Suicidal ideation

Oscar-winning actor and comedian Robin Williams’s suicide on Monday shocked the world.

According to media reports, in the last period of his life, Williams was in a bad emotional state and "struggled with severe depression."

Millions of American adults continue to struggle with this chronic ailment.

Fortunately, in most cases, medications and psychotherapy help to raise their spirits and change their worldview.

For some, however, hopelessness does not go anywhere, even with treatment. About 39,000 suicides each year are recorded in America, many of them due to depression, anxiety, or psychosis.

What makes depression deadly for some people? And are there any specific warning signals that can help loved ones to intervene in time?

The medical publication WebMD asked two experienced psychiatrists to share their thoughts on this matter. None of these doctors took part in the treatment of Robin Williams.

What makes depression so common and difficult to cure?

“It’s a matter of life and death for some people, but we don’t know why,” says Dr. Lon Schneider. Dr. Schneider is a professor of psychiatry, neurology and gerontology at the Keck School of Medicine at the University of Southern California. In his opinion, the phrase “struggling with depression” is very accurate.

The disease can be complicated and, according to the doctor, it can take various forms. Someone with chronic depression, for example, "is in a slightly depressed state most of the time." Someone after an exacerbation of depression may be in a relatively stable mood, and may fall into depression again. Many people have relapses of depression.

"Depression is a very difficult disease to treat, because it is associated with both genetic disorders and environmental exposure," says Dr. Scott Krakower. Dr. Krakawer works as an assistant to the head of the psychiatry department at Zucker Hillside Hospital of the North Shore LIJ Medical Group.

According to Dr. Krakovera, the genetic basis of depression is not fully understood.

Those who have fame, power and success, do not have immunity against depression. “You can make an amazing career, have a successful life, but at the same time, you can all be in severe depression,” says Krakover.

What else can affect depression?

“Physical illness, especially chronic (long-term) illness, can aggravate depression,” says Dr. Schneider. In 2009, Robin Williams had a heart surgery, although it is unknown how this affected his struggle with depression.

Alcohol and drugs, as Schneider says, can also affect depression. But he adds: “I think that it is necessary to declare very carefully about a person who was addicted to alcohol or drugs in the past, that this supposedly alcohol and cocaine brought him to this.”

Robin Williams was frank, talking about his rehabilitation and efforts in the fight against alcohol and drugs. It is reported that he undertook at least two trips to rehabilitation centers, the last of which was at the beginning of this summer.

“Depression can be part of bipolar disorder,” says Schneider. Bipolar disorder is characterized by wide changes in mood, energy, and level of activity. People with this diagnosis tend to have far more depressive episodes than manic ones. But it was not reliably known whether Williams suffered from bipolar disorder.

“People often do not take medicine correctly. Patients say they do not want to experience side effects of the drug. People also do not want this fact to be marked as mentally ill, ”says Dr. Krakover.

“Even if they started taking medicines, then as soon as they feel better, they think that they no longer need their drugs. Since they stopped taking them, they are even worse off if the depression strikes again, ”he says.

“The risk of suicide may increase when people stop taking antidepressants, contrary to FDA recommendations. Some patients who stop drinking their antidepressants may experience repeated suicidal thoughts, ”says Dr. Schneider.

Why is depression deadly for some people?

The pain and severity of a mental illness, which is often incomprehensible to mentally healthy people, can be simply unbearable. Many patients experience feelings of hopelessness and emptiness, because others cannot understand them.

“Severe depression can be just deadly. Some decide to commit suicide to stop the daily pain. Even with proper treatment in some patients, these feelings remain, depression can become resistant (resistant) to drugs. But for those with depression as part of bipolar disorder, a quick switch from happiness to sadness significantly increases the risk of suicide, ”Krakover says.

What can relatives of the patient do to prevent depression from becoming fatal?

According to Dr. Schneider, even for professionals it is very difficult to predict which of his patients intends to commit suicide. But there are several warning signals that can speak of such intentions of the patient.

One of the most dangerous signals is the talk of death or suicide!

Other dangerous signs of experts from the American Foundation for the Prevention of Suicides include:

1. Talk about hopelessness, helplessness, aimlessness
2. Feeling of being trapped, despairing and anxious
3. Constant sadness and low mood
4. Increased aggressiveness and irritability
5. Loss of interest to loved ones and to life
6. Incomprehensible farewell to familiar people.
7. Having trouble sleeping

But identifying a person who intends to commit suicide is still the middle of a battle. It is very difficult to say exactly when he will attempt, and even harder to stop him.

“Not all suicide attempts are carefully planned or hatched. Attempts can be impulsive. Something goes wrong, and a person in a fit of emotion hurts himself, ”Krakover says.

What is the best to do in this situation? First, you need to insist that a person receive qualified help from a psychiatrist.

Other steps may include:

1. Call the police or ambulance.
2. Never let a person be alone
3. Remove all weapons, medicines and other things that can harm yourself.
4. If possible, take the patient to the nearest clinic with precautions.


Suicidal ideation is a term that has a simple definition: “thoughts about suicide,” however, besides the actual thoughts, there are also other signs and symptoms of a person’s concern for this topic. Some of these symptoms are comorbid conditions, such as involuntary weight loss, a sense of hopelessness, unusually heavy fatigue, low self-esteem, excessive talkativeness, a desire for goals that were previously unimportant to a person, a feeling that the mind went out of business. The appearance of these or similar symptoms in combination with the inability to get rid of them or cope with them and their consequences, as well as possible psychological inflexibility is one of the signs that may indicate the appearance of suicidal thoughts. Suicidal thoughts can lead to psychological stress, repetitive patterns of behavior, but the opposite is also possible - psychological stress can lead to the appearance of suicidal thoughts. Among other possible indications of suicidal thoughts are the following:

  • sense of hopelessness
  • anhedonia,
  • insomnia or hypersomnia,
  • loss of appetite or polyphagia,
  • depressed
  • severe anxiety disorders
  • impaired concentration
  • agitation (strong emotional arousal),
  • panic attacks,
  • heavy and deep guilt feelings.

Scales edit |Diabetes mellitus and depression: risks of developing the disease and treatment

For many years, unsuccessfully struggling with diabetes?

The head of the Institute: “You will be amazed how easy it is to cure diabetes by taking it every day.

Today is a scientifically proven relationship that has diabetes and depression. During depression increases the likelihood of carbohydrate metabolism, and vice versa - diabetes in many patients provokes a decrease in mood.

This combination was first mentioned in 1684, when researcher Willis described the exact relationship between carbohydrate metabolism disorders and nervous disorders. It was only in 1988 that a hypothesis was advanced that a depressive state may contribute to a decrease in the sensitivity of cells to insulin.

Disappointing statistics indicate that among patients with a diagnosis of "diabetes mellitus" there are 26% suffering from depression. In addition, the depressive state provokes the occurrence of various cardiovascular diseases.

Therefore, in our time it is very important to cope with this problem, it is not for nothing that people say that all diseases arise because of nerves.

Signs of Depression

The depressed state of the patient occurs for many reasons - emotional, genetic or environmental. Magnetic resonance imaging (MRI) shows that in patients with depression, the image of the brain looks quite different than in healthy people.

Patients with the second type of diabetes are most susceptible to mental disorders. If you do not take any action, it can lead to disastrous consequences. But depression and diabetes are treated by eliminating at least one pathology, the second also lends itself to successful therapy. The following are typical symptoms that occur during depression:

  • decrease in interest in work or hobby,
  • sadness, irritability, anxiety,
  • bad sleep
  • reticence, unwillingness to communicate with people
  • loss or lack of appetite
  • reduced attentiveness
  • constant exhaustion,
  • physical and mental slowness,
  • bad thoughts, such as death, suicide, etc.

If a diabetic patient has noticed one of the above symptoms, he should immediately see a doctor for further diagnosis. There are no special studies to determine depression, the diagnosis is made by telling the patient about suspicious symptoms and the way of life. However, persistent exhaustion can be observed not only because of the depressive state.

Since the source of energy - glucose does not enter the body’s cells in the right quantity, they “starve”, so the patient feels constantly tired.

Relationship between diabetes and depression

Often, depression in diabetes is the same as in absolutely healthy people. In our time, the exact effect of the “sweet affliction” on the manifestation of a mental disorder has not been investigated. But many suggestions suggest that:

  • The complexity of diabetes therapy can lead to a depressive state. To maintain a normal blood sugar level, it is necessary to make a lot of effort: to control glucose levels, to adhere to proper nutrition, to play sports, to observe insulin therapy, or to take medicines. All these moments take a lot of time for the patient, so they can cause a depressive state.
  • Diabetes mellitus leads to the appearance of pathologies and complications that can contribute to the development of a depressive state.
  • In turn, depression often causes an indifferent attitude toward oneself. As a result, the patient treats his health incorrectly: he does not follow the diet, neglects physical exertion, smokes or takes alcohol.
  • Depression negatively affects concentration of attention and clear thinking. Therefore, it may be a factor in unsuccessful treatment and control of diabetes.

To overcome a mental disorder in a diabetic, the doctor develops a treatment regimen that includes three steps.

Fighting diabetes. To do this, you need to pull yourself together and follow all the rules to keep the glucose level at a normal level.

Consultation with a psychologist and a course of psychotherapy. If possible, you should talk with a specialist about your problems and follow all his recommendations.

The drugs are strictly prescribed by the attending physician, self-medication can not be engaged, because each tool has certain side effects.

Cognitive-behavioral psychotherapy

The psychotherapist may apply various methods to overcome depression, but cognitive-behavioral psychotherapy is considered the most popular. Since during the depression the patient notices only all that is bad, he develops certain forms of thinking:

  1. "All or nothing." This type of thinking contains only specific concepts, such as winning or losing. Also, the patient often uses words such as "never" and "always", "nothing" and "completely." For example, if a patient has eaten any sweetness, he will think that he has spoiled everything, his sugar level will rise, and he will not be able to control diabetes.
  2. Guilt or excessive demands on yourself. The patient sets the standards too high, for example, that his glucose level will be no more than 7.8 mmol / l. When getting results that exceed his expectations, he will blame himself on this.
  3. Waiting for something bad. A patient suffering from depression cannot look at life optimistically, so he expects only the worst. For example, a patient who is going to see a doctor will think that the content of glycated hemoglobin has increased, and his vision will soon deteriorate.

The specialist tries to open the patient's eyes to their problems, and to perceive them in a more effective way. You can also try to get rid of negative thoughts.

To do this, it is recommended to notice your small “victories”, praise yourself for them and tune in to positive thoughts.

Antidepressants for diabetes

To successfully combat depression, a specialist prescribes tricyclic antidepressants. They are drugs that affect the increase in the brain levels of serotonin and norepinephrine, contributing to a better interaction of nerve cells with each other.

When these chemicals are disrupted, mental disorders occur, antidepressants help restore balance.

Famous drugs of this type are:

Antidepressants are another type. Their full name is selective serotonin reuptake inhibitors (SSRIs). These drugs have much fewer side effects than drugs of the first group. These include:

Another type of antidepressant is selective serotonin and noradrenaline reuptake inhibitors (SSRI). From the name it becomes clear that such drugs interfere with the reabsorption of substances dissolved in water. Patients generally take these antidepressants:

You should know that self-administration of these drugs can cause some adverse reactions.Tricyclic antidepressants can trigger symptoms such as blurred vision in diabetes, dizziness and headaches, digestive disorders, poor sleep, irritability, erectile dysfunction, tremor, and an increase in heart rate.

Patients who have taken SSRIs may complain of nightmares, nausea, diarrhea, headaches, dizziness, agitation, disturbances in sexual life.

The group of SSRIs can cause symptoms such as nausea, constipation, fatigue, dizziness, increased blood pressure, excessive sweating, and erectile dysfunction.

To avoid adverse reactions, the doctor at the beginning of therapy prescribes small dosages and increases them over time. Before taking the drug, you need to carefully read the instructions, since the incorrect use of funds from the patient can also cause unwanted reactions.

Recommendations for fighting depression

In addition to taking antidepressants and getting therapy from a psychotherapist, you must follow a few simple rules that can also improve the physical and mental state of the patient:

Alternate physical activity and rest. Defective sleep reduces the body's defenses, makes a person irritable and inattentive. Therefore, diabetics need to sleep at least 8 hours a day.

In addition, without exercise, the patient may have trouble sleeping. It must be remembered that healthy sleep and moderate exercise are the best antidepressants in the world.

  1. Do not isolate yourself from the outside world. Even if there is no desire to communicate with people or do something, you need to overcome yourself. For example, do what you always wanted to learn (draw, dance, etc.), plan your day, visit some interesting event, or at least visit a friend or relative.
  2. Remember that diabetes is not a sentence. To do this, you need to realistically assess your health and understand that you can not completely overcome the disease. But at the same time many people live with this diagnosis, as well as healthy ones.
  3. Make a specific plan for your treatment. For example, the patient wants to lose weight. One desire is not enough for this, action is needed. It is necessary to think about how many times a week he wants to play sports, what exercises he will perform, etc.
  4. Do not keep everything to yourself. You can share your problems with your family or loved ones. They are like no one will understand the patient. They can also be introduced to the rules of insulin therapy or the use of a blood glucose meter. Thus, the patient will feel that he is not alone and can always ask for help, which he will necessarily have.

And so, a patient with diabetes mellitus of the second type should closely monitor their health, in particular their state of mind. If you find signal signs that may indicate the development of depression, you need to consult a doctor.

The prognosis for treatment of these two pathologies is in many cases positive. With the timely cooperation of the patient, the attending physician and the therapist, you can achieve really good results. Well, the support of loved ones, families and internal awareness of the problem will also contribute to a quick exit from the depressive state.

About the relationship of depression and diabetes described in the video in this article.

Watch the video: Are you having suicidal thoughts? (February 2020).