Some Practical Information For Treatment Resistent Depression

Hi Bob,
I missed Linda's first article about her sister's suicide, so what I'm writing here might be redundant. In my job as a diagnostic interviewer for psychiatric studies, I work with people who have treatment resistent depression and assess them for suicide risk. I thought of some practical information I could add to the heightened awareness you have already provided.

When people are deeply depressed, they often feel that no one can understand. They often feel worthless and useless and guilty. Unfortunately, the people they talk to might unintentionally add to these feelings with encouraging remarks like, "Pull yourself out of it!" or "Wear bright colors!" or "Get more exercise!" These things are not helpful because depression is not a character defect; it is an illness, just like diabetes or multiple sclerosis.

And it can be a fatal illness, as we have sadly seen in our community. The World Health Organization's National Strategy for Suicide Prevention estimates that in the U.S. about 60% of people who commit suicide have had a mood disorder (e.g., major depression, bipolar disorder, dysthymia). Younger persons who kill themselves often have a substance abuse disorder in addition to being depressed.

Suicidality is one symptom of depression. The other symptoms are change in appetite, change in sleep pattern, difficulty concentrating, lethargy, and feelings of worthlessness. If someone you know seems to have several of these symptoms, don't be afraid to ask him or her about it. Listen just the way you would if the person were describing any type of medical condition. If someone says that he or she wishes they were dead, don't brush it off or try to talk them out of it.

Take it seriously as a symptom of the illness. Gently ask about thoughts of death or dying. Get more information. Often people think that they would be better off dead, or they wish that they were dead, as a way to escape their emotional pain. These people may have no plan or intention to kill themselves. But sometimes, people have gone so far in their minds as to think of how they might kill themselves.

Sometimes, after thinking about it alot, people begin the process - they collect pills, for example, or they make preliminary investigations into how they might buy a gun. Gentle questions can reveal this information, if we are willing to listen without judgement. When I talk to people who are thinking this way, I tell them that I am concerned about their safety. I ask if I might talk to their doctor about it. And then I call the doctor without delay.

I want to end by saying that a depressed person who is determined to commit suicide will do so, no matter how much help and protection is provided. This is because suicidality is a pernicious symptom of a serious illness. If we want to help our friends and neighbors who suffer from depression or who have lost a loved one to suicide, we must understand that.

Thanks for letting me go on, Bob.

Melissa Cockerham, M.A.
Columbia University
VNS Study