.
Stopping the medication early can result in the return of your original symptoms. You may be asked to gradually decrease or "taper off" the medication. "Tapering off" is particularly important with some medications to allow your body an adjustment period.
In the majority of cases, depression is an illness that can be effectively treated with medication and counseling. However, there is always a chance that your depression may return once a medication is stopped. Continuing antidepressants and/or therapy for the recommended time period minimizes this possibility. Unfortunately, in a small number of cases, depression reoccurs after treatment is complete. Recognizing the signs of a new depressive episode and seeking treatment early are very important.
The currently prescribed medications that are approved for the treatment of depression are not considered addictive. Drug addiction implies that you would crave increasing amounts of a substance. While certain medications used in treating unusual forms of depression do have potentially addictive qualities, these medications are not considered standard antidepressants and are not the subject of this brochure.
Although antidepressants are not addictive, you may experience some symptoms that lead you to wonder whether you are getting "high." Early on in treatment, antidepressants may cause you to feel unusually energized, especially compared to your previous state. As with most prescription medications, there are also potential drug side effects with antidepressants.
Feeling "high" or intoxicated suggests an unusual reaction to your medication, an interaction with another medication, complications from drug or alcohol use, or other unwanted side effects. In addition, some patients with manic-depressive illness may experience an unwanted episode of euphoria. Should you experience any of these problems, contact your psychiatrist immediately.
Medication will not change who you are as a person, your unique personal characteristics, or your life circumstances. The goal of antidepressant therapy is to allow you to work toward positive changes in your mood state and thinking patterns. Antidepressant medication assists people in experiencing the full range of human emotions without feeling overwhelmed. Although these positive changes may seem like personality changes, most often they are a sign that you are recovering your ability to react to people and situations in a non-depressed way.
Sometimes antidepressant medication produces temporary side effects that feel like negative changes in personality. In particular, you may feel less emotionally sensitive or less "intense" than you did before taking medication. In the event that this occurs and is distressing for you, don't hesitate to discuss your concerns with your counselor and psychiatrist.
The first step is usually an appointment with a psychiatrist to discuss your depressive symptoms. Your psychiatrist may ask the same questions you have already been asked by another professional. While you may find this repetition frustrating, keep in mind that questions are repeated so that your doctor can gain a thorough understanding of your symptoms, medical history, medication use, and drug or alcohol use. For female patients it will also be important to discuss the issues of pregnancy and birth control use since medication may be potentially harmful to a fetus or nursing infant. Since certain drugs, as well as some medical conditions, can produce depressive symptoms, you may also be referred to another physician for a complete physical exam and laboratory tests.
There are approximately 20 antidepressants currently available and approved for the treatment of depression. Antidepressants are generally classified by the chemical properties of the drug and the way in which they are thought to work. Groups of medication your doctor may refer to include: Selective Serotonin Reuptake Inhibitors (SSRIs), Tricyclic Antidepressants (TCAs) or Monamine Oxidase Inhibitors (MAOIs).
Some clinicians may refer to medications discovered in the last 10 to 15 years as "new" medications and those medications which have been available in the last 30 years as "older" medication. Like shoe sizes, not every medication is the right fit for every individual; a medication that worked well for a friend may not be the best match for you.
Your psychiatrist will consider potential adverse effects of medication. The goal of treatment is to effectively eliminate depression with a medication that produces minimal problems or adverse effects. Unfortunately, an "ideal" medication that does not pose some potential problem or risk is not yet available. Side effects are generally mild and decrease with time. Research is focusing on more selective medications for depression that produce fewer and less problematic side effects. It is important that you ask your doctor about any concerns you might have about a medication or its potential side effects.
Antidepressants are a relatively safe treatment option in otherwise healthy individuals being treated for depression. Like most prescribed (and some over-the-counter medications), antidepressants may cause mild, and usually temporary side effects in some people. Most of the time, side effects are mild, manageable and disappear over time. Common side effects include nausea, loose stools or constipation, dizziness, drowsiness, nervousness, sleep changes, dry mouth, headache and blurred vision. Some people experience a change in sexual interest or functioning. While more severe problems are less common, they are possible.
Your doctor or pharmacist will have information sheets that outline a range of potential side effects. Each time you meet with your doctor for follow-up sessions, she or he will ask about your response to the medication and check for problematic effects. Unusual side effects or those that could interfere with your ability to work or study should be reported to your doctor immediately so that changes in the medication can be made. Most side effects are reversible and gradually disappear after a medication is stopped.
All antidepressants take time to work. Don't be discouraged if you don't feel better right away. Therapeutic response typically occurs within two to four weeks after treatment is started, although some people feel better sooner. It is not unusual for your friends and family to notice signs of improvement before you do. When the medication begins to work, you may find yourself increasingly able to accomplish things and enjoy life in a way that is more "normal" for you. If you do not respond to one medication, your doctor may recommend a change of dosage or a change to other medication(s).
Each person is unique in his or her response to medication. Treatment of depression is an ongoing process, with your doctor monitoring and "fine tuning" your medication, depending on how it is working for you.
An important question! Sometimes when antidepressants are taken in combination with other drugs, the chances of side effects or drug interactions increase. It is very important to consult with your prescribing physician, particularly about allergy medications. Be sure to tell your doctor about any medications you use, even over-the-counter or "natural" vitamins and herbal products.
There is no evidence that antidepressants decrease contraceptive protection. However, like other medications, antidepressants are potentially harmful to the fetus if you are or become pregnant.
There has been a great deal of publicity about herbal preparations such as St. John's Wort for the treatment of depression. Unfortunately, in the United States there are currently no adequate studies to prove that this or other herbal remedies are an effective treatment, especially when compared to standard antidepressants for certain forms of clinical depression.
In addition, herbal preparations may not have any significant impact on severe forms of depression. Currently it is not recommended that traditional antidepressants be mixed with herbal antidepressants. If you are curious about any new developments in the research on herbal preparations, talk with your psychiatrist before "self-medicating".
Although the cost of medication may be difficult for some students to budget, the costs of not treating a depression are also high. Your ability to function in school, relationships and outside employment may be significantly affected by an untreated episode of depression. The average cost of medication for depression will be about $10 to $70 per month (taking one medication at the average dose level). Many insurance companies pay a portion of medication costs. You may be required to pay a "co-pay" (often $4 to $12) for your portion of the cost. Other insurance companies pay a certain percentage of the cost. You will need to check your individual insurance policy to find out what medication expenses are covered.
Did you know that alcohol itself is an extremely potent depressant? You certainly don't want to feel more depressed! The use of alcohol and drugs can complicate the diagnosis and treatment of a depressive illness. Many depressive conditions are associated with the excessive use of alcohol and some drugs. Using drugs or alcohol can increase the risk of dangerous behaviors including suicide or cause complicated interactions with your prescribed medication. In sum, alcohol or drug use can reduce the effectiveness of your treatment, prolong your illness, and increase the risk of negative medication side effects.
Alcohol and drugs can make your depression worse.
This is something you'll want to discuss with your doctor. In most cases, if you miss a dose of your medication, don't take a double dose next time. Simply continue with the next scheduled dose and try not to miss again. If you miss several consecutive doses you may experience problems such as headache and nausea. Most importantly, if you often forget to take the medication, your recovery is likely to take longer.
Often the people who care about you are already aware of and concerned about the changes in your mood and energy levels. They may be very relieved that you are getting help. Since depression can leave you feeling exhausted or helpless, getting support from others at this time is very important. However, many people have never experienced a serious depression and have trouble fully understanding how disabling it can be. They might not mean to hurt you but they may say or do things that do hurt. It may help to share this brochure with those you most care about so that they can better understand and help you.
For many people the combination of medication and psychotherapy is the most effective way to treat depression. While medication can help improve depressive symptoms, it can't change the events, thoughts or behaviors that are problematic or distressing for you. Even before becoming depressed you may have been struggling with personal or family issues that affected how you felt about yourself and your relationships.
Psychotherapy can help you begin to explore and resolve these concerns. Individual and/or group psychotherapy may also be recommended to assist you in improving self-esteem, relationship skills and strategies for managing stressful events. Good nutrition, good quality sleep and exercise are also important elements of your recovery. To feel better as quickly as possible, consider all the recommendations made to you by your counselor and your psychiatrist.
The combination of medication and psychotherapy is often the most effective way to treat depression.
We're here for you. Please contact the Counseling Center for an evaluation and counseling (554-4172). Together with your counselor, you can decide if medication is a good option for you. We also have a psychiatrist on staff at SCU who can help you find the best treatment.