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“Mourning and Melancholia” by Sigmund Freud
“The distinguishing features of melancholia are a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree utterence in self-reproaches and self-revilings” (244).  This quote lists the most common symptoms of melancholia (depression).

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Chapter 7, pg. 75
“I was about nine and running along the hot white beaches with my father the summer before he died. . . I thought how strange it had never occurred to me before that I was only purely happy until I was nine years old.”  This quote confirms the source of Esther’s depression.

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The chart shows suicide rate in different countries based on gender.

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Rising suicides at college campuses prompt concerns over mental health care

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Rising suicides at college campuses prompt concerns over mental health care

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This article describes the mental health crisis in 15 to 25 year olds. The article tells how colleges are helping students suffering with mental health problems.

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Stanford University has agreed to change its involuntary leave of absence policy, mental health staffing and training to better accommodate students facing mental illness crises, including those who have been hospitalized following a suicide attempt. The decision is the result of a settlement agreement with a group of students who filed a class action lawsuit to reform allegedly discriminatory policies affecting student in mental health crises.

This development is timely as it directly addresses concerns over global suicide trends.

Suicide rates continue to increase across all age groups in America, but the rising youth suicide epidemic, which has progressively increased since the 1950s, is particularly concerning among those who study it.

Suicide is the 10th-leading cause of death across the U.S. population, but is second-most among college-aged students.

"We are facing a national mental health crisis, and college campuses are reflecting what's going on in society at large," Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a nonprofit that aims to prevent suicides among young people, said in an interview with ABC News.

Dr. Doreen Marshall, vice president of programs at the American Foundation for Suicide Prevention, agreed: "We hear from college and university counseling centers, they are seeing more students coming in reporting that they have some current or past suicidal ideation, which is a signal that this is a time that students are really struggling."

According to the CDC, suicide rates across all ages increased in nearly every state between 1999 and 2016, and suicide rates went up more than 30% in half of states since 1999.

Independent of college, statistics reveal a spike in suicidality between the ages of 15 and 25. Until the age of 25, rational thinking and the ability to regulate emotions and impulses are still developing. The biological risk factors coupled with the inevitable challenges of acclimating to a new environment make college students more vulnerable to experiencing anxiety and mental health issues regardless of their mental health history.

"It's often their first time living independently and living away from their family, and a change in terms of access to their usual support networks from family and parents," said Marshall.

Dr. Stephanie Samar, a clinical psychologist at the Child Mind Institute, added that college students' lifestyle choices can aggravate depressive symptoms and stress.

"Many college students aren't taking care of their bodies. Many are experimenting with substances and not eating very well, or sleeping very well, in a way that would support them to meet all these new challenges," Samar said.

College students today also face challenges that are particular to their generation, such as greater financial stress and an increasingly digital world that replaces face-to-face connection and may contribute to sensations of loneliness and isolation.

Sepp Panzer, a junior at Columbia University has experienced these anxieties first hand -- having struggled with depression throughout his childhood and attempting suicide in high school.

"My primary support was gone, and the pressure to succeed was such a strain and drove me back to depression," Panzer told ABC News, of going to college.

Panzer recalled not wanting to get out of bed and said his suicidal thoughts resurfaced during his second year at Columbia.

"I felt suicidal and alone," he said. "Going through the day depressed you always think everything in your life is your fault, you automatically resort to the fact that I'm not good enough or I don't have what it takes."

Working to change his mindset and connect with those on campus, Panzer thinks that colleges need to promote quicker access to counseling services.

"In this state of crisis, students can't wait three weeks for an appointment. Changing that time frame will stop people from going over the edge," said Panzer.

College counseling services face a particular challenge in developing protocols that can effectively triage and recognize students at higher risk.

Schwartz noted that college campuses can sometimes be a protective factor, since many colleges students can see a clinician faster than they can in their hometowns. Nevertheless, set up primarily as an educational institution, colleges are not always equipped to provide extensive mental health counseling that meets the needs of a heterogenous student body.

Dr. Anitha Iyer, chief clinical officer and vice president of Vibrant Emotional Health, the organization that runs the National Suicide Prevention Lifeline, emphasizes that the most important step is creating "spaces and opportunities for students to connect with one another" in order to engage students and parents in an ongoing and active dialogue around mental health before they have even stepped foot on campus their freshman year.

On college campuses, that means taking a more comprehensive approach and fostering a culture of wellness that originates from the highest administrative level. It means equipping professors and students alike with the skills to support and empower one another so that the toll doesn't fall only on the counseling centers.

"It would also be good to have a metric to see if colleges can compare themselves to others and themselves," Dr. Jane Pearson, chair of Suicide Research at the National Institute of Mental Health, said in an interview with ABC News.

This may mean developing better methods to compare the mental health services across U.S. campuses and keeping track of suicide attempts and deaths.

After Wendell Tang's son, Luke, died by suicide during his sophomore year of college in 2015, he began urging parents to check in with their kids.

"Kids cannot be independent overnight," Tang told ABC News. "Talk to them and try to understand their challenges. Sometimes they are very lonely and we don't even know."

Marshall also stressed the importance of peer relationships.

"This generation is talking more openly about their mental health and many in this age group will talk to one another long before they talk to an adult mental health professional," she said.

National suicide prevention organizations have spearheaded peer-to-peer educational campaigns like "Seize the Awkward" and #BetheOneTo, which are providing students with the tools to talk about mental health among their social circles and recognize early warning signs of suicide.

Panzer recalled that support from his peers and especially his partner helped him overcome his suicidal tendencies and depression.

"Sometimes it just takes that one person to make you understand it is not your fault, someone in your corner to remind you that things will get better," the Columbia student said.

And colleges are moving in the right direction.

"In the 25 years I have worked here we have had success stories," Dr. Jacqueline Pistorello, director of counseling services at the University of Nevada, Reno, said in an interview with ABC News. "We were actively trying to lower stigma around mental health services and encourage students to seek help. These two things have happened."

Now, they are trying to reach students before they even step into their offices, by stationing mental health counselors at tables around busy campus areas for students to take just five minutes to talk, by visiting classrooms and running outreach programs across academic, Greek life and residential bodies. They even have a mandatory mental health counseling fee included in students' tuition.

These initiatives help prevent major tragedies and build resilience across the student body. For many college students it's not the desire to be dead that leads them to contemplate suicide, but the lack of tools to solve the problems they face. Efforts invested in college students transcend the college campus and can positively impact the global suicide crisis at large.

"Suicide is preventable and mental health is treatable," said Iyer. "Mental health and suicide prevention is everybody's problem. We all have to partake in helping our society."

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741-741.

Eden David is a senior at Columbia University majoring in neuroscience, matriculating into medical school in 2020 and a member of the ABC News' Medical Unit.

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Rising suicide rates at college campuses prompt concerns over mental health care

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Stanford University has agreed to change its involuntary leave of absence policy, mental health staffing and training to better accommodate students facing mental illness crises, including those who have been hospitalized following a suicide attempt.

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“Many people feel that suicide can never be justified, that it is never an acceptable way to solve a problem. ... On the other hand, many people argue that choosing the time and manner of one’s death is like choosing the way one lives—a basic human right that should always be respected. In between these views are many shades of opinion and feeling” (Woog 41).
This quote exemplefies the different viewpoints many people hold about suicide.

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This source provides an overview of suicide through various statistics.

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American Foundation for Suicide Prevention

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Are you in a crisis? Call 800-273-8255 or text TALK to 741741.

Learn the latest statistics on suicide. Data on suicide are taken from the Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2018, as of March 1, 2020. Suicide rates listed are Age-Adjusted Rates.

Suicide is the

10th

leading cause of death in the US

In 2018,

48,344

Americans died by suicide

In 2018, there were an estimated

1.4M

suicide attempts

In 2015, suicide and self-injury cost the US

$69B

Become an advocate to help prevent suicide Learn more

Additional facts about suicide in the US

The age-adjusted suicide rate in 2018 was 14.2 per 100,000 individuals.

The rate of suicide is highest in middle-aged white men.

In 2018, men died by suicide 3.56x more often than women.

On average, there are 132 suicides per day.

White males accounted for 69.67% of suicide deaths in 2018.

In 2018, firearms accounted for 50.57% of all suicide deaths.

More resources

Suicide research videos

Short and easy-to-understand, these new research-themed videos make suicide prevention research accessible, and are perfect for sharing on social media, helping to spread the word that through research, we can #StopSuicide.
Learn more about research

Suicide Rates in the United States

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Years 11.8 12 12.2 12.4 12.6 12.8 13 13.2 13.4 13.6 13.8 14 14.2 Rate per 100,000 Individuals

Suicide rates by race/ethnicity

Suicide methods

Suicide rates by age

Suicide rates by race/ethnicity

Suicide methods

In 2018, the suicide rates were higher among adults ages 45 to 54 years (20.04 per 100,000) and 55 to 64 years (20.20 per 100,000), with the rate highest among adults ages 52 to 59 years (21.56 per 100,000). Younger groups have had consistently lower suicide rates than middle-aged and older adults. In 2018, adolescents and young adults aged 15 to 24 had a suicide rate of 14.45.

Suicide rates by age

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Years 2 4 6 8 10 12 14 16 18 20 Rate per 100,000 Individuals

Public policy priorities

Learn more about our top Federal and State policy priorities for suicide prevention.
Learn more

Suicide attempts

When it comes to suicide and suicide attempts there are rate differences depending on demographic characteristics such as age, gender, ethnicity and race. Nonetheless, suicide occurs in all demographic groups.

In the U.S., no complete count of suicide attempt data are available. The CDC gathers data from hospitals on non-fatal injuries from self-harm as well as survey data.

In 2015, (the most recent year for which data are available), approximately 575,000 people visited a hospital for injuries due to self-harm.

Based on the 2018 National Survey of Drug Use and Mental Health it is estimated that 0.5 percent of the adults aged 18 or older made at least one suicide attempt. This translates to approximately 1.4 million adults. Adult females reported a suicide attempt 1.5 times as often as males. Further breakdown by gender and race are not available.

Based on the most recent Youth Risk Behaviors Survey from 2017, 7.4 percent of youth in grades 9-12 reported that they had made at least one suicide attempt in the past 12 months. Female students attempted almost twice as often as male students (9.3% vs. 5.1%). Black students reported the highest rate of attempt (9.8%) with white students at 6.1 percent. Approximately 2.4 percent of all students reported making a suicide attempt that required treatment by a doctor or nurse. For those requiring treatment, rates were highest for Black students (3.4%).

About AFSP

Learn about the American Foundation for Suicide Prevention, and our mission to save lives and bring hope to those affected by suicide.
Learn more

Become an advocate for suicide prevention

By signing up as an AFSP Field Advocate, you will become a vital part of a large grassroots movement of people across the U.S. who are speaking out for suicide prevention and mental health policies at all levels of government.
Learn more

Boards, commitees and councils

The American Foundation for Suicide Prevention's National Board, Councils and Committees are dedicated to the fight to stop suicide.
Learn more

Action Center

Visit our Action Center to stay up to date on the federal and state bills that need your support.
Take action

Sign up for email alerts

Receive updates from the American Foundation for Suicide Prevention

© 2020 American Foundation for Suicide Prevention. All rights reserved.

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Are you in a crisis? Call 800-273-8255 or text TALK to 741741. Learn the latest statistics on suicide. Data on suicide are taken from the Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2018, as of March 1, 2020. Suicide rates listed are Age-Adjusted Rates.

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A Series of Complex Suicide
This article describes 16 complex suicide cases.  The article describes a complex suicide as a suicide in which more than one methods are used in order to increase the odds of a successful suicide.  The 16 cases vary in motive, method, gender, etc.

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“Mourning and Melancholia” by Sigmund Freud
This book compares the causes and symptoms of mourning and melancholia (depression).  “The fact is, however, that when the work of mourning is completed the ego becomes free and uninhibited again” (Freud 245).  “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself” (Freud 246).

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This source provides the suicide rate by country in 2019. This is interesting because it shows how different standards of living and different cultures change how suicide is viewed, as well as how often it occurs.

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Suicide occurs throughout the world, affecting individuals of all nations, cultures, religions, genders and classes. In fact, statistics show that the countries with the highest suicide rates in the world are incredibly diverse.

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This quote shows what Brent experiences when he lights himself on fire, as well as the regret he feels. “I fall down. I’m going to die. I’m going to find out what death is like. I’m going to know. But nothing’s happening. This hurts too much. I need to stop it. I need to get up.” (Runyon, 21)

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This source is an interesting overview of the history of depression. It shows all of the different ways depression was viewed through history, and the earliest attempts to treat it.

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While no single person can be credited with the discovery of depression, there are many great thinkers whose ideas contributed-and continue to contribute-to our growing knowledge of what this illness really is. In order to better understand how researchers, doctors, and psychologists think about this condition today, it can be helpful to take a look back at the history of depression.

When Was Depression Discovered?

When was the first case of depression? The earliest written accounts of what is now known as depression appeared in the second millennium B.C.E. in Mesopotamia. In these writings, depression was discussed as a spiritual rather than a physical condition. Like other mental illnesses, it was believed to be caused by demonic possession. As such, it was dealt with by priests rather than physicians.

The idea of depression being caused by demons and evil spirits has existed in many cultures, including those of the ancient Greeks, Romans, Babylonians, Chinese, and Egyptians. Because of this belief, it was often treated with methods such as beatings, physical restraint, and starvation in an attempt to drive the demons out.

Greek and Roman doctors used therapeutic methods such as gymnastics, massage, diet, music, baths, and a medication containing poppy extract and donkey's milk to treat their patients.﻿﻿

Ancient Greek and Roman Philosophy

Hippocrates, a Greek physician, suggested that depression (initially called "melancholia") was caused by four imbalanced body fluids called humours: yellow bile, black bile, phlegm, and blood.﻿﻿ Specifically, he thought that melancholia was caused by too much black bile in the spleen. Hippocrates' treatments of choice included bloodletting, baths, exercise, and diet.

A Roman philosopher and statesman named Cicero, in contrast, believed that melancholia had psychological causes such as rage, fear, and grief.

In the last years before the common era, in spite of some steps toward believing in more physical and mental causes of depression, it was still a very common belief among even educated Romans that depression and other mental illnesses were caused by demons and by the anger of the gods.

History of Depression in the Common Era

During the common era, many barbaric and primitive treatments for depression continued to be the norm. Cornelius Celsus (25 BCE to 50 CE) reportedly recommended the very harsh treatments of starvation, shackles, and beating in cases of mental illness.﻿﻿

A Persian doctor named Rhazes (865-925 CE), however, did see mental illness as arising from the brain. He recommended such treatments as baths and a very early form of behavior therapy which involved positive rewards for appropriate behavior.

During the Middle Ages, religion, especially Christianity, dominated European thinking on mental illness, with people again attributing it to the devil, demons, or witches. Exorcisms, drowning, and burning were popular treatments of the time. Many people were locked up in so-called "lunatic asylums."

During the Renaissance, which began in 14th century Italy and spread throughout Europe during the 16th and 17th centuries, witch hunts and executions of the mentally ill were still quite common; however, some doctors were revisiting the idea of mental illness having a natural rather than a supernatural cause.

In the year 1621, Robert Burton published "Anatomy of Melancholy," in which he outlined the social and psychological causes of depression (such as poverty, fear, and loneliness). In this book, he made recommendations like diet, exercise, travel, purgatives (to clear toxins from the body), bloodletting, herbs, and music therapy in the treatment of depression.﻿﻿

History of Depression in the Age of Enlightenment

During the 18th and 19th centuries, also called the Age of Enlightenment, depression came to be viewed as a weakness in temperament that was inherited and could not be changed. The result of these beliefs was that people with this condition should be shunned or locked up.

During the latter part of the Age of Enlightenment, doctors began to suggest the idea that aggression was at the root of the condition.﻿﻿

Other doctors of the time spoke of depression as resulting from internal conflicts between what you want and what you know is right. And yet others sought to identify the physical causes of this condition.

Treatments during this period included water immersion (staying underwater for long as possible without drowning) and using a spinning stool to put the brain contents back into their correct positions. Additional treatments included:

Benjamin Franklin is also reported to have developed an early form of electroshock therapy during this time.﻿﻿

History of Depression in the 19th and 20th Century

In 1895, the German psychiatrist Emil Kraepelin became the first to distinguish manic depression, what we now know as bipolar disorder, as an illness separate from dementia praecox (the term for schizophrenia at the time). Around this same time, psychodynamic theory and psychoanalysis -the type of psychotherapy based on this theory-were developed.

Psychoanalytic Explanations

In 1917, Sigmund Freud wrote about mourning and melancholia where he theorized about melancholia as being a response to loss, either real (for example, a death) or symbolic (such as failure to achieve the desired goal).

Freud further believed that a person's unconscious anger over their loss leads to self-hatred and self-destructive behavior. He felt that psychoanalysis could help a person resolve these unconscious conflicts, reducing self-destructive thoughts and behaviors.﻿﻿

Other doctors during this time, however, saw depression as a brain disorder.

Behavioral Explanations

The behaviorist movement in psychology contributed to the idea that behaviors are learned through experience. The behaviorists rejected the idea that depression was caused by unconscious forces and instead suggested that it was a learned behavior.

Just as these depressive behaviors had been learned, they could also be unlearned. Principles of learning such as association and reinforcement could be used to establish and strengthen more effective, healthier behaviors.

Cognitive Explanations

During the 1960s and 1970s, cognitive theories of depression began to emerge. The cognitive theorist Aaron Beck proposed that the way that people interpret negative events could contribute to symptoms of depression.

According to Beck, depressed people tend to automatically interpret events in negative ways and view themselves and helpless and inadequate.

The psychologist Martin Seligman suggested that learned helplessness could play a role in the development of depression. According to this theory, people often give up on trying to change their situation because they feel that nothing they do will make a difference. This lack of control leaves people feeling helpless and hopeless.

The emergence of these cognitive models of depression played an important role in the development of cognitive behavioral therapy (CBT), which has been shown to be effective in the treatment of depression.

Biological and Medical Explanations

Where older conceptualizations of depression stressed the role of early experiences, more recent approaches increasingly stress the biopsychosocial model that looks at the biological, psychological, and social factors that play a role in depression.

During the 1970s, the medical model of mental disorders emerged and suggested that all mental disorders are primarily caused by physiological factors. The medical model views mental health conditions in the same way as other physical illnesses, which means that such conditions can also be treated with medication.

Biological explanations for depression focus on factors such as genetics, brain chemistry, hormones, and brain anatomy. This view played an important role in the development and increased use of antidepressants in the treatment of depression.

The 19th and 20th Century Treatments

During the late 19th and early 20th centuries, treatments for severe depression generally weren't enough to help patients.

Desperate for relief, many people turned to lobotomies, which are surgeries to destroy the brain's prefrontal lobe. Though reputed to have a "calming" effect, lobotomies often caused personality changes, a loss of decision-making ability, poor judgment, and sometimes even death.﻿﻿

Electroconvulsive therapy (ECT), which is an electrical shock applied to the scalp in order to induce a seizure, was also sometimes used for patients with depression.

In the 1950s and 60s, doctors divided depression into subtypes of " endogenous" and "neurotic" or "reactive." Endogenous depression was thought to result from genetics or some other physical defect, while the neurotic or reactive type of depression was believed to be the result of some outside problems such as a death or loss of a job.

The 1950s were an important decade in the treatment of depression thanks to the fact that doctors noticed that a tuberculosis medication called isoniazid seemed to be helpful in treating depression in some people.﻿﻿ Where depression treatment had previously been focused only on psychotherapy, drug therapies now started to be developed and added to the mix.

One of the first drugs to emerge for the treatment of depression was known as Tofranil (imipramine), which was then followed by a number of other medications categorized as tricyclic antidepressants (TCAs). Such drugs provided relief for many people with depression but were often accompanied by serious side effects that included weight gain, tiredness, and the potential for overdose.﻿﻿

Other antidepressants later emerged, including Prozac (fluoxetine) in 1987, Zoloft (sertraline) in 1991, and Paxil (paroxetine) in 1992. These medications, known as selective serotonin reuptake inhibitors (SSRIs), target serotonin levels in the brain and usually have fewer side effects than their predecessors.

Our Understanding of Depression Today

The term major depressive disorder (MDD) was first introduced by clinicians in the United States during the 1970s. The condition officially became part of the DSM-III in 1980. The current edition of the diagnostic manual is the DSM-5 and is one of the primary tools used in the diagnosis of depressive disorders.

While the condition is much better understood today than it was in the past, researchers are still working to learn more about the causes of depression. At the present time, doctors believe that depression arises from a combination of multiple causes including biological, psychological, and social factors.

Modern views of depression incorporate an understanding of the many symptoms of this condition as well as the often cyclical effect that the symptoms can have. For example, depression can cause disturbances in sleep, appetite, and activity levels; in turn, poor sleep, diet, and exercise can exacerbate symptoms of depression.

In addition to considering the psychological factors that contribute to depression, doctors are also aware that certain medical conditions such as hypothyroidism may cause depressive symptoms. The diagnosis of depression includes ruling out other medical conditions and other possible causes such as alcohol or substance use.

Thanks to the improved understanding of the causes of depression, effective treatments have emerged. Psychotherapy and medications that target molecules called neurotransmitters are generally the preferred treatments, although electroconvulsive therapy may be utilized in certain instances, such as in treatment-resistant depression or severe cases where immediate relief is required.

Unfortunately, the causes of depression are more complex than we yet understand, with no single treatment providing satisfactory results for everyone. Because depression is such a complex condition, mental health professionals often recommend a treatment approach that includes medications, psychotherapies, and lifestyle modifications.

Frequently Asked Questions

How was depression treated in the 1800s?

During the 1800s, mental health conditions were still largely viewed as untreatable. People were often labeled as "mad" or "lunatics" and imprisoned in asylums under harsh conditions.

How did depression start?

The earliest accounts of depression viewed the condition as a spiritual rather than a mental problem. In the middle ages, it was viewed as having supernatural or even demonic causes. It was not until the 1970s that doctors and researchers emphasized the biological factors that contribute to depression.

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When Were the Earliest Accounts of Depression?

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Depression has gone through a plethora of different understandings and treatments throughout the ages. Learn more about it in this brief history of depression.

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“The Burn Journals” is a non-fiction book written by a boy suffering from depression who tried to kill him self by lighting himself on fire. In the beginning of the book he details his depression and suicide attempts before he lit himself on fire.
“I wonder why all the ways I’ve tried to kill myself haven’t worked. I mean, I’ve tried hanging. I used to have a noose tied to my closet pole. I’d go in there and slip the thing over my head and let my weight go. But every time I started to lose consciousness, I’d just stand up” (Runyon, 15)

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“But when it came right down to it, the skin of my wrist looked so white and defenseless that I couldn’t do it.”

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https://www.healthcentral.com/condition/depression
This image shows various statistics about depression and highlights just how much of an impact depression has.

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This sources specifically highlights depression in women. Which is what the main character in “The Bell Jar” experiences. One wonders if this kind of the help was available in the 50’s would things have turned out differently.

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Depression is not a normal part of being a woman. Most women, even those with the most severe depression, can get better with treatment.

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Engineer creates ‘forbidden emojis’ to raise money for suicide prevention 

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Engineer creates ‘forbidden emojis’ to raise money for suicide prevention 

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This article shows how far our society has moved since the 50’s. Mental health is becoming less of a taboo subject and people are much more open about mental health and suicide.
#emojis #suicide prevention

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Engineer Ian Charnas is known for his unique projects - and clever ways to raise money for causes he is passionate about.

Ian is a director and co-founder of Sears think[box], a 7-story maker space and innovation center at Case Western Reserve University that is free and open to the public.

Remember when he synced up windshield wipers to music and then donated the proceeds from the patent to charity?

Well, Ian is back at it again.

He created 36 "forbidden emojis" - things you always wish you could use in a quick text or email - and is unlocking them one by one.

Every dollar donated helps free another emoji.

"They're very silly and funny and positive emojis. Very lighthearted," Ian said.

You have emojis like dumpster fire, mic drop, actual eggplant, and Ian's personal favorite-brain fart.

"Why is there no brain fart emoji? There should be one by now!" he said, laughing.

It's a lighthearted approach to help raise money for a very serious subject.

All proceeds go to the American Foundation for Suicide Prevention.

"I learned about this foundation doing really great work to research what it takes to prevent suicide and then actually put that into action," Ian explained. "And they offer their research findings and training to medical professional and educational professionals all around the world."

Ian's mother died from suicide when he was just 8 years old, making the cause that much more impactful.

Soon after the fundraiser started, Ian said he received emails from suicide survivors and students, saying how much this means.

One letter talks about how the writer nearly lost their closest friend to suicide and reads, "While I am nothing but a poor college student, I can't contribute much, however I would like to give $25."

And since the fundraiser went live a few days ago, they've already raised nearly $4,000 at last check - and unlocked 20 emojis.

You can click here to donate to #stopsuicide and click here to learn how to use the emojis in your texts and emails.

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Engineer creates 'forbidden emojis' to raise money for suicide prevention

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Engineer Ian Charnas is known for his unique projects - and clever ways to raise money for causes he is passionate about. Ian is a director and co-founder of Sears think[box], a 7-story maker space and innovation center at Case Western Reserve University that is free and open to the public.

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Mental-Health Researchers Ask: What is ‘Recovery’?

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Mental-Health Researchers Ask: What is ‘Recovery’?

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This article shows how little is known about depression. Most people with depression don’t completely recover and experience multiple periods of depression in their life.

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There are many ways to measure mental distress. But it's far harder to predict, or even describe, the improvement that often follows.

Credit... Daniel Zender

For years, Claire Bien, a research associate at Yale, strained to manage the gossipy, mocking voices in her head and the ominous sense that other people were plotting against her. Told she had a psychotic disorder, she learned over time to manage her voices and fears with a lot of psychotherapy and, periodically, medication. But sometime in late 1990, she tried something entirely different: She began generating her own voices, internal allies, to counter her internal abusers.

"I truly felt I was channeling my father, my ancestors, a wise psychiatrist, giving me advice," said Ms. Bien, who has written a book about her experience, "Hearing Voices, Living Fully."

She added: "Recovery for me means knowing that my mind is my own, and even when it doesn't feel that way, I know it's only temporary. Knowing that allows me to hold a job - a good job - and be productive, respected and even admired by the people with whom I work."

Mental-health researchers have numerous scales to track symptom relief, like the easing of depression during talk therapy, for instance, or the blunting of psychotic delusions on medication.

But the field has a much harder time predicting, or even describing, what comes next. How do peoples' lives change once they have learned to address their symptoms? Mental disorders are often recurrent, and treatment only partially effective. What does real recovery - if that's the right word - actually look like, and how can it be assessed?

This is what people in the thick of mental distress desperately want to know, and a pair of articles in a recent issue of the journal Psychiatric Services shows why good answers are so hard to come by.

In one, the first study of its kind, Dutch researchers tested a standard life-quality measure, the Recovery Assessment Scale, that is typically used to rate an individual's confidence, hope, sense of purpose, willingness to ask for help, and other features of a full, stable life.

The team administered the 24-item questionnaire to three groups of people: one with a diagnosis of a psychotic disorder, like schizophrenia; the siblings of members of this first group, who had no such diagnosis; and a control group of unrelated people who had no history of mental-health problems. The scale found little detectable differences between the groups.

The widely used R.A.S., as the scale is known, is "of questionable usefulness," the authors concluded. If everyone looks roughly the same on the scale, then how can the scale be used to measure improvement?

In the other paper, an editorial, Larry Davidson, a psychiatric researcher at Yale, pointed out that the results were not surprising. The researchers had intentionally left out a subset of R.A.S. queries that probably mattered most, involving how well respondents were managing their symptoms - statements like "Coping with mental illness is no longer the main focus of my life" and "My symptoms interfere less and less with my life."

By taking out these questions, Dr. Davidson said, the study demonstrated only that, in the absence of mental distress, "the everyday lives of people with a mental diagnosis are just like everyone else's." The authors, however, noted that those questions were excluded because, by definition, the comparison groups had no symptoms.

In effect, both parties agree: The R.A.S., and many similar scales, amount to little more than symptom checklists, in the end not much different from those used to track the short-term effects of a drug. The field could use different, and better, means of assessing how people shake off or learn to manage a mental-health diagnosis.

The scales originated decades ago with mental-health consumers, or "survivors," who saw the usual clinical definitions of symptoms relief, like the Hamilton Depression Scale, as unable to capture the fullness of personal recovery.

The scale analyzed in the Dutch study, for instance, asks people to rate, on a scale of 1 to 5, how strongly they agree with various statements like, "If people knew me, they would like me," "If I keep trying, I will continue to get better" and "It's important to have healthy habits." Researchers rely on scales like this to gauge the longer-term, real-world effects of all variety of mental-health programs, like group therapy for rape victims in the Democratic Republic of Congo or community outreach for psychosis in Wisconsin.

But as the new study finds, questions like these are applicable to anyone, with a diagnosis or not; not to mention that responses can vary by the day, or even the hour, depending on what insults or encouragements hold sway in the moment.

People who find a way to move on with their lives after receiving a psychiatric diagnosis - depression, anxiety, bipolar disorder, schizophrenia - generally must do so the hard way: gradually, by fine-tuning some combination of personal rituals, social connections, work demands, therapy and, when necessary, medications. And these idiosyncratic regimens of self-care are not easily captured by the measures currently available to researchers.

Now, given the clear limits of the R.A.S. and other quality-of-life measures, some experts say it is time to find ways to better assess how a person's daily experience changes in the months and years after receiving a mental-health diagnosis. "Personal recovery," Dr. Davidson wrote, "has as much to do with the quality of a person's sense of identity and belonging to a community as it does to subjective experiences of mental illness per se." He argues that the field needs to develop reliable tools to assess what it's like to live with mental distress over time, in the same way that cardiology and other branches of medicine use "patient-reported outcomes" to track longer-term responses to treatment.

Gail Hornstein, a professor emerita of psychology at Mount Holyoke College, has been tracking a group of more than 100 people who attend or have attended meetings of the Hearing Voices Network, a grass-roots, Alcoholics Anonymous-like group where people talk with one another about their mental distress and possible ways of managing it.

Most people in the study have a diagnosis of a psychotic disorder, like schizophrenia, and consider their experience in the groups to have been supportive, even transformative. But many still hear voices, and sometimes reassuring ones, Dr. Hornstein said in an email. So assessing improvement by asking the usual kinds of questions - for instance, "Are the voices gone?" - isn't necessarily useful.

Instead, Dr. Hornstein asks whether the voices - like those that Ms. Bien still occasionally encounters - or other aspects of an individual's life have changed as a result of participating in the groups.

People's responses are extremely varied, Dr. Hornstein said in a phone interview. They might say, "I have a different relationship with my voices now." Or, "My voices used to bully me, and terrify me; now I have relationship with them based on mutual respect."

"That's a change, for the better - it's improvement," Dr. Hornstein said: "But you wouldn't pick it up unless you knew how to ask."

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Mental-Health Researchers Ask: What Is 'Recovery'?

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There are many ways to measure mental distress. But it's far harder to predict, or even describe, the improvement that often follows. For years, Claire Bien, a research associate at Yale, strained to manage the gossipy, mocking voices in her head and the ominous sense that other people were plotting against her.

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Chad’s Story of Hope after Two Suicide Attempts

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Chad’s Story of Hope after Two Suicide Attempts

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#hope #success

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Chad's Story of Hope after Two Suicide Attempts

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We tell suicidal people to go to therapy. So why are therapists rarely trains in suicide?

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We tell suicidal people to go to therapy. So why are therapists rarely trains in suicide?

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This article outlines how most therapists are not trained to deal with a person who is suicidal. This article raises concerns with how we treat suicidal people.

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We tell virtually every suicidal person to do it. It's part of most suicide prevention campaigns. When we don't have the answers, it's where we tell our loved ones they'll find them.

"See a therapist."

And yet suicide prevention experts say outside of psychiatrists, the majority of mental health professionals have minimal to no formal training in how to effectively treat suicidal people.

Suicide-specific training is not commonly offered as part of college curriculums, optional postgraduate training opportunities are limited, costly and time-consuming, and experts say some therapists may not be aware they even need the education.

"Any profession's ethical standards require that you not treat a problem you don't know, and yet every day thousands of untrained service providers see thousands of suicidal patients and perform uninformed interventions," said Paul Quinnett, a clinical psychologist and founder of the QPR Institute, an organization that educates people on how to prevent suicide.

"People think if you send someone, a loved one, to a therapist, that therapist will be skilled in how to address ... their risk for suicide. Nothing could be farther from the truth."

Numbers released in January from the U.S. Centers for Disease Control and Prevention show 48,344 people died by suicide in 2018, a small increase from the year before, though the rise in deaths over time has been steady. Since 1999, the suicide rate has climbed 35%.

Suicide is the nation's 10th-leading cause of death, yet experts say training for mental health practitioners who treat suicidal patients - psychologists, social workers, marriage and family therapists, among others - is dangerously inadequate.

Many suicide prevention experts say combating suicide requires a holistic approach that includes communities, families, educators and religious leaders working together. But society, they say, has placed the burden of caring for suicidal people on a mental health workforce woefully underprepared to help them.

In Depth: Funding for suicide lags behind other top killers

There are no national standards that require mental health professionals be trained in how to treat suicidal people, either during their education or their career. Only nine states mandate training in suicide assessment, treatment and management for health professionals, according to the American Foundation for Suicide Prevention.

Whitcomb Terpening, a licensed clinical social worker who works exclusively on suicide

Having someone on your side that gets what you're going through, that can advocate for your needs, and that gives you the space to talk through your thoughts is a game-changer.

The American Psychological Association and the Council on Social Work Education, which accredit graduate programs in psychology and social work, have standards to prepare graduates to treat patients in crisis but do not require specific competencies regarding suicide.

For its 2014 report on guidelines to improve training among the clinical workforce, the National Action Alliance for Suicide Prevention assessed the state of education by sending surveys to 443 academic institutions. Of those, 69 responded, and 70% said no specific training for suicide was provided.

A 2012 paper by the American Association of Suicidology cites decades of studies that underscore the training gap, and experts say not much has changed in the last several years. It found about half of psychology students receive formal classroom training on suicide during their graduate education. Only about 25% of social workers receive any suicide prevention training. Marriage and family therapists had even less. Most psychiatrists receive some instruction, but many experts agree it's insufficient.

"When people ask me, 'Who should I see?' the only thing I can say is 'See a psychiatrist if you can,' because ... they're supposed to cover that topic during the course of their training," Quinnett said. "You have some assurance that they know something about it. But you can't say that for any other (mental health) profession, which is astounding to me."

Suicidal people have a spectrum of experiences with therapy, some harmful, some lifesaving. Many people living with suicidal thoughts say when they found the right clinician, someone who didn't overreact and who made an earnest effort to understand their pain, they felt less suicidal.

"Having someone on your side that gets what you're going through, that can advocate for your needs, and that gives you the space to talk through your thoughts is a game-changer," said Whitcomb Terpening, a licensed clinical social worker and founder of The Semicolon Group, a therapy practice in Houston that works exclusively on suicide.

"They'll have your best interest in mind, not just to keep you alive, but to help you find a life worth living."

When someone who's feeling suicidal opens up to a therapist, they do so expecting the person sitting across from them wants to understand their suffering. But Stacey Freedenthal, a suicide attempt survivor and associate professor at the University of Denver Graduate School of Social Work, says a common feeling among therapists when they realize they're sitting across from a suicidal person is panic.

They worry the patient might try to kill themselves, could succeed and they may get sued or lose their license. Their reflex is to send the patient to an emergency room.

"You've got this person who has taken weeks or months or more to work up the nerve to go to a professional and the professional is saying, 'I can't help you, you have to go somewhere else.' And that can be very harmful," Freedenthal said.

Research shows emergency room visits and involuntary hospitalizations - triggered when a mental health professional believes someone is at imminent risk of killing themselves - can increase a person's risk of suicide.

Susan Stefan, a scholar and litigator on behalf of people with psychiatric disabilities, says that in many cases, an emergency room can be the worst place for a suicidal person.

"It's loud, it's hurried, people are in a rush," she said. "There is no training, generally, for emergency physicians, or staff to deal with suicidal people. In many places, there's not much sympathy."

Even if a therapist doesn't overreact, that doesn't mean they know how to help. Freedenthal says she once had a therapist who made her "promise" she would never do anything to hurt herself.

"That's great in principle, but I kind of wouldn't have been going for help if it was that easy," she said.

Susan Stefan, a scholar and litigator

I think we as a society waste a lot of time trying to stop people from killing themselves as opposed to exploring why they want to die in the first place.

Some therapists try to avoid the question of suicide altogether. Freedenthal says she always asks her students and even colleagues with decades of experience, "What is your fear about asking someone if they're thinking of suicide?"

The most common answer: "That they'll say yes."

Some chronically suicidal people say they've been dropped by therapists who were unable to tolerate the intensity of their pain. Others say their clinicians were so fixated on predicting how likely they were to kill themselves, they didn't spend enough time listening to why they were hurt or what they might need.

"A lot of people who say they're suicidal are trying to convey the depth of their despair," Stefan said. "I think we as a society waste a lot of time trying to stop people from killing themselves as opposed to exploring why they want to die in the first place."

Back in the 90s, Quinnett was the clinical director at a mental health center in Spokane, Washington. One year, they lost 13 patients to suicide. When Quinnett reviewed the death records, he realized his clinicians didn't know how to treat suicidal patients.

"They were good people. They were goodhearted. They were crushed when their patients died, but they didn't even know how to ask the question, let alone how to assess and manage the risk," he said.

Afterward, Quinnett said he helped put together a comprehensive, mandatory training program on suicide. Once it was fully up and running, he said clinic deaths plummeted, to one or none a year. Eventually a new CEO took over and Quinnett said he decided to shutter the program over cost concerns. Quinnett said suicides started up again, so he quit.

Almost all mental health professionals see suicidal patients at some point in their careers, experts say, yet only a small fraction seek out specialized training.

For those who do want it, it can be hard to come by. Some of the best therapies aren't available for training at scale, and those that are require time and money.

David Jobes is director of the Catholic University of America's Suicide Prevention Lab and created CAMS - Collaborative Assessment and Management of Suicidality - widely regarded as one of the most effective approaches to treating suicidal patients. In the absence of training, Jobes said many clinicians spend most of their time trying to treat a patient's underlying mental illness, rather than asking the person, "What makes you want to kill yourself?"

CDC data published in 2018 shows 54% of people who died by suicide had no known mental health condition.

CAMS, Jobes said, is a model that endeavors to understand the sources of people's suffering. But very few people are trained, he said, and those who could benefit from it most have probably never heard of it.

Andrew Evans, president of CAMS-care, which trains practitioners on the CAMS approach, said last year that the company trained about 5,000 mental health professionals in the U.S.

April Foreman, a clinician and board member of the American Association of Suicidology

Unless you seek out on your own specialized training, and most people do not get this, it will become exquisitely painful for you and impact your well-being.

"That's a drop in the bucket, because millions of people have suicidal thoughts," said Jobes, noting CDC data from 2017 that showed 10.6 million American adults seriously thought about suicide.

Terpening, who works with suicidal patients, says that as long as training for mental health providers is voluntary, patients won't get the care they need.

"Everyone's told 'Reach out, there's always somebody to talk to.' But there isn't. Because we're not trained in graduate schools, we're not trained in our clinical intern hours, we're not offered those kinds of opportunities," she said.

Lack of training, Terpening added, doesn't just leave practitioners ill-equipped, it leaves them afraid.

"Therapists want to do well, they just don't know how," she said. "Fear is born out of the unknown."

Many therapists are so frightened of treating suicidal people they'll screen out potential patients who they think may be at risk, Quinnett said. Clinicians also are afraid of liability, though Stefan said the concern is far less real than most mental health professionals think. Even if a grieving family sues, she said, most cases are not successful. Facts, however, are not always persuasive when the undesired outcome feels so catastrophic.

A survey of mental health providers in Colorado, which has one of the highest suicide rates in the nation, showed many do not think they need more training, but desire it, according to a 2018 article in the Journal of Public Health Policy. It found providers reported being "generally pleased with their existing training and felt prepared to address suicide within their practice," though 80% supported mandating suicide-related continuing education.

When confronted with the intensity of pain a suicidal person is feeling, some therapists find themselves overwhelmed - wanting to help, fearing they're not capable, with stakes that feel enormously high.

"It is emotionally painful," said April Foreman, a clinician and board member of the American Association of Suicidology. "Remember, you're a therapist because you're emotionally sensitive, and then we give you training to be even more sensitive. Then we put you in a room with someone who has the kind of pain and despair and behaviors that put them at risk of dying.

Anthony Pisani, associate professor of psychiatry and pediatrics

Addressing suicide risk is not something you can get trained in once and be done. This is such a hard problem with such serious consequences that people are going to feel and be unprepared unless they are engaged in an ongoing way.

"Unless you seek out on your own specialized training, and most people do not get this, it will become exquisitely painful for you and impact your well-being."

Foreman says therapists practicing Dialectical Behavior Therapy, another highly effective treatment approach for severe suicide risk, are expected to have a consultation team to help manage stress and burnout.

"I will tell you, having lost patients to suicide, the consultation group is invaluable," she said.

Terpening says being able to talk with peers is a crucial part of her own self-care.

"The work can be isolating," she said, "so to be able to hear from other people is so helpful and so healing in ways that a spin class never could be."

The issue of inadequate training has been documented for decades. In 2001, the National Strategy for Suicide Prevention said it was critical that "mental health personnel receive appropriate graduate school training on the subject of suicide while preparing for their professions."

Nearly 20 years later, experts say not enough has changed. Anthony Pisani, associate professor of psychiatry and pediatrics at the Center for the Study and Prevention of Suicide at the University of Rochester, said it is essential the goal be met, and training must extend well beyond school.

"Addressing suicide risk is not something you can get trained in once and be done," he said. "This is such a hard problem with such serious consequences that people are going to feel and be unprepared unless they are engaged in an ongoing way."

The American Association of Suicidology report on gaps in mental health training made several recommendations for improving care. It said accrediting organizations must include suicide-specific education as part of their requirements so graduate programs have the training in their curriculum. State licensing boards, it said, must require clinicians be competent in suicide treatment.

And the report said government has a role to play, too, by requiring that health care systems receiving state or federal funds ensure their mental health professionals are trained in suicide risk detection, assessment, treatment and prevention.

Maybe, most importantly, experts say clinicians have to overcome their fear of not knowing with certainty who may live or die.

"I get the fear - our licenses are our livelihood, we need to be able to protect them," Terpening said. "But we also have to be able to see past the risk to do what's right for our patients."
If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online. Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741. The American Foundation for Suicide Prevention has resources to help if you need to find support for yourself or a loved one.
Alia E. Dastagir is a recipient of a Rosalynn Carter fellowship for mental health journalism. Follow her on Twitter: @alia_e

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We tell suicidal people to go to therapy. So why are therapists rarely trained in suicide?

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We tell virtually every suicidal person to do it. It's part of most suicide prevention campaigns. When we don't have the answers, it's where we tell our loved ones they'll find them. "See a therapist." And yet suicide prevention experts say outside of psychiatrists, the majority of mental health professionals have minimal to no formal training in how to effectively treat suicidal people.

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“I started adding up all the things I couldn’t do.”
This shows the main character’s mindset and how depression affects it. People would normally try to think about happy things, but she actively thinks about her flaws.

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“I felt very still and very empty, the way the eye of a tornado must feel, moving dully along in the middle of the surrounding hullabaloo.”

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This quote shows the main character after she has attempted to drowned herself while swimming with friends. The main character complains about how our bodies want to keep us alive even when our brains don’t.
“I fanned myself down, but before I knew where I was, the water had spat me up into the sun, the world was sparkling all about me like blue and green and yellow semi-precious stones.”
https://www.reddit.com/r/itookapicture/comments/6f0yno/itap_of_dark_ocean_texture/

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This quote shows how melancholy the main character is and how her depression makes it difficult for her to connect to other people.
“And then I wondered if as soon as he came to like me he would sink into ordinariness, and if as soon as he came to love me I would find fault after fault, the way I did with Buddy Willard and the boys before him.”

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The main character wakes up after trying to kill her self by taking pills. She is still unaware of whether she is alive or dead.
“I felt the darkness, but nothing else, and my head rose, feeling it, like the head of a worm. Someone was moaning. Then a great, hard weight smashed against my cheek like a stone wall and the moaning stopped.”
https://www.abc.net.au/science/articles/2008/10/21/2396935.htm

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This source provides a large scope overview of the current science behind depression. It explains what we currently think causes depression, and brings to light how complicated the issue really is.

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Onset of depression more complex than a brain chemical imbalance

It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.

Scientists have learned much about the biology of depression, but their understanding of the biology of depression is far from complete. Major advances in the biology of depression include finding links between specific parts of the brain and depression effects, discovering how chemicals called neurotransmitters make communication between brains cells possible, and learning the impact of genetics and lifestyle events on risk and symptoms of depression.

This article will address the how different parts of the brain affect mood.

Brain regions and mood

Popular lore has it that emotions reside in the heart. Science, though, tracks the seat of your emotions to the brain. Certain areas of the brain help regulate mood. Researchers believe that - more important than levels of specific brain chemicals - nerve cell connections, nerve cell growth, and the functioning of nerve circuits have a major impact on depression.

Increasingly sophisticated forms of brain imaging - such as positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI) - permit a much closer look at the working brain than was possible in the past. An fMRI scan, for example, can track changes that take place when a region of the brain responds during various tasks. A PET or SPECT scan can map the brain by measuring the distribution and density of neurotransmitter receptors in certain areas.

Use of this technology has led to a better understanding of which brain regions regulate mood and how other functions, such as memory, may be affected by depression. Areas that play a significant role in depression are the amygdala, the thalamus, and the hippocampus (see Figure 1).

Research shows that the hippocampus is smaller in some depressed people. For example, in one fMRI study published in The Journal of Neuroscience, investigators studied 24 women who had a history of depression. On average, the hippocampus was 9% to 13% smaller in depressed women compared with those who were not depressed. The more bouts of depression a woman had, the smaller the hippocampus. Stress, which plays a role in depression, may be a key factor here, since experts believe stress can suppress the production of new neurons (nerve cells) in the hippocampus.

Researchers are exploring possible links between sluggish production of new neurons in the hippocampus and low moods. An interesting fact about antidepressants supports this theory. These medications immediately boost the concentration of chemical messengers in the brain (neurotransmitters). Yet people typically don't begin to feel better for several weeks or longer. Experts have long wondered why, if depression were primarily the result of low levels of neurotransmitters, people don't feel better as soon as levels of neurotransmitters increase.

The answer may be that mood only improves as nerves grow and form new connections, a process that takes weeks. In fact, animal studies have shown that antidepressants do spur the growth and enhanced branching of nerve cells in the hippocampus. So, the theory holds, the real value of these medications may be in generating new neurons (a process called neurogenesis), strengthening nerve cell connections, and improving the exchange of information between nerve circuits. If that's the case, depression medications could be developed that specifically promote neurogenesis, with the hope that patients would see quicker results than with current treatments.

Figure 1: Areas of the brain involved with depression

The regions shown here are mirrored in both hemispheres of the brain. Also, these structures are interlocking; the illustration suggests relative position but not precise location.

Amygdala: The amygdala is part of a group of structures deep in the brain that's associated with emotions such as anger, pleasure, sorrow, fear, and sexual arousal. Recalling an emotionally charged memory, such as a frightening situation, activates the amygdala. Activity in the amygdala is higher when a person is sad or clinically depressed, and this continues even after recovery from depression. This increase in activity may actually cause the amygdala to enlarge.

Basal ganglia (not pictured): The basal ganglia are a related group of structures deep in the brain. They are connected to and interact with structures that are closer to the brain's surface. They may help facilitate movement and may be involved in memorizing, thinking, and emotional processing. Some studies have found shrinkage and other structural changes in the basal ganglia in people with depression.

Hippocampus: The hippocampus plays a key role in processing long-term memory. Interplay between the hippocampus and the amygdala might account for the adage "once bitten, twice shy." It is this part of the brain that registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people, and research suggests that ongoing exposure to stress hormones impairs the growth of neurons in this part of the brain.

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What causes depression? - Harvard Health

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Depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

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This site outlines suicide and depression and give a good overview of both. Helps explain the the stigma behind suicide.

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What Is Depression?

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.

Signs of Depression

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 like 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 like a drastic measure, it can be life-saving, and it may allow the person to get the treatment and support that they need.

Suicide

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 likely:

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 like "Everything's fine" or "Your life is good-you have no reason to feel suicidal!" Try saying something like "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.
Resources

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.

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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.

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Suicide in American: Frequently Asked Questions

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Suicide in American: Frequently Asked Questions

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Government site that answers people’s questions about depression. The site gives a good overview of the effects of depression.

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NIMH " Suicide in America: Frequently Asked Questions

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This fact sheet can help you, or a friend or family member, learn about the signs and symptoms, risk factors and warning signs, and ongoing research about suicide and suicide prevention.