Today we woke to the sad news of the suicide of chef and TV personality Anthony Bourdain whose love of food and acerbic commentary delighted millions.  Bourdain's passing follows on the heels of another celebrity suicide, that of noted fashion designer Kate Spade who took her own life earlier in the week.  Although the suicides of two well-known individuals in the same week may be coincidence, the publication a few days ago of a new CDC report warning about the increase in the number of suicides in America over the last two decades confirms that we are in the midst of a suicide epidemic.

In August of last year, the CDC reported a startling 65% increase in prescription antidepressants in the U.S. during the last 15 years.  Despite the fact that one-in-eight Americans over the age of 12 is now medicated for depression, in half of the states suicides have increased by 30% since 1999.  This raises the obvious question of why the current standard-of-care for unipolar depression is so clearly failing to prevent more individuals from taking their own lives.

Of course, the issue involves a complex web of factors, and it would be unfair and unrealistic to lay all of the blame a the feet of American psychiatry.  According to the CDC findings, 46% of suicides have never received a diagnosis of clinical depression, suggesting that treatment failures only account for about half of suicides.  We can assume that, of the remaining half who are not being treated, some receive regular medical care while others do not.  We can also safely state that some of the individuals who make up the untreated half present with obvious symptoms of clinical depression but remain undiagnosed, while others end up taking their own lives without ever having manifested any signs or symptoms of depression. 

Accordingly, in order to stem the rising tide of American suicides, healthcare professionals need to take steps to ensure that patients who present with the symptoms of clinical depression do not slip through the cracks.  It is also necessary to reach out to Americans who may not regularly see a healthcare professional but need help managing their unipolar depression.  Not only should our public healthcare measures target potential patients, it is also imperative to inform a broader group who might be able to identify a potentially lethal depression in their friends and family members.  In other words, it is high time to raise national awareness regarding suicide.

Finally, we return to the elephant in the room:  why do 54% of suicides occur despite medical treatment?  We must recognize that there currently exists no comprehensive biological model of mood in modern psychiatry, so behavioral healthcare professionals do their best through therapy and the manipulation of certain components of brain chemistry to battle this dangerous disease.  At some point, however, as more and more Americans reach the apex of clinical depression that tragically culminates in self-inflicted death, we need to admit that our current model of care is inadequate and rethink our approach to helping those crippled by this increasingly common mental ailment.  Barring a thorough reassessment of the extant standard-of-care and a fresh, innovative approach to the treatment of depression, it is likely that suicide will continue to rise in rank among the leading causes of death in America.