Depression and Suicide

If you think you may be depressed, use the screening tool below and reach out for help. Scroll down to learn more about depression in children, adolescents, adults and seniors.

Depression and depressive illnesses are classified as mood disorders in the medical field, including everything from Major Depression to Dysthymia. They have a number of symptoms that affect people socially, occupationally, educationally, interpersonally, etc. How does one become depressed? Basically, here's how it works: the nerves in our brain don't touch each other, but rather pass messages from one to the next through chemicals called neurotransmitters. We need just the right amount of this chemical between the nerves to pass the exact same message to the next nerve. If there isn't enough of that chemical, the message doesn't get passed along correctly and in this case, depression or a depressive illness can result. When it comes to depressive disorders the chemicals most frequently out of balance areserotonin andnorepinephrine.

A person living with depression oftentimes experiences completely different thoughts before and after a depressive episode. This can be a result of a chemical imbalance and can lead to the person not understanding the options available to help them relieve their suffering. Many people who suffer from depression report feeling as though they've lost the ability to imagine a happy future, or remember a happy past. Often they don't realize they're suffering from a treatable illness, and seeking help may not even enter their mind. Emotions and even physical pain can become unbearable. They don't want to die, but it's the only way they feel their pain will end. It is a truly irrational choice. Suffering from depression is involuntary, just like cancer or diabetes, but it is a treatable illness that can be managed.

The diagnosis and treatment of depression and depressive illnesses can be made by a medical doctor, or mental health professionals such as a psychologist, social worker, or psychotherapist. However, if we recognize and pay attention to the symptoms of depression, we can help these professionals better treat the disease.

Please note: Other illnesses and certain medications can cause symptoms that mimic the symptoms of depression. A complete medical examination should be performed to rule out the presence of other medical conditions potentially causing depressive symptoms.  It's normal to feel some of the following symptoms from time to time, but experiencing several or more for  more than two or three weeks may indicate the presence of depression or another depressive illness. Remember, you must seek a professional for an accurate diagnosis of depression. The link below is an external site and is provided only as a tool to help you talk with your doctor or treatment provider about your concerns and develop an action plan for successful recovery.

Take a Screening Now

The following screen is for adults only and is in no way meant to diagnose depression. Results may be shared with your doctor. SAVE is in no way affiliated with the creators of the screening or with Mental Health America. The screening is an external link that will open in another tab.

Not all people with depression will show all symptoms or have them to the same degree. If a person has four or more symptoms, for more than two weeks, consult a doctor or mental health professional right away. While the symptoms specified for all groups below generally characterize major depression, there are other disorders with similar characteristics including: bipolar illness, anxiety disorder, or attention deficit disorder with or without hyperactivity.

In Adults

  • Persistent sad or "empty" mood.
  • Feeling hopeless, helpless, worthless, pessimistic and/or guilty.
  • Substance abuse.
  • Fatigue or loss of interest in ordinary activities, including sex.
  • Disturbances in eating and sleeping patterns.
  • Irritability, increased crying, anxiety or panic attacks.
  • Difficulty concentrating, remembering or making decisions.
  • Thoughts of suicide; suicide plans or attempts.
  • Persistent physical symptoms or pains that do not respond to treatment.

In Infants and Children

It's important to understand what constitutes normal development in infants, children and adolescents vs. what may be signs of a depressive illness.

  • Unresponsive when talked to or touched, never smile or cry, or may cry often being difficult to soothe.
  • Failure to gain weight (not due to other medical illness).
  • Unmotivated in play.
  • Restless, oversensitive to noise or touch.
  • Problems with eating or sleeping.
  • Digestive disorders (constipation/diarrhea).

In children, depressive illnesses/anxiety may be disguised as, or presented as, school phobia or school avoidance, social phobia or social avoidance, excessive separation anxiety, running away, obsessions, compulsions, or everyday rituals, such as having to go to bed at the exact time each night for fear something bad may happen. Chronic illnesses may be present also since depression weakens the immune system. Other signs include persistent unhappiness, negativity, complaining, chronic boredom, no initiative.

  • Uncontrollable anger with aggressive or destructive behavior, possibly hitting themselves or others, kicking or self-biting or head banging.
  • Harming animals.
  • Continual disobedience.
  • Easily frustrated, frequent crying, low self-esteem, overly sensitive.
  • Inability to pay attention, remember, or make decisions, easily distracted, mind goes blank.
  • Energy fluctuations from lethargic to frenzied activity, with periods of normalcy.
  • Eating or sleeping problems.
  • Bedwetting, constipation, diarrhea.
  • Impulsiveness, accident-prone.
  • Chronic worry & fear, clingy, panic attacks.
  • Extreme self-consciousness.
  • Slowed speech & body movements.
  • Disorganized speech – hard to follow when telling you a story, etc.
  • Physical symptoms such as dizziness, headaches, stomachaches, arms or legs ache, nail-biting, pulling out hair or eyelashes. (ruling out other medical causes)
  • Suicidal talk or attempts.

In Adolescents

Depressive illnesses/anxiety may be disguised as, or presented as, eating disorders such as anorexia or bulimia, drug/alcohol abuse, sexual promiscuity, risk-taking behavior such as reckless driving, unprotected sex, carelessness when walking across busy streets, on bridges or cliffs. There may be social isolation, running away, constant disobedience, getting into trouble with the law, physical or sexual assaults against others, obnoxious behavior, failure to care about appearance/hygiene, no sense of self or of values/morals, difficulty cultivating relationships, inability to establish/stick with occupational/educational goals.

  • Physical symptoms such as dizziness, headaches, stomachaches, neck aches, arms or legs hurt due to muscle tension, digestive disorders. (ruling out other medical causes)
  • Persistent unhappiness, negativity, irritability.
  • Uncontrollable anger or outbursts of rage.
  • Overly self-critical, unwarranted guilt, low self-esteem.
  • Inability to concentrate, think straight, remember, or make decisions, possibly resulting in refusal to study in school or an inability (due to depression or attention deficit disorder) to do schoolwork.
  • Slowed or hesitant speech or body movements, or restlessness (anxiety).
  • Loss of interest in once pleasurable activities.
  • Low energy, chronic fatigue, sluggishness.
  • Change in appetite, noticeable weight loss or weight gain, or abnormal eating patterns.
  • Chronic worry, excessive fear.
  • Preoccupation with death themes in literature, music, drawings, speaking of death repeatedly, fascination with guns/knives.
  • Suicidal thoughts, plans, or attempts.

In Elderly

Many people feel that it is normal for elderly persons to be depressed. This is a dangerous misconception. If you suspect an older adult is suffering from a depressive illness, a thorough medical examination should be given as soon as possible.

  • Unusual complaints of aches and pains (back, stomach, arms, legs, head, chest), fatigue, slowed movements and speech, loss of appetite, inability to sleep, weight increase or decrease, blurred vision, dizziness, heart racing, anxiety.
  • Inability to concentrate, remember or think straight (sometimes mistaken for dementia). An overall sadness or apathy, withdrawal; inability to find pleasure in anything.
  • Irritability, mood swings or constant complaining; nothing seems to make the person happy.
  • Talk of worthlessness, not being needed anymore, excessive and unwarranted guilt.
  • Frequent doctor visits without relief in symptoms; all tests come out negative.
  • Alcoholism, which can mask an underlying depression.
  • Decreased need for sleep.
  • Restless, agitated, can't sit still. Increased energy, or an inability to slow down.
  • Racing, disorganized thoughts, easily distracted.
  • Rapid, increased talking or laughing
  • Grandiose ideas, increased creativity.
  • Overly excited, euphoric, giddy, exhilarated.
  • Excessive irritability, on edge.
  • Increased sex drive, possibly resulting in affairs, inappropriate sexual behaviors.
  • Poor judgment, impulsiveness, spending sprees
  • Embarrassing social behavior.
  • Paranoia, delusions, hallucinations.

Many suicidal children and adolescents have clinical depression alone or in conjunction with another mental illness like anxiety disorder, attention deficit disorder, bipolar illness (manic depression), or child-onset schizophrenia. Each child's personality, biological makeup, and environment are unique, and depression and suicidal ideation in children are complex issues involving many factors. By recognizing and treating children we can improve the chances a young person with depression can live a longer, healthier, more quality life.

In addition to the standard symptoms of depression, and warning signs of suicide look for the following in children:

Verbal Clues

  • "I shouldn't be here."
  • "I'm going to run away."
  • "I wish I were dead."
  • "I'm going to kill myself."
  • "I wish I could disappear forever."
  • "If a person did this or that… would he/she die?"
  • "The voices tell me to kill myself."
  • "Maybe if I died, people would love me more."
  • "I want to see what it feels like to die."
  • "My parent's won't even miss me."
  • "My boy/girlfriend won't care anyway."

Behavioral Clues

  • Talking or joking about suicide.
  • Giving away prized possessions.
  • Preoccupation with death/violence; TV, movies, drawings, books, at play, music.
  • High risk behavior such as jumping from high places, running into traffic, self-injurious behaviors (cutting, burning).
  • Having several accidents resulting in injury; "close calls" or "brushes with death."
  • Obsession with guns and knives.
  • Previous suicidal thoughts or attempts.

High Risk Children

  • Are preoccupied with death, and don't understand it is permanent.
  • Believe a person goes to a better place after dying or can come alive after dying.
  • Are impulsive (act without realizing the consequences of their actions).
  • Have no or little sense of fear or danger.
  • Tend to have perfectionist tendencies.
  • Truly feel that it would be better for everyone else if they were dead.
  • Believe that if they could join a loved one who died, they would then be rid of their pain and be at peace.
  • Have parents or relatives who have attempted suicide (modeling behaviors/genetic factors can be involved here).
  • Are hopeless; feeling that things will never get better, that they will never feel better.

An Attempt or Suicidal Behavior

  • Doesn't know why they're doing it, but feels unable to stop it.
  • May not remember the attempt when it's over
  • Feels as if they were/are in a trance.
  • May think they will be rescued.
  • Acting out pain because of an inability to verbalize feelings.
  • Increased impulsiveness and impaired judgment, perceptions and cognitive skills.

Healthy, non-impulsive children who talk about death or seem preoccupied after losing a friend or loved one, but have a clear understanding that death is final, and who are not depressed, are probably at a very low risk for suicidal behavior.

Typically, when asked about their own death, children most often state it will happen due to old age or getting sick when they're old. Many suicidal children believe that when others die, death is final, but that if they die, their death is reversible. Vulnerable children and adolescents who may be under stress (internal or external) may have a change in perceptions of and feelings about death.

Know What To Do

Because children aren't always able to understand and explain their feelings, as adults we must be more vigilant in understanding the ways depression and suicide manifest in children, and work to get them the help they need.

If you think a child may be suicidal…

Ask questions about suicide like, "Do you ever…

  • …have thoughts of hurting yourself?"
  • …feel so badly that you have thoughts of dying?"
  • …wish you could runaway or disappear?"
  • …wish you could go to sleep and not wake up?"
  • …have scary dreams about dying?"

Treatment options might include:

  • Depression Inventory Scales, Suicidal Risk Assessments, Suicidal Intent Scales, Degree of Hopelessness Scales, Diagnostic Interview Questionnaires.
  • Out-patient psychotherapy:
    • Cognitive Therapy – teaches more positive thinking, coping skills and problem-solving
    • Interpersonal Therapy – might teach children how to make friends
    • Group Therapy – with others of similar age that have a depressive illness
    • Family Therapy – works with the entire family and discusses various family dynamics
  • Various supports at school. Talk with a school nurse about the options available.
  • Various forms of play therapy, relaxation therapy, biofeedback, visualization.
  • Antidepressant medications, stimulants, also some types of alternative medicine.
  • Hospitalization (in-patient, partial hospitalization, day-treatment).

How to Help

  • Educate yourself on childhood & adolescent depressive illnesses and suicide.
  • Assure your child they can feel better, that suicidal thoughts are only temporary, and that there are people who can help them.
  • Always take suicidal tendencies seriously and respond immediately.
  • Know that early intervention is the key to successful treatment for children who suffer from depressive illnesses.
  • Understand that treatment should be a team-approach including a psychotherapist, a child/adolescent psychiatrist, parents, relatives, caregivers, school personnel, friends, babysitters, neighbors and other significant people in the child's life.

It is a myth that depression is part of the aging process. It is not normal for people of any age to suffer from depression; this includes our elderly population. Major depression (also known as clinical depression) is a medical illness. It is a chemical imbalance in the brain and can appear in people regardless of age, race or economic status. The illness can appear after a triggering event or for no apparent reason at all.

Symptoms

Watch for standard symptoms of depression, as well as these symptoms common among the elderly suffering from depression:

  • Complaints of aches and pains (back, stomach, arms, legs, head, chest), fatigue, slowed movements and speech, loss of appetite, inability to sleep, weight increase or decrease, blurred vision, dizziness, heart racing, anxiety.
  • Inability to concentrate, remember or think straight (sometimes mistaken for dementia). An overall sadness or apathy, withdrawn; unable to find pleasure in anything.
  • Irritability, mood swings or constant complaining; nothing seems to make the person happy.
  • Talk of worthlessness, not being needed anymore, excessive and unwarranted guilt.
  • Frequent doctor visits without relief in symptoms; all tests come out negative.
  • Alcoholism can mask an underlying depression.

A complete physical examination to rule out other problems is critical before a diagnosis of depression is made. Other physical diseases (Parkinson's, multiple sclerosis, diabetes, thyroid disorders, certain viral infections, strokes, tumors) and certain medications (steroids, hormones, blood pressure and arthritis medications) used to treat those illnesses can mimic the symptoms depression; they can cause a chemical imbalance in the brain. Therefore, a thorough exam is extremely important, as well as a complete medical history and list of medications currently being taken (both over-the-counter and prescription drugs). Family history of depressive illness should also be noted, due to the genetic component of brain illnesses. Untreated or mistreated depression can result in suicide.

Behaviors

Watch for the following behaviors:elderly_family

  • Talk about suicide, e.g. "I have nothing left to live for." "I won't be a burden on my family much longer." "I should just kill myself." Statements of hopelessness, helplessness or worthlessness.
  • Preoccupation with death.
  • Suddenly happier, calmer.
  • Loss of interest in things one cares about.
  • Unusual visiting or calling people one cares about – saying goodbyes.
  • Making arrangements; setting one's affairs in order.
  • Giving things away.
  • Stockpiling pills or obtaining a weapon.
  • Refusal to follow doctor-prescribed medications and/or special diet.

The National Institute of Mental Health and the Centers for Disease Control report that as many as 3 out of every 100 people, over 65, suffer from clinical depression and that the suicide rate is twice as high in this population compared to other age groups.

Depression is treatable and suicide can be prevented!

Nearly 90 percent of people with clinical depression can be treated successfully with medications and psychotherapy done together. Some depressions among the elderly may respond better to electroconvulsive therapy. ECT is an effective treatment that is used in extremely severe cases of major depression when very rapid improvement is necessary, or when medications cannot be used or have not worked. Improved procedures make this treatment much safer than in previous years.

Where to get help:

  • Family physicians, clinics and health maintenance organizations can provide treatment or make referrals to mental health specialists.
  • Mental health specialists like psychiatrists, psychologists, family therapists and social workers. Psychiatrists can prescribe antidepressant drugs because they are physicians. Other mental health specialists, however, often work with physicians to ensure that their patients receive the medications they need.
  • Community mental health centers often provide treatment based on the patient's ability to pay, and usually have a variety of mental health specialists.
  • Hospitals and university medical schools may have research centers that study and treat depression.

What to do:

Stigma associated with depressive illnesses can prevent people from getting help. Your willingness to talk about depression and suicide with your family members can be the first step in getting help and preventing suicide.