- Depression and Suicide
- What Causes Depression?
- What Treatments Are Available?
- How Can You Tell if Suicide Is a Possibility?
- Misconceptions About Suicide
- How Can I Help a Depressed Person?
- Depression and Anxiety
- Who Gets Depression?
- What Are the Treatments for Depression?
- Depression and Suicide: Getting Help in a Crisis
- Additional Resources
Depression and Suicide
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.
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 them or that they have a terminal illness when there is no supporting proof)
- Hopelessness about the future
- Thoughts of suicide
What Causes Depression?
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 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.
How Can You Tell if Suicide Is a Possibility?
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 ly:
- Previous suicide attempt(s)
- Having a family member or friend who recently killed themselves; multiple suicides in the community
- Other recent, significant 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
Misconceptions About Suicide
«People who talk about it won't do it.»
Suicide threats should always be taken seriously. 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.
«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 also.
«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.
How Can I Help a Depressed Person?
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 «Everything's fine» or «Your life is good—you have no reason to feel suicidal!» Try saying something «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» 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.
See our Resources page for additional information, self-help tools, and links to other resources.
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.
Depression and Anxiety
Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:1
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable‚ easily frustrated‚ or restless
- Having trouble falling asleep or staying asleep
- Waking up too early or sleeping too much
- Eating more or less than usual or having no appetite
- Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling tired‚ even after sleeping well
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself
The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
Who Gets Depression?
In general‚ about 1 every 6 adults will have depression at some time in their life.3 Depression affects about 16 million American adults every year.4 Anyone can get depressed, and depression can happen at any age and in any type of person.
Many people who experience depression also have other mental health conditions.1,5 Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry, and/or panic.1 These feelings can interfere with daily activities and may last for a long time.
Smoking is much more common among adults with mental health conditions, such as depression and anxiety, than in the general population.6 About 3 every 10 cigarettes smoked by adults in the United States are smoked by persons with mental health conditions.
6 Why smokers are more ly than nonsmokers to experience depression, anxiety, and other mental health conditions is uncertain. More research is needed to determine this. No matter the cause‚ smoking is not a treatment for depression or anxiety.
Getting help for your depression and anxiety and quitting smoking is the best way to feel better.
What Are the Treatments for Depression?
Many helpful treatments for depression are available. Treatment for depression can help reduce symptoms and shorten how long the depression lasts. Treatment can include getting therapy and/or taking medications. Your doctor or a qualified mental health professional can help you determine what treatment is best for you.
- Therapy. Many people benefit from psychotherapy—also called therapy or counseling.7,8 Most therapy lasts for a short time and focuses on thoughts‚ feelings‚ and issues that are happening in your life now. In some cases‚ understanding your past can help‚ but finding ways to address what is happening in your life now can help you cope and prepare you for challenges in the future.With therapy, you’ll work with your therapist to learn skills to help you cope with life, change behaviors that are causing problems‚ and find solutions. Do not feel shy or embarrassed about talking openly and honestly about your feelings and concerns. This is an important part of getting better.Some common goals of therapy include:
- Getting healthier
- Quitting smoking and stopping drug and alcohol use
- Overcoming fears or insecurities
- Coping with stress
- Making sense of past painful events
- Identifying things that worsen your depression
- Having better relationships with family and friends
- Understanding why something bothers you and creating a plan to deal with it
- Medication. Many people with depression find that taking prescribed medications called antidepressants can help improve their mood and coping skills. Talk to your doctor about whether they are right for you. If your doctor writes you a prescription for an antidepressant‚ ask exactly how you should take the medication. If you are already using nicotine replacement therapy or another medication to help you quit smoking, be sure to let your doctor know. Several antidepressant medications are available‚ so you and your doctor have options to choose from. Sometimes it takes several tries to find the best medication and the right dose for you, so be patient. Also be aware of the following important information:
- When taking these medications‚ it is important to follow the instructions on how much to take. Some people start to feel better a few days after starting the medication‚ but it can take up to 4 weeks to feel the most benefit. Antidepressants work well and are safe for most people‚ but it is still important to talk with your doctor if you have side effects. Side effects usually do not get in the way of daily life‚ and they often go away as your body adjusts to the medication.
- Don’t stop taking an antidepressant without first talking to your doctor. Stopping your medicine suddenly can cause symptoms or worsen depression. Work with your doctor to safely adjust how much you take.
- Some antidepressants may cause risks during pregnancy. Talk with your doctor if you are pregnant or might be pregnant, or if you are planning to become pregnant.
- Antidepressants cannot solve all of your problems. If you notice that your mood is getting worse or if you have thoughts about hurting yourself‚ it is important to call your doctor right away.
Quitting smoking will not interfere with your mental health treatment or make your depression worse. In fact, research shows that quitting smoking can actually improve your mental health in the long run.9,10,11
Depression and Suicide: Getting Help in a Crisis
Some people who are depressed may think about hurting themselves or committing suicide (taking their own life). If you or someone you know is having thoughts about hurting themselves or committing suicide‚ please seek immediate help. The following resources can help:
If you are a smoker and dealing with depression or anxiety, consider the following resources:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Editionexternal icon. Arlington, VA: American Psychiatric Publishing, 2013 [accessed 2018 Mar 22].
- Belmaker RH, Agam G. Major Depressive Disorderexternal icon. New England Journal of Medicine 2008;358:355–68 [accessed 2018 Mar 22].
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replicationexternal icon. Archives of General Psychiatry 2005;62(6):593-602 [accessed 2018 Mar 22].
- Substance Abuse and Mental Health Services Administration.
Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings pdf icon[PDF – 2.37MB]external icon. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2014 [accessed 2018 Mar 22].
- Kessler RC, Birnbaum HG, Shahly V, Bromet E, Hwang I, McLaughlin KA, Sampson N, Andrade LH, de Girolamo G, Demyttenaere K, Haro JM, Karam AN, Kostyuchenko S, Kovess V, Lara C, Levinson D, Matschinger H, Nakane Y, Browne MO, Ormel J, Posada-Villa J, Sagar R, Stein DJ.
Age Differences in the Prevalence and Co-Morbidity of DSM-IV Major Depressive Episodes: Results From the WHO World Mental Health Survey Initiativeexternal icon. Depression and Anxiety 2010;27(4):351–64 [accessed 2018 Mar 22].
- Centers for Disease Control and Prevention.
Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years with Mental Illness—United States, 2009–2011. Morbidity and Mortality Weekly Report 2013;62(05):81–7 [accessed 2018 Mar 22].
- American Psychiatric Association. Practice Guidelines for the Treatment of Patients With Major Depressive Disorder, Third Edition pdf icon[PDF – 1.
64MB]external icon. Arlington, VA: American Psychiatric Publishing, 2010 [accessed 2018 Mar 22].
- Davidson JRT. Major Depressive Disorder Treatment Guidelines in America and Europeexternal icon. Journal of Clinical Psychiatry 2010;71(Suppl E1):e04 [accessed 2018 Mar 22].
- Tidey JW, Miller ME.
Smoking Cessation and Reduction in People With Chronic Mental Illnessexternal icon. BMJ 2015; doi:http://dx.doi.org/10.1136/bmj.h4065 [accessed 2018 Mar 22].
- Evins AE, Cather C, Laffer A. Treatment of Tobacco Use Disorders in Smokers With Serious Mental Illness: Toward Clinical Best Practicesexternal icon.
Harvard Review of Psychiatry 2015;23(2):90–8 [accessed 2018 Mar 22].
- Hitsman B, Moss TG, Montoya ID, George TP. Treatment of Tobacco Dependence in Mental Health and Addictive Disordersexternal icon. Canadian Journal of Psychiatry 2009;54(6):368–78 [accessed 2018 Mar 22].