Depression can be a very debilitating and devastating illness. Nonetheless, most people, through medical treatment, counseling, and/or emotional support from family and friends can overcome it. The questions remains - what about the people who do not successfully overcome this illness? What happens to them? The most obvious answer is that they end up committing suicide (although there are some people who end up living with the illness for the rest of their lives). I had always wondered what is it that makes one person strong enough, or selfish enough-as some people believe, to commit suicide? Is it something in their brain chemistry, their personality, their surrounding environment, their diet etc? Here are a few facts about depression: 1. "Suicide is the eighth leading cause of death in the United States and is among the three leading causes of death for those aged 15 to 34 years. For every person in the U.S. who dies by suicide, 10 people attempt suicide but survive." (1) 2. 80% of people who suffer from depression never attempt suicide (2) 3. There are 1 million suicides per year worldwide. (5) Depression can be caused by a number of things, such as diet, genetic makeup, or a traumatic event. However it is believed that the final step before depression occurs takes place in the brain. Serotonin, dopamine, and/or neuroepinephrine levels are disrupted, leading to depression.(6) There are several theories on why only a fraction of depressed people commit suicide. There is evidence today to suggest that the pre-frontal cortex of suicide victims, where all the executive decisions are made, is malfunctioning; specifically, the serotonin breaking system. (2) Another part of the brain which is thought to be different in suicide victims is the brain stem. Mark Underwood, a neurobiologist at the New York State Psychiatric Institute, has found 30 percent more serotonin neurons in this area, along with a lower serotonin activity. These neurons seem to be smaller and malfunctioning. (2) Because serotonin victims seem to have more serotonin neurons, it is believed that they inherit this problem (given that you are born with an exact number of neurons). However, environmental factors should also be taken into consideration. For example, people who have experienced abuse during their childhood are prone to greater impulsivity. (5) Currently Selective Serotonin Reuptake Inhibitors (SSRI) increase serotonin levels and are known to alleviate severe depression and with it, the probability of suicide. Cognitive therapy has also proven to reduce the probability of suicide, without treating the depression. So the person is still depressed but they are less likely to commit suicide. However, if that is the case, then that doesn't explain how the suicidal individual overcomes the low serotonin activity level and the small, malfunctioning serotonin receptors. Cognitive therapy does not change the chemistry of the brain. Therefore, it may be the case that serotonin activity may only cause depression and not be related to probability of a depressed person committing suicide. To complicate the situation, there are two types of suicides: suicide thinking of a normal person and suicide thinking of a depressed person. Depressed suicides are likely to happen suddenly, whereas "normal" (there is nothing normal about suicides but the term is used to describe people who do not suffer from depression) suicides are more planned. Also, depressed suicides are more likely to try and cut themselves first in order to escape the mental pain. (7) If that does not work, they are likely to attempt suicide. There are still several statements which do not make sense to me. One such statement is: "Serotonin, which influences how nerves in the brain transmit messages, seems to work abnormally in the frontal lobes of people who commit suicide. In other words, it doesn't trigger the normal restraint against extreme actions like suicide." (5) If that is the case, why is it that these people do not kill other people, or rob stores, or rape, or poison the NYC water system? If they can't control extreme actions, why is it that the only extreme action which they take is suicide? Once again, serotonin levels only seem to cause depression but may not be directly responsible for the increased probability of suicide. Another statement which disturbed me was this description of depression: "Depression is a disorder of the brain and body's ability to biologically create and balance a normal range of thoughts, emotions, & energy." (4) First, how do we know what "normal" means. Who defines normal? Second, thoughts and emotions are not just created by the brain. There has to be some kind of outside input in order for a thought or emotion to be created. Maybe someone pissed you off. Or maybe you had an experience which really left a mark on you. So I believe that it is a lot more complex that just "the brain creates thoughts/emotions". The creation on energy is obviously even more ridiculous. The creation of energy depends on nutrition, sleep, stress level etc. So a definition like the one above is nothing short of complete ignorance on the part of the person who wrote it. The worst part is that it comes from a site where FAQ about depression are posted. I can only be outraged that this person(s) want(s) to share and spread their ignorance to other people who are in desperate need to answers. Although I have not found an answer to my original question, I do finally understand why it is that the topic of depression and suicide is taboo. It is clear from the sites I have visited that suicide is thought of as a brain disease. It is an action which is done on impulse and it implies that the person does not have control over their actions. This obsession with control (which we have partly covered in class) is extremely inappropriate in this case. Depression is a lot more complex and it is affected by biological, environmental, and genetic factors. A person's ability to control their depression/suicide tendencies may not even exist. We do not know enough about this illness to make it taboo. 1) by - Kevin Malone, M.D. and J. John Mann, M.D. 2)3)4)5)6)7)

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