Frequency of Suicide in Chronic Depression vs.

Clinical Depression Overview

Credit: Mateusz Stachowski www.sxc.hu Suicide is a tragedy. Nationwide it accounts for more than 1 percent of all deaths and was ranked as the eleventh leading cause of death in 2006 for the United States. The majority of suicides can be directly linked to depressive disorders such as clinical depression (major depressive disorder) and chronic depression (dysthymia). Individuals who suffer from these disorders are at a greater risk for suicide, especially if they dont receive immediate treatment. Symptoms Clinical depression, the most common and severest form of depression, can seriously affect a persons ability to function in daily life. The symptoms of clinical depression are so debilitating that some patients actually qualify for disability. Chronic depression is less severe. It usually has an onset in early adolescence and young adulthood. People who experience chronic depression have a more persistent, depressed mood, which can last longer than two years. In some cases, a person with chronic depression may experience symptoms for 20 to 30 years. Examples of symptoms prevalent in both disorders are low self-esteem, loss of interest in daily activities, lack of energy and high risk of suicidal ideations. Clinical depression and chronic depression can co-occur together in what is called double depression. This can be quite dangerous because the suicide risk increases due to the combined symptoms of both disorders. Notably, 40 percent of people with chronic depression also meet the criteria for a diagnosis of clinical depression. Suicide Prevalence A diagnosis of clinical depression or chronic depression makes a person vulnerable to a variety of risk factors, especially suicide. According to a 1999 report of the Surgeon General, clinical depression is responsible for about 20 to 30 percent of all suicide-related deaths. However, research indicates the rate of suicides in clinical depression could be higher than 30 percent. Moreover, individuals suffering from chronic depression, also a mood disorder (a persistent disturbance in emotion or mood), appear to commit suicide in larger numbers. Patients who have affective disorders (mood disorders) like clinical and chronic

depression also often have a family history of suicide. Those at highest risk are ages 15-40 and 65 and older. People who attempt suicide or complete suicide also tend to have double depression. Prevention Suicide is preventable if family and friends become aware of the risk factors. Some risk factors include a family history of suicide and mental illness, previous sexual abuse, substance abuse or previous suicide attempts. Patients with mood disorders who have undiagnosed mental illnesses are also at risk Here are some warning signs to watch out for: talking or thinking about death or having a death wish, clinical depression with a deep/dark sad mood, loss of interest in life, trouble sleeping or eating which worsens, learned helplessness (a loss of hope that the situation will ever improve) and the calm before the storm (a sudden change from sadness to a calm attitude). The calm before the storm is the most insidious. It means the person has already made the decision to die and feels relief that their pain can finally be over. Treatment Treatment for clinical depression and chronic depression consists of a combination of psychotherapy (with a therapist or psychiatrist) and medication management with anti-depressants. Typical anti-depressants used for both disorders are SSRIs-Selective Serotonin Reuptake Inhibitors (i.e., Zoloft, Paxil, Zelexa) which work on the neurotransmitter serotonin by blocking the reabsorption of serotonin in the brain, thereby affecting mood. Other popular antidepressants, SNRIs (Serotonin & Norepinephrine Reuptake Inhibitors such as Effexor, Cymbalta, Effexor XR) reduce depression symptoms by augmenting the neurotransmitters serotonin and norepinephrine which restricts reuptake in the brain. Considerations Clinical depression and chronic depression require long-term treatment and management of symptoms. Because suicide is a risk with these disorders it is important to note that the use of some antidepressants, especially for children and adolescents, can raise the risk of suicidal ideations due to unexpected side effects from the medication. In an MSNBC article entitled, Suicide Risk with Antidepressants Linked to Age, the Food and Drug Administration (FDA) reported that people under the age of 25 were at an increased risk for suicide due to antidepressant use. In 2005, the FDA mandated that drug manufacturers put warning labels on antidepressants highlighting the danger. However, the risk for suicide decreases significantly for people over the age of 25 using antidepressants. Keywords

suicide clinical depression and chronic depression dysthmia major depression suicide risk symptoms and warning signs prevention of suicide in clinical and chronic depression

treatment for depression and suicide risk

Reference

Risk Management with Suicidal Patients Bruce Bongar, Alan L. Berman, Ronald W. Maris, Morton M. Silverman Preventing Suicide: A Resource for General Physicians World Health Organization 2000 Dysthymia: Medical Look

Resource

Suicide Risk with Antidepressants Linked to Age Depression and Suicide