Prognosis of Depressive Disorder

Ideas of suicide in the context of a depressive disorder must be considered as one more symptom of the illness. There is a tendency by medical and non-medical staff to recriminate the person for having these ideas, calling them “coward”, or constantly reminding them that there are “many interesting things in life”, that “life is not that bad” and that “many people will suffer due to your decision”. These critical comments are usually detrimental for the patient.

The person affected by a depressive disorder is usually aware that, objectively speaking, it is not “logical” to want to die, but does not know how to stop that thought, and this inconsistency between objectivity and their thoughts frightens them. For this reason, it would be good idea to be very aware that these types of critical comments must be avoided.

The most appropriate attitude with presence of the ideas of death symptom is usually to communicate to the patient that we understand that, under the pathological state of pessimism common to their illness, they may have or can have these ideas of suicide. In parallel, it obviously has to be remembered that these ideas are provoked by the illness and that, for this reason, specialist help must be sought urgently. That is to say, an attempt must be made so that they don’t feel guiltier. This will help the patients to feel closer to the people around them and, at the same time, more understanding. This increase in confidence helps them to communicate their ideas more clearly and that may be able to confront them with more diligence.

The widely spread idea also has to be rejected is that, those that communicate their wishes to die, do not commit suicide. Independently of whether the warning is a request for help (or, as used to be said, in such a pejorative way, “a call for attention”) or whether it is a real desire to die, probably the best clinical approach may be to consider that everyone that thinks in one way or another in the possibility of dying or self-harm, is experiencing a very high level of suffering. To alleviate this suffering the most appropriate attitude is usually to approach the topic from a medical point of view, without making personal assessments of whether or not it is correct to think of the possibility of committing suicide.

Furthermore, it is worth remembering that, in a large number of countries there are emergency medical services and even telephone helplines, like the “Esperanza” [hope] telephone line, which can be particularly useful in these extreme situations.