Anxiety, Depression, and Suicidal Thoughts and Behaviors

Anxiety is the anticipation of a future real or perceived threat and is often associated with “muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors.”

Symptoms may include excessive anxiety, palpitations, restlessness, fatigue, trembling, choking sensations, sweating, chest pain, nausea, dizziness, paresthesia (numbness or tingling sensations), difficulty concentrating, irritability, and disturbed sleep.

Unlike normal feelings of fear or anxiety, anxiety disorders are excessive or persistent. Generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder (social phobia), selective mutism, substance/medication-induced anxiety disorder, and separation anxiety disorder are examples of anxiety disorders.

Many anxiety disorders develop in childhood and tend to persist if not treated. Depression or depressive disorder, with the classic condition being major depressive disorder, is a mood disorder characterized by a “sad, empty or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function.”

A major depressive episode differs from normal sadness and grief, including bereavement. Major depressive disorder symptoms can vary from mild to moderate to severe and can include the following:

• Depressed mood (e.g., feeling sad, empty, or hopeless) most of the day, nearly every day
• Markedly diminished interest or pleasure in activities once enjoyed (anhedonia)
• Changes in appetite; significant weight loss or gain unrelated to dieting
• Trouble sleeping (insomnia) or sleeping too much (hypersomnia)
• Loss of energy or increased fatigue nearly every day
• Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
• Feeling worthless or guilty nearly every day
• Difficulty thinking, concentrating or making decisions almost every day
• Recurrent thoughts of death, recurrent suicidal ideation, or suicide attempt Suicide is caused by an intentional self-directed harmful act carried out to push one’s death. Common warning signs of suicidal behavior include:
  • Talking about wanting to die, tremendous guilt or shame, and being a burden to others.
  • Feeling empty, hopeless, trapped, or having no reason to live, unfortunate, more anxious, agitated, full of rage, and unbearable emotional or physical pain.
  • Behaviors include planning or researching ways to die, withdrawing from friends, saying goodbye, giving away essential possessions or making a will, taking dangerous risks like driving extremely fast, displaying extreme mood swings, eating or sleeping more or less, and increasing drug or alcohol use.

A suicide attempt is a non-fatal, self-directed, and potentially harmful behavior with the intent to die. Suicidal ideation refers to thinking about or planning suicide. The thoughts lie on a continuum of severity from a wish to die with no method, plan, intent, or behavior, to active suicidal ideation with intent and a specific goal. Self-harm, also known as self-directed violence, is deliberately self-directed behavior that results in injury or the potential for injury. The term encompasses suicidal and non-suicidal self-injury (NSSI) and self-harm with unclear intent.