Depression is often chronic, with episodes of recurrence and improvement. About a third of patients with a single episode of major depression will have another episode within 1 year after discontinuing treatment, and more than half will have a recurrence at some point in their lives. Depression is more likely to recur if the first episode was severe or prolonged, or if there have been prior recurrences. To date, even newer antidepressants have failed to achieve permanent remission in many patients with major depression, although the standard medications are very effective in treating and preventing acute episodes.
Risk for Suicide
Suicidal preoccupation or threats of suicide should always be treated seriously. Depression is the cause of up to two-thirds of all suicides. Suicide attempts are a major risk factor for a later suicide. Suicide is the third most common cause of death among adolescents, and is one of the most devastating events than can happen to a family. Behavioral therapies, combined with antidepressants, may help prevent suicide. However, antidepressants can also raise the risk for suicidality (suicidal thoughts and behavior) in some young people, particularly those ages 18 - 24. [See “Suicidal Risk and Antidepressant Medications” in Drug Treatment Guidelines section in this report.]
Children, adolescents, and young adults who are prescribed antidepressant medication should be carefully monitored by both their parents and doctor, especially during the first few months of treatment, for any worsening of depression symptoms or changes in behavior.
The following are danger signs in young people:
- Withdrawal from friends
- Sudden decrease in school performance
- Loss of interest in activities that were previously pleasurable
- Unusual irritability
- Unusual changes in sleep or eating habits
Risk factors for suicide include a history of neglect or abuse, history of deliberate self-harm, a family member who committed suicide, access to firearms, and living in communities where there have been recent outbreaks of suicide among young people. A romantic break-up is often the trigger for a suicidal attempt in teenagers. Feeling connected with parents and family can help protect young people with depression from suicide.
Review Date: 01/27/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.