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On internship, I remember one of my favorite supervisors saying to me, “I just want you to remember that when you are in private practice, that the standard of care for depression includes having the patients on an SSRI medication.  It could open you to liability if a patient kills themselves.”  I responded to him by saying that the research seems to indicate that by taking antidepressant medication, you may increase your risk of suicide, so you may be opening yourself up to liability by having the patient start an antidepressant medication.  He seemed to understand my position, but noted that it is the general “standard of care.” 

Over at PsychCentral, John Grohol, PsyD, presents new evidence that the pharmaceutical industry conducted questionnable statistical analyses that minimized the affect of Paxil in increasing suicide.  I’m not saying Paxil directly causes suicide, because that is an individual decision.  But it may increase other factors, such as agitation, which may increase the risk.  I’m saying that psychologists and therapists who are comfortable in treating depression need not fear “increased risk of liability” for treating patients who are depressed without referring them for medication.  It is a good idea to refer them to rule out physiological bases for their depression (such as hypothyroidism), but frankly there is no evidence at all that you would be increasing their suicide risk if they did not take medication for depression.  Quite the opposite in my opinion. 

Suicide is one of the most terrible and horribly damaging things that a person can do to friends and family.  Many family members live with guilt, regret, and sadness for the rest of their lives.  By comitting suicide you increase the risk that someone else in your family will do the same.  You may be depressed and feel there are no other options.  But there are always other options.  I have seen patients who thought they had no other options completely turn their lives around and later think that they could never concieve of thinking about suicide again.  If you consider suicide, get some help and know that you will not always feel the same way you do now.  Emotions are temporary, and don’t last forever.  Even though depression may last for a significant period of time, it will end.  And with help it can end sooner.