And even when treatment is not particularly effective, depression often passes on its own accord. It is not an incurable cancer that offers a guaranteed foreshortened future of unbearable pain. Because of this, depressed people kill themselves over something that would have lifted had they just been able to hang in there.
The other reason depression-driven suicides are so tragic and terrible is because they cast such long shadows on families and other loved ones.
Children especially suffer. They grow up wondering why, and whether they could have done something, and whether they'll have to struggle with the same urges.
I think of people I have known in this situation, and I have to think of something else to keep from tearing up as I write this. More than once I've "guilted" acutely suicidal patients into not killing themselves for the sake of their children and have done so with a clear conscience.
We may or may never know why Scott apparently killed himself, but we can be sure that his family and friends will spend many years wondering what they might have done to have protected him. This is part of the painful legacy left by suicide, and my heart goes out to them.
In fact, even psychiatrists have a difficult time predicting when someone is at heightened risk for suicide. In part, this comes from the fact that many people who really want to kill themselves keep their mouths shut about it and just go do it. In part, it comes from the fact that suicide is often an impulsive act driven by acute and unpredictable increases in anxiety and despair that one cannot predict in advance.
For families and friends worried about the suicidal potential of a loved one, there are a few useful pieces of advice I can offer from the research literature, such as it is.
First, older men are more likely by far than other people to kill themselves.
Second, people who kill themselves often will tell someone ahead of time. Any such communications should be taken with utmost seriousness, and all efforts should be made to keep the person safe and get him or her to appropriate treatment immediately.
Third, even over the suicidal person's objections, the means for committing suicide should be removed from the environment. Guns should be taken out of the house. Pain pills should be taken elsewhere.
Fourth, studies conducted over the last 20 years suggest that the biggest short-term risk for depressed people to kill themselves is the development of unbearable anxiety. If a loved one with depression begins to pace the floors or do other things suggesting that they are becoming consumed with terror, panic or dread, the risk for suicide shoots up.
Finally, it is not true that talking about suicide increases the likelihood it will happen. In fact, studies suggest the opposite.
So if you have a loved one with depression who is struggling with the will to live, one of the best things you can do -- over and above getting them immediate health care -- is to check in with them regularly and honestly and act if their drive to die intensifies.
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