If a loved one is diagnosed with cancer, the journey toward recovery is always difficult, but the treatment path is often clear. We can, at the very least, take solace in the fact that some of the causes of the disease are known, and that medical research is advancing rapidly to develop new treatments and provide (some) hope to patients and their families.
Unfortunately, when it comes to recovery from mental illnesses like depression, we’re not yet out of the woods in terms of finding a clear path for treatment. What makes things even more difficult, as demonstrated by the tragic and shocking deaths earlier this year of two major popular culture icons, Anthony Bourdain and Kate Spade, is that when it comes to the causes of mental illness and strategies for suicide prevention, there are still far too many “parts unknown.”
More than 4,000 Canadians take their lives each year, but the scope of the problem remains shrouded by stigma and a lack of prevention strategies: Imagine a loaded 747 crashing each and every month with no survivors, no explanation as to why the crashes keep happening, and no assurance that this tragedy won’t happen again. This is the daunting reality we currently face when it comes to suicide in our country.
Furthermore, the prevalence of suicide varies widely across diverse communities. In particular, in some Indigenous communities, the problem of suicide is disproportionately acute: Recently, an Inuit community in northern Quebec lost 13 young people to suicide.
So what is being done?
Although suicidal thoughts and acts are not well understood, we do know that suicides are, in about 90 percent of cases, associated with depression.
According to the World Health Organization, depression ranks as the leading cause of disability worldwide. In Canada, almost one in four people will suffer from some form of mental illness in any given year. According to Statistics Canada’s 2012 Canadian Community Health Survey on Mental Health, 5.4 percent of the Canadian population aged 15 years and over reported symptoms that met the criteria for a mood disorder, including 4.7 percent for major depression.
We are learning now that there are many different types of depression, and that while suicide can result from depression, not everyone with suicidal behavior is depressed.
The exact causes of suicide and depression are complex and likely result from a combined influence of internal biological factors and external environmental influences and stressors—what might be a trigger for one person’s suicidal behavior might not affect another. The medical field is working hard to better understand the biological underpinnings of depression and suicide, and to develop predictive analytic techniques to try to identify people at risk so that they can seek help.
Currently, the treatments we have involve a lot of trial and error, and they don’t work for everybody. But the good news is they are steadily improving.
In the last few years, a new class of fast-acting antidepressants has made major inroads. Work led by Dr. Pierre Blier at the Royal’s Institute of Mental Health Research, affiliated with the University of Ottawa, for instance, is using ketamine to treat depression. This long-time anesthetic agent has been proven to rapidly—within minutes, in fact—reduce symptoms of depression and suicidal thoughts for some individuals.
More work is now needed to develop new ways to identify individuals at risk and to direct treatment strategies. Using brain imaging techniques, the field of psychiatry is starting to be able to distinguish different types of depression through visualizing the connections in the brain and the circuits they create. As we get better at identifying a person’s specific type of depression or vulnerability to suicide, we may be able to tailor targeted treatments to these circuits.
Preventing suicide should be a national imperative, beyond the patchwork of national and provincial frameworks. Indeed, Canada remains one of the few industrialized countries that still does not have a national suicide prevention strategy.
Despite this, the Canadian mental health community is engaged in the fight to combat depression and suicide on a daily basis. Working behind the scenes is a tireless network of professionals who dedicate their lives to suicide prevention through improving public awareness in our communities and in our schools; providing mental health first-aid trainings, crisis support, and support when tragedy does strike; and by constantly trying to evaluate and improve programs.
Sadly, it is when people fall through the cracks that suicide is noticed, while the lives saved by these ongoing efforts may never be counted.
If you or someone you know is depressed or experiencing suicidal thoughts, it is important to seek treatment, as an early intervention (be it through medication or therapy), can drastically improve outcomes and reduce suicide risk.
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Thank you very much for this thoughtful piece. I’m wondering if you can speak more about the social determinants of health in relation to depression and suicide? Although it certainly is the case that folks from all socioeconomic statuses (SES) are at risk of depression and suicide, those of lower SES are at higher risk than folks of higher SES (https://www.ncbi.nlm.nih.gov/pubmed/16420711 as just one random review paper notes). It strikes me that focusing primarily on the benefit of new antidepressants (which is fantastic) and immediate crises support is too narrowly focused on the downstream causes of suicide (i.e., depression). My criticism is that much more attention needs to be paid to the political and economic contexts in which suicides occurs (as, for example, the greater rates of suicide among Inuits in Quebec, as you well note).