In overly simplistic terms, suicidal thoughts and behaviors start when vulnerable individuals encounter stressful events, become overwhelmed, and conclude that suicide is the only reasonable way (given their very likely biased way of thinking) to stop the pain they are experiencing. Determining what makes events stressful is difficult because of the highly individual nature of human coping abilities and perspectives. What may seem relatively trivial to one person may seem devastating or insurmountable to another.
Both negative and positive events can be sources of significant stress. Examples of events that cause positive stress include marriage, moving (when it is a desired move), having a child, and changing jobs (when that is desired). Examples of negatively stressful events include losses related to health, significant relationships and jobs, debts, peer pressure to be thin and beautiful, and similar difficult situations. Some suicidal individuals never quite developed the skills necessary to successfully cope with stressful situations and have personalities that are vulnerable to becoming overwhelmed by negative circumstance. Other suicidal individuals may have reasonable coping skills in place at one point, but find themselves worn down by circumstance to the point where they can no longer manage.
The most frequent stressful event leading up to suicide (what is often called a precipitating event) in the US today is mental illness, which is estimated to account for about 90 percent of all suicides. As we discussed earlier, a newly diagnosed and/or poorly treated mental illness can trigger a suicide in some cases. In addition, a change in someone's existing mental illness (for the worse or better) can function as a precipitating event for suicide. Most people incorrectly assume that only deteriorating conditions should be monitored. However, as was previously discussed, people who have been severely depressed and are now starting to regain their energy may suddenly find themselves with enough energy to carry out suicide plans.
Depression is the most common mental illness in people who commit suicide, so we will briefly detour from the topic of suicide to discuss this common disorder, which is discussed in significant detail in our Depression topic center. According to the DSM-IV-TR (the latest version of the manual used by clinicians to diagnose mental disorders) you must meet the following criteria in order to qualify for a diagnosis of Major Depression:
At least five of the following symptoms are present during the same period. At least (1) depressed mood or (2) loss of interest or pleasure must be present. Symptoms are present most of the day, nearly daily for at least 2 weeks.
1. Depressed mood (sometimes irritability in children and adolescents) most of the day, nearly every day.
2. Markedly diminished interest or pleasure in almost all activities most of the day, nearly every day (as indicated by either subjective account or observation by others of apathy most of the time)
3. Significant weight loss/gain.
4. Insomnia/hypersomnia (Impaired sleeping or sleeping too much).
5. Psychomotor agitation/retardation (restlessness or reduced movement).
6. Fatigue (loss of energy).
7. Feelings of worthlessness (guilt).
8. Impaired concentration or indecisiveness.
9. Recurrent thoughts of death or suicide.
It's helpful to know the criteria that professionals use to diagnose depression, but it is not a good idea to attempt to diagnose yourself. One reason why this is true is that the consequences of getting the diagnosis wrong can be quite negative. Though depression is a serious condition that is associated with significant suicide risk and does thereby end up being a lethal disorder sometimes, it is also a very treatable disease which can be addressed by either medical or psychological means (or both). If you wrongly conclude that you are not depressed when you are, you might very well miss out on treatment opportunities that a diagnosing clinician could offer you.
Don't assume that you must feel sad and depressed in order to qualify for a diagnosis of major depression, as this is not the case. You may experience irritability during the required two week period of symptoms. Or, you may experience your depression as physical pain. If you even meet one of the symptoms listed above (particularly the suicide symptom), it would be a very reasonable idea to consult with a mental health professional. Of course, if you have several symptoms, you definitely should schedule an appointment.
In addition to major depression, depressive symptoms may also be caused by bipolar disorder, or may co-occur with another disorder. Bipolar disorder is typically characterized by alternations of mood and energy levels occurring over months, weeks or days. Symptoms may include periods of hyperactivity, fast speech, expansive sexuality, lack of need for sleep and feelings of inflated-well being; and corresponding periods of depression where some or all of the symptoms listed above are present. Extensive information concerning bipolar disorder can be found in our Bipolar Disorder topic center.