Major Depression

According to the DSM-IV, mood disturbance consists of two symptoms: (1) depressed mood (feeling sad, blue, or down in the dumps), also known as dysphoria, and (2) lack of interest or pleasure in almost all activities most of the day, also known as anhedonia. To be diagnosed with major depression, a person must experience at least five depressive symptoms from the following list, including at least one of the two hallmark features of depressiondepressed mood and loss of interest. These symptoms must be present most of the day nearly every day for at least two weeks:
y y y y y y y y y

depressed mood loss of interest significant weight loss or gain trouble sleeping or sleeping too much restless feelings and inability to sit still or slowed down fatigue, loss of energy, or tired all the time worthless or guilty feelings impaired concentration and difficulty making decisions recurrent thoughts of death or suicide

To be classified as indicative of major depression, these symptoms must cause significant distress or impairment in social, occupational, and other important areas of functioning. Furthermore, the formal diagnosis must rule out other medical causes of depressed mood, including medication effects, substance abuse, or general (i.e., other than psychiatric) medical condition such as hypothyroidism. Finally, the symptoms should be distinguished from those of grief or bereavement associated with loss of a loved one or extraordinary distress.

Mild-to-Moderate Depression
According to the DSM-IV, mild-to-moderate depressiontermed dysthymic disorderis marked by milder symptoms than major depression, but the symptoms are prolonged and protracted. Dysthymia is characterized by depressed mood for most of the day, on more days than not, for at least two years. Additionally, a diagnosis of dysthymia requires the presence of at least two of these symptoms while depressed:
y y y y y y

poor appetite or overeating trouble sleeping or sleeping too much fatigue, loss of energy, or tired all the time low self-esteem impaired concentration and difficulty making decisions feelings of hopelessness and helplessness

To be considered as indicative of dysthymia, the first two years of depressed mood cannot include any episodes of major depression. Furthermore, diagnosis of dysthymia precludes a history of manic episodes and requires that depressed mood occur not during the course of some other psychiatric disorder such as schizophrenia. In addition, no underlying cause of depressed mood, such as a general (i.e., other than psychiatric) medical condition or substance abuse, must be present. The symptoms of dysthymia cause significant distress or impairment in social, occupational, and other important areas of functioning.

Bipolar Disorder
Bipolar disorders are episodic conditions characterized by at least one episode of mania (extreme highs) or hypomania (moderate highs). The large majority of people who experience manic episodes also experience recurrent episodes of major depression. Others experience dysthymia. Cycling between the poles of highhigh (mania) and lowlow (depression) is the very essence of the diagnosis of bipolar disorder, which contrasts with major and mild-to-moderate depression -disorders characterized by lows without intervening manic highs (hence the name unipolar depression used sometimes for depression). To be diagnosed as having a manic episode, a person must experience manic symptoms -feeling unusually high, euphoric, elevated, or expansive -- for at least one week and also experience three or more of the following symptoms:
y y y y y y y

inflated self-esteem and grandiosity marked decrease in the need for sleep talkative with rapid, pressured speech flight of ideas (rapidly racing thoughts) distractibility increase in goal-directed activity excessive involvement in pleasurable activity with a high risk of painful consequences (buying sprees, sexual indiscretions, or foolish investments)

Three types of bipolar disorder are distinguished based on the degree of cycling: Bipolar I disorder involves one or more manic episodes along with multiple major depression episodes. Thus, cycling is the most extreme, ranging from highhigh to lowlow. Bipolar II disorder involves hypomanic (mediumhigh) episodes cycling with multiple major depression episodes. Cycling is between mediumhigh and lowlow. Cyclothymia involves multiple episodes of hypomania cycling with multiple episodes of mildto-moderate depression (dysthymia). Cycling is between mediumhigh and mediumlow.

Suicide
Over 30,000 people took their own lives in 1997, making suicide the eighth leading cause of death in the U.S. Suicide was responsible for more deaths than either homicide or HIV/AIDS. In that same year, suicide was the third leading cause of death for 15 to 24 year olds and the second leading cause of death for people 25 to 34 years of age. Certain segments of the population appear to be at greater risk for suicide. Males in general exhibit higher rates of suicide, particularly elderly Caucasian men. Suicide among African American youths has increased dramatically in recent years. In the period from 1979 to 1992, suicide rates for Native Americans were about 1.5 times the national average. Women attempt suicide more frequently than do men by a ratio of 2:1. However, more men complete suicide with a gender ratio of 4:1. For every suicide completed, the National Institute of Mental Health (NIMH) estimates that there are 8 to 25 suicide attempts. Firearms constitute the most common means used by both men and women to take their lives, accounting for 58% of all suicides. Low levels of serotonin are associated with the risk for suicide. Research has shown diminished serotonin levels in the brains of suicide victims. It is not surprising that depression is one of the strongest risk factors for suicide in the adult population, along with alcohol abuse, cocaine use, and divorce and separation. Additional risk factors for suicide in youth include aggressive or disruptive behaviors. The main risk factors for suicide in all populations include:
y y y y y y y y y y y

aggression depression divorce or separation exposure to suicidal behavior of others (e.g., family members, peers, or via news or fictional stories) family history of mental or substance abuse disorder family history of suicide family violence (physical or sexual abuse) firearms in the home incarceration prior suicide attempt substance abuse

Suicidal individuals may exhibit a variety of behaviors (listed below). Verbal threats of suicide should always be taken seriously. It is a common misconception that individuals who talk about suicide do not try to take their own lives. The followings are warning signs of potential suicide:
y y y y y

withdrawal -- overwhelming urge to be alone moodiness -- extreme high mood one day followed by extreme low mood or inexplicable calm the next day life crisis or trauma -- experience of a major life-changing event (e.g., death of a loved one or serious illness) may trigger suicidal thoughts personality change -- drastic change in personality, energy level, or appearance threat -- verbalized suicidal intentions always to be taken seriously

y y y

gift giving -- cherished belongings given to loved ones depression -- feelings of sadness accompanied by decreased capacity to function at home, work, or socially risk taking -- unsafe sex practices or excessive speeding

What to do if someone you know is suicidal:

y y y y y y y y y

Trust your instincts that the individual is in danger and may attempt suicide. Talk with that person and obtain appropriate mental health intervention for him or her. Ask the person about his or her plan. If the person is able to explain the suicide plan in great detail, he or she is at greater risk. Listen carefully. Get professional help even if the person does not express any desire for it. Never leave a suicidal person alone. Never swear that you will keep secret the person's plan for suicide. Do not judge the person. Do not attempt to counsel the person.

What is suicide?

Suicide is the process of purposely ending one's own life. The way societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, such as in protest to persecution (for example, hunger strike), as part of battle or resistance (for example, suicide pilots of World War II; suicide bombers) or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members). Nearly 1 million people worldwide commit suicide each year, with anywhere from 10 million to 20 million suicide attempts annually. About 30,000 people reportedly kill themselves each year in the United States. The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single-car accident, overdose, or shooting, are not recognized as being a suicide. Suicide is the eighth leading cause of death in males and the 16th leading cause of death in females. The higher frequency of completed suicides in males versus females is consistent across the life span. In the United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys 15-19 years of age complete suicide five times as often as girls their age, and men 20-24 years of age commit suicide 10 times as often as women their age. Gay, lesbian, and other sexual minority youth are more at risk for thinking about and attempting suicide than heterosexual teens. Suicide is the third leading cause of death for people 10-24 years of age. Teen suicide statistics for youths 15-19 years of age indicate that from 1950-1990, the frequency of suicides increased by 300% and from 1990-2003, that rate decreased by 35%. However, from 2000-2006, the rate

of suicide has gradually increased, both in the 10-24 years and the 25-64 years old age groups. While the rate of murder-suicide remains low at 0.0001%, the devastation it creates makes it a concerning public-health issue. The rate of suicide can vary with the time of year, as wells as with the time of day. For example, the number of suicides by train tend to peak soon after sunset and about 10 hours earlier each day. Although professionals like police officers and dentists are thought to be more vulnerable to suicide than others, important flaws have been found in the research upon which those claims are based. As opposed to suicidal behavior, self-mutilation is defined as deliberately hurting oneself without meaning to cause one's own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Self-tattooing is also considered self-mutilation. Other self-injurious behaviors include self-burning, head banging, pinching, and scratching. Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2009, Oregon and Washington were the only states with laws in effect that authorized physician-assisted suicide. Physician-assisted suicide seems to be less offensive to people compared to assisted suicide that is done by a non-physician, although the acceptability of both means to end life tends to increase as people age and with the number of times the person who desires their own death repeatedly asks for such assistance.