Mood Disorders and Suicide

A mood disorder is a prolonged and disturbed emotional state affecting mental processes, behaviors, and interpersonal relationships. In the DSM-5 most mood disorders are classified into the broad categories of depressive disorders or bipolar and related disorders. There are many different depressive disorders. One of the most serious is major depressive disorder (often called clinical depression), which is characterized by sadness, irritability, or an inability to feel pleasure. Other symptoms of major depression include sleep disturbance, fatigue, hopelessness, weight and appetite changes, and trouble thinking or remembering things. Persistent depressive disorder (formerly called dysthymia) is a chronic mild depression that lasts at least two years. It has many of the same symptoms as major depression but with lower levels of severity.

Depression can occur at any age but becomes more common during the teen years. Each year over six percent of American adults and almost 13 percent of American adolescents experience an episode of major depressive disorder. Some will have just one episode, and others will have recurring episodes. Women are twice as likely to be diagnosed with this disorder, perhaps partly because men underreport symptoms. Depression has a genetic component. A person with a parent or sibling who has suffered major depression has a two to three times higher risk of developing the disorder than someone with no family history of depression. Depression is also linked to environmental stressors, including:

• losing a loved one through separation, divorce, or death
• experiencing physical, sexual, or emotional abuse
• facing social isolation
• undergoing negative life changes such as losing a job
• being raised by someone with symptoms of depression

Bipolar disorders are mood disorders typically involving alternating periods of depression and mania. A person in a manic phase, which can last for a week or more, feels euphoria and experiences high self-esteem. They may have racing thoughts, high energy, little need for sleep, and bursts of creativity. People in the manic phase sometimes also exhibit reckless behavior. There are many variants of bipolar disorder based on the severity of manic and depressive episodes. For a diagnosis of bipolar I disorder, people must experience at least one manic episode, which may be preceded or followed by a major depressive episode. For a diagnosis of bipolar II disorder, people must experience at least one major depressive episode along with hypomania (a less severe form of mania). About four percent of Americans will experience a bipolar disorder in their lifetime. Brain scans show that transitions between depressive and manic episodes are linked to clear differences in brain activity, with heightened activity occurring during manic states. Depressive disorders and bipolar disorders increase risk for suicidal thinking and behavior. However, not everyone who commits suicide has a depressed mood. Risk factors for suicide include:

• threats of suicide
• a clear plan for committing suicide
• hopelessness
• talk about being a burden to others
• substance abuse
• social withdrawal
• expressions of recklessness or rage
• impulsivity
• access to a means to commit suicide
• a recent stressor or loss
• overwhelming psychological symptoms, such as panic attacks
• chronic physical pain

Asking people about suicidality does not make people more likely to commit suicide. When people are thinking about killing themselves, they are less likely to do so if they can talk about it with somebody, preferably a mental health professional.