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Depression expert: If someone you know is struggling, don’t be afraid to ask about it

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Suicide rates in the United States have risen nearly 30 percent since 1999, according to a Centers for Disease Control and Prevention report that published June 7.

The recent news of Anthony Bourdain and Kate Spade’s deaths by suicide have served as solemn reminders of the significant toll that depression can take on people who struggle with the disease.

Suicide rates in the United States have risen nearly 30 percent since 1999, according to a Centers for Disease Control and Prevention report that published June 7. Depression is the leading cause of disability worldwide, according to the World Health Organization. Globally, more than 300 million people suffer from the disease.

In Virginia the rate of suicide has risen nearly 25 percent in the past 15 years, according to the Virginia Department of Health. Out of every 100,000 Virginians, 13.4 committed suicide in 2016, according to the most recent state data.

Joel Silverman, M.D., chair of the Department of Psychiatry at VCU School of Medicine, says depression is a manageable disease if people seek treatment. Silverman explained to VCU News how depression can be managed, what to look for as signs that a loved one might be contemplating suicide, and how to provide help.

What are the symptoms of depression?

The most common depression symptoms are having a sad mood, difficulty sleeping and concentrating, crying spells, loss of appetite, feeling hopeless and having thoughts of suicide.  

Joel Silverman, M.D.
Joel Silverman, M.D.

If you have a loved one who is depressed, what can you do to support them?

Social support is one of the most important factors for improvement.

Ask the person you are concerned about if they are having thoughts of hurting themselves and if they are receiving professional help. Getting treatment is critical and asking about suicide is important.

The stigma around depression has dropped in recent years. People are more comfortable now than they have been in the past in seeking help, but there is still a fair amount of concern that if you see a mental health professional, it means you are not a good person, rather than framing it from the standpoint of, “You have an illness that is treatable and has a good prognosis if it is treated properly.”

If you look at depression as it is — a medical illness — then you can approach it just like any other medical illness. If you look at it as a personal or moral failure, that is a very different approach. Depression is treatable, and it has excellent outcomes as long as the person takes the treatment.

What is the outlook for a person who might be struggling with depression? How likely is recovery?

Treatment works excellently. Medication and psychotherapy work well, and if you put the two together they work even better than if they are separate. As with the rest of medicine, if you don’t participate in the treatment then it doesn't work. If you are a diabetic and you don't take the insulin you have been prescribed, then it doesn’t help you. As long as people are involved in therapy with a trained mental health professional and are dosing their medication appropriately, the outcome is excellent.

Social support is one of the most important factors for improvement. Ask the person you are concerned about if they are having thoughts of hurting themselves and if they are receiving professional help. Getting treatment is critical and asking about suicide is important.

Are there warning signs to look for that identify someone might be considering suicide?

The most obvious signs are if people say goodbye, give away their belongings or decide to write a will, but there are other signs that are important to think about.

If someone has tried to hurt himself or herself in the past, they are at higher risk for suicide. When people do minor gestures like scratch their wrist with a paper clip or take an overdose with two Valium, those are real signs of danger even if they are not going to end someone’s life. Even if someone doesn’t do something major, it is still important to intervene.

Other risk factors for suicide include abusing substances, having chronic pain, not having social support, and not having hope. Having weapons in the environment like guns also represents a higher risk. That isn’t to say that there aren’t other ways you can kill yourself, but if you take an overdose, for example, the chance of reversing it is much higher than if you put a gun to your body and pull the trigger.

Does asking if someone is considering suicide make them more suicidal?

Absolutely not. There is a myth that if you talk about it, people are more likely to do it. It is just the opposite. The more you talk about it, the more you can get people help, and the safer they are going to be.

What is your advice for people who are struggling with depression or suicidal thoughts?

There is hope and there is help. Reaching out and doing something rather than steeping oneself in the sad feelings will make a difference.

For family members and friends of an individual who might be depressed, my advice is to talk about it when you are concerned and to act on your concern. That could mean getting somebody psychiatric help, taking dangerous things like guns out of their environment, or even just sitting with the person. There is a lot that can be done if you are worried.