Critical appraisal of major depression with suicidal ideation
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Annals of General Psychiatry Open Access
CASE REPORT
Critical appraisal of major depression with suicidal ideation Maurizio Pompili*
Abstract Background: Regardless of its nature, suicidal ideation, in the absence of another diagnosis, is quintessentially associated with major clinical depression. Although for the characteristics of being depressed it is reasonable to have some wish to die, there is no real attempt to understanding the suicidal mind. Clinicians are therefore often inclined to consider suicidal ideation a symptom of major depression. Yet, most depressed patients do not die by suicide, and many of them never experience suicidal ideation even in the most severe depressing scenario. At a closer look, when one works with suicidal individual, suicide appears complex and not line with the obsolete medical model. There are often warning signs for suicide, and suicidal individuals experience mental pain as a common denominator of many adverse events. Case presentation: A case report of an entrepreneur with no previous psychiatric history describes the process of meditating suicide as a dimension overlapping the depressive disorder. Details of how this 63-year-old male developed high suicide risk are reported, and clinicians are guided into the understanding of suicide risk. Conclusions: Nowadays, clinicians are requested to provide an in-depth investigation into the suicidal mind, an assessment adjunctive to the psychiatric evaluation. A phenomenological approach may be the key to unlock the suicidal mind. Clinicians may use such tool in light of the need for the empathic understanding of human suffering as well as a paradigm shift in the care of suicidal individuals. Background Notwithstanding the strong association between suicidal ideation and depression, it is time to re-consider both major depression and suicide risk. For both scholars and laypeople, depression does result in the wish to die, and clinicians are often inclined to include suicidal ideation as well as a suicidal crisis into the clinical manifestations of major depression. This assumption is reasonable for any patient. An individual who is depressed, with insomnia, anhedonia, and facing dysphoria and overall hopelessness about the future could easily conclude that life is not worth living, especially if a rapid reduction of such misery is not readily available or not possible. Moreover, lack of joy and pleasure, impaired ability to concentrate and unpleasant future expectations, as well as feeling of *Correspondence: [email protected] Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
worthlessness and guilt, are all symptoms that can result in the wish to die. As Esquirol [1] noted, “Suicide presents all the characteristics of insanity of which it is but a symptom.” Only a minority of depressed patients die by suicide, and a large percentage of severely depressed patients never think about suicide [2]. Although some rese
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