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risk of suicide

Mental Health and Grief

Grief and Mental Health – When the Two Merge

Grief is something that we all experience at one time, or another.  The stages of grief – sometimes explained as 3, 5 or 7 different stages – are pretty well known and include shock, denial, anger, sadness, acceptance in some order.  Most people will struggle but eventually come to some resolution with no prediction as to how long that will take.

Resolution of deep sorrow can be made much more difficult when a pre-existing mental illness is imposed.  A severe loss can trigger a relapse of virtually any mental illness, even when the illness was well treated, and the patient was stable.  Patients may relapse into severe depression, bipolar episodes, panic attacks or a return of obsessive compulsive behavior.  If the patient was not well stabilized, the whole apple-cart can be upset.

Depressed and Suicidal GirlEven the most mentally healthy person can become unstable if unable to resolve the feelings caused by painGrief has been known to result in clinical depression, lasting for a long period which can lead to extreme difficulties and even death in the case of suicide.  The problem comes in a case where one becomes “stuck” at a certain point – usually during the agitation period.

There is a saying;   “depression is anger turned inward.”  The existence of anger over an extended period can cause depression.

Anger allows us to have a heightened response to a threatening situation.  Anger fuels energy, giving us a false sense of power, but over time, the brain and the body run out of that same energy.  This can result in fatigue, emotional lability, and symptoms of depression.  In some cases, depression caused by grief may be resolved with grief counseling.

In other cases, however, depression may have become severe enough that medication may be warranted.  Clinical depression is characterized by:

•    Fatigue and decreased energy
•    Cloudy thinking
•    Feelings of guilt, worthlessness or helplessness
•    Insomnia or excessive sleeping
•    Irritability
•    Loss of interest in pleasurable activities
•    Body pain or digestive problems
•    Persistent sad or empty feelings
•    Thoughts of suicide

How different is this from grief – not much.  The only difference would be in how long it lasts.  Depression carries a high risk of suicide and if symptoms last longer than what would be considered “normal” – for any reason – you should seek treatmentMental Health ChaosDepression that is severe enough to interfere with normal activities for longer than four to six weeks should be treated – even if life circumstances explained it.  Counseling may work – or you may need medication for a short period.

If you have some known mental disorder, stay in contact with your mental health professional.  Most – and I did not say “all”, but most mental health patients find it difficult to self-assess, some find it difficult to be openly honest.  The only way to ensure that an episode of grief is resolved without severe consequences of going “off track” is to allow someone else to help assess your mental state.

Whether you are or are not a mental health patient, know that grief can cause mental illness and can worsen an existing illness – even if only for a short time.  It is not something to be dismissed or ignored as the risks are high.

Melissa Lind

Depression is Anger Turned Inward

Suicide in Depression

Why does treatment for depression increase the risk of suicide?

Whether you are bipolar or suffer from major depressive disorder – when you start taking medication for depression, your risk of suicide actually goes up for a short period of time.

The risk of suicide in depression

Every time an advertisement for a medication for depressive disorder or bipolar depression comes on the television, one thing that seems to stick out is the warning that states “May increase the risk of suicide“.  This is often an arguing point for people who are opposed to psychiatric medications.  If it is supposed to improve your mood, why does the risk of suicide go up?  Shouldn’t the opposite be true?

How do antidepressants work?

Antidepressant medications work by increasing the activity of neurotransmitters in the mood centers of the brain.  Nerve cell signals are transmitted by the release of chemicals known as neurotransmitters.  These include naturally occurring chemicals such as serotonin, norepinephrine and dopamine.  The neurotransmitter is released from one cell which signals the next cell to react.  The same cell then “gathers up” the neurotransmitter to be used again later.

Most antidepressants specifically work by blocking the “reuptake” of neurotransmitters so that they are in the synapses or spaces between the nerve cells for a longer period of time.  This increases the likelihood that the neurotransmitter will send a “happy” signal to the next cell – sooner.

Why do antidepressants increase the risk of suicide?

Suicide and DepressionThe problem with depression and how long it takes to recover is twofold, because depression involves both mood and energy levels.  In a person with depression, the mood state is lowered because there are often not enough neurotransmitters available.  This leads to the mental effects of depression causing sadness and an inability to enjoy normal activities.  There is also a corresponding drop in energy levels making the victim lethargic and sleepy.

When antidepressants are prescribed, most healthcare practitioners make it pretty clear that the mood state will not really begin to get noticeably better for at least 2 to 3 weeks. What is not always made clear is that energy levels actually begin to improve before the mood level is increased.

Once this person with low mood level and low energy level begins to take antidepressant medication, their energy levels go up fairly quickly.  The mood level, however, stays depressed – sad and unable to see the light at the end of the tunnel.

If patients had been thinking of suicide as part of their depression, they may not have had the energy to make actual plans or to carry them out.  Once their energy levels are boosted – they may find themselves still having the same thoughts, but this time – able to act.

Are the newer medications worse?

This increased risk of suicide is not new, despite what the media has portrayed.  It is not specific to a certain medication or even a certain kind of medication.  It is a fact, a well-known risk that has existed since the beginnings of treatment of depression.

Suicide and MedicationOur medications, today, are really much less dangerous than medications of old.  Thirty years ago, your choices for the treatment of depression included only tricyclics such as Elavil and Tofranil or MAO inhibitors such as Parnate.  Both of these medication types carried a lot of very debilitating side effects (dry mouth, constipation, excessive sweating, dizziness, and food intolerances) as well as the increased risk of suicide.  While they were effective, they were also quite dangerous in the event of an overdose – possibly resulting in death.

We now have more advanced medications – the SSRIs or Serotonin specific reuptake inhibitors, Norepinephrine reuptake inhibitors (NRIs) and newer MAO inhibitors that have much fewer side effects and are less likely to result in a serious overdose – but they have not been able to eliminate the actual risk of suicide.  This is inherent in the treatment of depression because the energy improves before the mood.

With older medications, the psychiatrist would often only prescribe a few days’ worth of medication at a time because the old medications could be dangerous if too many were taken and lead to overdose by someone trying to commit suicide.  This often meant that the patient was seen once a week or more often during the first month.

Now that overdose is not such a risk, physicians often prescribe an entire months’ worth of meds at once, and no one keeps track of the patient during this dangerous period  – giving them plenty of time to plan and act.  Generally the newer medications cannot be used as a suicide tool but it does not stop patients from finding other tools.

What can help decrease the risk?

The solution is to know your patient – know your friends, know your family.  If you have a friend or relative who has been depressed and is placed on medication, be aware.Check on them frequently. Drag them around to social activities, out to eat, to outdoor events. Note any changes or patterns that indicate they may be considering suicide.  Help them through the funk.  You may get on their nerves, but you may also save their life.

A little effort and toleration of irritating friends is way better than going to a funeral and wishing you had done something.

 

Newer medications used for prevention of suicide in depression are much less dangerous than medications of old.