What is the role of depression in the development of suicidal behaviors?

Updated: Aug 29, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Because depression involves a preoccupation with death, the twin killers of hopelessness and helplessness, and withdrawal, it is a major contributor to suicide. A dangerous time in depression occurs when a patient is coming out of the deepest part of the experience. At that point, the individual may mobilize his or her newly acquired energy to commit suicide.

The protracted and profound emotional roller coaster of manic-depressive illness puts a patient at risk both during the depressive phase and in the psychosis of mania. Suicide is a particular risk when executive functions and judgment have been compromised by bipolar disorder. [14] In particular, men with bipolar disorder have an increased risk for suicide. [15]

One important consideration in the treatment of depression is that selective serotonin reuptake inhibitors (SSRIs) have a lower rate of fatal overdoses than do tricyclic antidepressants (TCAs). [16]

Shah et al found that in adults younger than 40 years, depression and history of attempted suicide are significant independent predictors of premature cardiovascular disease and ischemic heart disease in males and females. [17]

An intriguing notion is emerging regarding the link between evidence of inflammation and suicidal thoughts in patient with Major Depressive Disorder (MDD). Holmes and colleagues have examined levels  of  translocator protein (TSPO) in MDD patients. TSPO is an indicator of neuroinflammation. Using positron emission tomography, they found significantly elevated levels of TSPO in the anterior cingulate cortex (ACC) in MDD patients with suicidal thoughts compared to those patients without suicidal thinking. [18]


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