What Drives So Many to Take Their Lives? : Depression: This common illness is physical and can be treated simply--but family and friends have to help.

Vincent W. Foster Jr. was an eminent Arkansas lawyer who went to Washington to serve his childhood friend as counselor to the President. After he was found dead, apparently by his own hand, people in Washington speculated that the stresses of his demanding job had been compounded by criticism in the media, and that he feared he had let the President down.

This is, sad to say, the typical response when people grope for an answer to suicide. It is easy to see a problem at work or at home as a reason that would depress any one of us. In fact, work and family problems are more commonly the result of depression’s effect on mood, thinking and judgment, not the cause.

Depression is a serious, life-threatening illness--the major cause of suicide. Depressive disorders affect an estimated 30 million Americans throughout the socioeconomic spectrum, people of any age, race, religion or education.

Once thought to be a psychological dysfunction, depression is now considered an illness of the brain, associated with biochemical changes that cause impaired sleep, concentration, energy, appetite and other changes in mood. Self-medication with alcohol or other drugs is common among depressed people and can easily be missed as a symptom of depression.

Treatment of depression first requires an appropriate evaluation, followed by a coherent and carefully supervised treatment plan. While safe and effective, psychotropic drugs can be complicated to administer, requiring skill, knowledge and monitoring.

Depression is debilitating. Afflicted individuals may not be able to seek care because their energy is too low or their judgment is impaired. Consequently, family and friends may have to intervene, even though it may be difficult to have the confidence that this intervention will be accepted and will actually help the person we care about. Often, all that is required of friends and relatives is just the first step of making the appointment for the depressed person, of pointing him or her in the right direction. This is particularly important with teen-agers.

The hardest part of what is required if we are to help is the rejection of stigma associated with mental illness. Depression is not caused by a weakness of character. Genetic factors predispose many individuals to depression, and stress at work or at home can trigger the onset of symptoms. However, in the majority of instances, specific stressors cannot be identified as causal. This often makes the patient feel guilty for not having a “good enough reason” to feel so bad or to be so impaired. Following a suicide, survivors may obsessively look for a “good enough reason” to explain the tragedy, frequently and erroneously blaming themselves.

We now know that these are biological diseases of the brain that we can show with sophisticated brain scanning techniques and biochemical tests in research settings. For example, suicidal behavior in depression is known to be associated with low levels of the brain chemical serotonin.

The cost of effective treatment can be minimal; in many cases, all that’s needed is a few office visits and carefully selected medication that “normalizes” the biochemical abnormalities that underlie depressive illnesses. The cost of not treating depression is extremely high and includes the loss of income and productivity. As for the ultimate loss, studies have shown a range of 25% to 50% of patients with depression or manic-depressive illness attempt suicide. The damage done to the survivors of a loved one’s suicide can continue to cause problems for generations from shame and guilt. Studies have shown that the risk of suicide is greater among survivors of a suicide than family members of nonsuicidal depressives.

Evaluation for depression should be considered for anyone who has diminished interest or pleasure in normal activities; sustained depressed or irritable mood that endures for two weeks or longer; marked difficulty staying asleep or excessive sleep; low level of energy; difficulty in concentration or reading; recurrent thoughts of death or sickness that are unrealistic; obsessively negative thinking or speaking. Although any mental-health professional (psychiatrist, psychologist, social worker) should be able to identify depression, medical treatment can be carried out only by a psychiatrist or another medical doctor. Specialists for mood disorders can be located through the medical staff offices of local hospitals or county medical societies. In larger cities, there also are specialized centers for mood disorders that can help patients and families directly and through support groups.