Major Depressive Disorder DSM IV Diagnostic Criteria 1 Depressed mood 2 Loss of interest pleasure in activities anhedonia 3 Change in sleep insomnia hypersomnia 4 Change in weight appetite 5 Loss of energy 6 Psychomotor retardation agitation 7 Excessive guilt or worthlessness 8 Concentration difficulty difficulty making decisions 9 Thoughts of death suicidality DSM requires 5 or more of the above for 2 weeks Depression Sub types A Melancholic neuro vegetative symptoms anergia anhedonia diurnal mood variation B Atypical hypersomnia weight gain anxiety C Psychotic delusions or hallucinations only present during depressive episode Prevalence Facts Lifetime risk 23 by age 75 2 1 ratio female male but about 1 1 during childhood old age Highest risk of onset age 15 24 Risk of relapse another depressive episode over 80 after 3 episodes 90 Risk increases with major loss events e g separation breakup failure events Social support buffers against loss failure risk Costs of Depression 50 billion year in medical expenses lost productivity 300 million work days year lost leading cause of disability up to age 50 increased lifetime risk of heart disease dementia some cancers inflammation neurotoxicity low BDNF damage to hippocampus basal ganglia frontal cortex decreased immune function increased marital relationship discord divorce 300 000 depression linked suicide attempts year treated in ER 30 000 suicides per year Suicide about 4 1 25 of depressed individuals commit suicide 7 men 1 women Most suicide victims are clinically depressed 2nd leading cause of death among adolescents young adults best psychological predictor hopelessness only about 1 8 suicide attempts lethal Over 50 of all suicides involve firearms women twice as likely to attempt as likely to complete lethality goes up with age Roughly 1 2 of all suicides involve alcohol or another dis inhibiting agent Suicide Prevention Majority of suicide victims confide in someone prior to attempt Suicidal thoughts are very common in depression With careful assessment level of risk can be ascertained Distinguish between 1 Ideation passive vs active 2 Intent 3 Plan 4 Means If imminently suicidal can t be left alone Contract for safety Involuntary commitment Steps You Can Take 1 Ask in normalizing non stigmatizing caring fashion 2 Arrange to stay with them or find someone else to do so until they 3 See a professional for evaluation treatment contract for safety 4 If they are imminently suicidal and you can t keep them safe call sheriff s office 911 Frequently Asked Questions If I ask them about suicide won t I just be planting the idea in their head If someone is determined to commit suicide isn t it impossible to stop them Isn t it true that anyone who would commit suicide must be completely crazy Aren t most people who hint at suicide just looking for attention parasuicidality Headquarters crisis center 785 841 2345 KU Psych Clinic 785 864 4121 Suicide Hotline 800 SUICIDE