Suicide and Depression: Two Linked Awareness Months

“Thirty days has September, all the rest have 31,” including, of course October.

Besides the memorable grade school rhyme, September is also Suicide Prevention Month while October is National Depression Education and Awareness Month.

The order of those months has been called into question by Dr. H. Steven Moffic, an internationally prominent psychiatrist and award-winning author. Moffic, a regular panelist on the long-running Talk Ten Tuesday, offered some academic advice for those who are responsible for naming awareness months for diseases.

“We are approaching a transition from summer to fall from suicide to depression in terms of education and awareness,” Moffic told audience members. “Actually, when you think about cause and effect, [the] depression month should come before suicide month because untreated depression is the leading cause of suicide. Well, not really always, for a suicide often causes prolonged grief and depression in the loved ones left behind.”

In the interest of full disclosure, I’ve been told that I suffer from prolonged grief disorder. Fortunately, I’m under the care of a therapist.

Moffic reminded the listening audience that suicides are a result of untreated depression with associated loneliness, anxiety, and hopelessness. This would even include medical-assisted deaths by suicide in the locations where that is allowed.

“The good news is that suicide is really rare, and preventable,” Moffic said. “Since the actual intent and action to die is often impulsive, it can be interrupted by the concern of others. That especially includes primary care physicians because often the patient who suicides has seen their doctor not long before the action.”

Moffic continued with this advice, noting that everybody should be aware (of possible suicide attempts) because the person often keeps their suicidal thoughts to themselves. Moffic said to be “especially concerned” when these events occur:

1. Someone worsens after an antidepressant is started, since that may be from the side effect of restlessness.
2. If a depressed person suddenly looks much better for no apparent reason as they might feel relieved by their suicide decision.
3. Command auditory hallucinations may be telling the patient to not trust others.

With respect to depression, Moffic said at least 10 percent of the population at any given time is clinically depressed. In its classic presentation, it’s easy to recognize—worsening sadness, worsening functioning, poor sleep, and decreased appetite over days to weeks.

However, Moffic noted, other presentations make it more difficult as influenced by age, culture, and gender, for instance:

1. Children and adolescents often act out with anger when depressed.
2. Those of Hispanic and Asian cultural background tend to have somatic symptoms like aches, tiredness, and headaches, for which there is no other explanation.
3. In the elderly, memory gets more impaired.
4. Postpartum, psychotic symptoms are often also present.
5. Seasonal affective disorder, or the winter blues, is best treated by certain kinds of light.

“As is now the case with anxiety, primary care physicians should be screening for depression, say with the PHQ-9 Questionnaire, Moffic advised. “As far as treatment goes, the standards are Cognitive Behavioral Psychotherapy and the variety of antidepressants. However, for those who don’t improve, transmagnetic stimulation as well as life-saving electroconvulsive treatment may be necessary.”

Moffic referenced the recent news that President Biden is relaunching the Cancer Moonshot started in 2016.

“I would say that we also need a mental health one because anxiety, depression, trauma, substance abuse and suicide have all been increasing,” Moffic said. “After the old, still popular song titled ‘Blue Moon,’ I’d recommend a Mental Health Blues Moonshot to speed the understanding and treatment of the inner space of our brains.”