chapter  5
22 Pages

Befriending the Black Dog: Solutions for Depression

In the midst of winter I finally learned that within me there lay an invincible summer. (Camus, 1955/1983, p. 202) Most of the work that is done every day in this country is done by people who don’t feel very well. (attributed to Henry Ford)

Down and out. High and low. Depression and suicide. Some words just seem to go together. In both the research literature

and the public mind, death by suicide is linked to depression. Suicidal thinking is in fact one of the defining clinical symptoms of depression (American Psychiatric Association, 1994; World Health Organization, 1993). The lifetime suicide risk associated with major depression is at least 15 percent (Angst, Angst, Gerber-Werder & Gamma, 2005; Lönnqvist, 2000) and probably higher (Clark & GoebelFabbri, 1999), and this risk increases exponentially when depression is accompanied-as it often is-by other diagnoses, especially substance abuse disorder (Keeley, Corcoran, & Bille-Brahe, 2004; Murphy, 2000). Nonfatal suicidal behavior is also strongly linked to depression (Kerkhof, 2000; Lönnqvist, 2000). Many suicidologists view identification and treatment of depression as the most powerful secondary prevention strategy available (e.g., Goldney, 2005; Jenkins & Singh, 2000), and some point to suggestive correlations between increased rates of antidepressant medication and decreased rates of suicide (Gibbons, Hur, Bhaumik, & Mann, 2005; Isaacson, 2000; Olfson et al., 1998; Olfson, Shaffer, Marcus, & Greenberg, 2003). However, the explanations for rate changes are unclear, and conclusions based on these findings are probably premature (Beautrais,

2006; Bertolote, Fleischmann, DeLeo, & Wasserman, 2004; Bostwick, 2006). Among other things, there is the niggling question of whether differences in toxicity between newer and older antidepressants, rather than fewer overdose attempts, may account for part of the observed change.