Suicide is Not 'Unavoidable' (Op-Ed)

Dr. John Campo is chair of the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

Everyone has their share of bad days, but when feelings such as worthlessness, helplessness, or hopelessness become predominant in everyday life, there may be a more serious issue at hand.

According to the U.S. Centers for Disease Control and Prevention (CDC), mental illness is responsible for more disability than any other specific illness in developed countries, with about 25 percent of all U.S. adults suffering from some sort of mental illness and nearly 50 percent of adults experiencing at least one mental illness during their lifetime. Depression, in particular, is a whole-body source of suffering and disability that can alter the way a person thinks, feels, and acts. Although deceptively common, depression is often tragically linked to suicide.

In fact, within the past decade, suicide rates in the United States significantly increased after a previous decade of decline. It's not clear why this is, but it's probably not just from one reason. And that's the challenge presented by suicide — it's a multifaceted problem that requires multifaceted solutions. The passing of Hollywood icon Robin Williams recently shed light on how profoundly depression can affect an individual's life. Williams, arguably one of America's favorite actors, killed himself in his own home after a lifelong struggle with depression, drug addiction and alcoholism, complicated by the recent diagnosis of Parkinson's disease. 

At face value, not many people would have guessed that he had suffered so terribly and for so long. A revered actor, he endeared himself to the world, not just by virtue of his comic genius, but also by his warmth and sweetness of character. While his death seems especially cruel in reminding us that mental illness has the potential to undermine anyone, it also creates an opportunity to share the news that depression is highly treatable and that suicide is preventable. 

Unfortunately, depression is a widely misunderstood and stigmatized disease. Although excellent treatments are available and it is the rare individual who will not respond to treatment, sometimes even wealth, resources and connections are insufficient in engaging sufferers with the good treatment they deserve. 

For example, suicide rates for middle-aged white men — who tend to have the resources at hand to treat their disease — have gone up tremendously in the last ten years, though researchers have not pinpointed the exact reason why. That said, based on what we now know about treatment, we should be unwilling to accept even a single suicide as being unavoidable. 

Depression is not the same as just being in a bad or unhappy mood. The diagnosis depends on a combination of symptoms that are sufficiently severe to impair an individual's day-to-day functions. Recognizing depression is crucial to helping people heal, although signs of depression can be tricky to spot or easily dismissed as "normal." 

There are a few common signs of depression to look out for. Contact your primary health care provider if you begin to notice changes in yourself, or a loved one, such as:

• Often feeling depressed, down, sad, angry or irritable.
• Loss of interest and pleasure in activities formerly enjoyed.
• Noticeable increase or decrease in appetite or weight, not attributable to dieting or deliberate effort. 
• Noticeable change in sleep pattern, such as fitful sleep, difficulty falling or staying asleep, early morning awakening, or sleeping more than usual.
• Fatigue or loss of energy. 
• Being noticeably slowed down or agitated in thinking or behavior.
• Inappropriate or excessive feelings of worthlessness or guilt.
• Diminished ability to concentrate or make decisions.
• Recurrent thoughts of death or suicide. 

It is also common for people who are depressed to feel overwhelmed and to suffer from otherwise unexplained, but real physical symptoms like headache, gastrointestinal distress or chronic pain. 

Depression can also sometimes distort thinking and generate unrealistic beliefs, a condition known as psychotic depression that can be reversed with treatment. 

Because each patient dealing with depression is unique, treatment must be individualized. This is especially true when "first line" treatments, such as psychotherapy or an antidepressant, alone are not successful. In such circumstance, a careful evaluation for potential medical causes of depression can be helpful, and it is often useful to combine modern psychotherapy and antidepressant medication, as science tells us that the combination of medication and psychotherapy is typically superior to either treatment alone. 

We also know that skillfully changing or combining antidepressants can produce potentially life-changing results. Even more exciting are new treatments that make use of weak electrical current and magnetic fields to improve mood and return individuals to health. 

Here at Ohio State's Wexner Medical Center, we offer treatments such as transcranial magnetic stimulation (TMS), as well as a modern, safe and effective version of electroconvulsive therapy (ECT). Depressed individuals who are discouraged by lack of progress need to understand that promising treatments are available, and that the persistence of patients and doctors is most often rewarded with success.

Depression is a serious illness that requires and deserves immediate care. If you or anyone you know thinks they may be suffering from depression, get ahead of the illness early to ensure a promising and happy future. Treatment really can make a difference and even prove lifesaving. 

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google +. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.