[Depression and suicide]

Although the phrase "no suicide without depression" may not be quite correct in this extreme wording, it must be stressed that the connection between depression and suicide is close and that the contribution of depression towards suicide is very large. The task of the examining physician is twofold. In the first place he has to judge from the phenomenological-psychopathological point of view to which extent the patient shows signs of the so-called "pre-suicidal syndrome", consisting of multi-dimensional narrowing in, inhibited and self-directed aggression, and increasing suicidal fantasies. Secondly, he has to investigate the pattern of the existing depression. Endogenous depression, senile depression and neurotic depression have to be taken into consideration and the extent of the risk of suicide depends, not least, on the type of depression. As to therapy, neurotic depression requires psychotherapy, senile depression calls for socio-therapeutic measures and endogenous depression necessitates the administration of antidepressives. In all cases, however, the foundation for successful therapy rests on the achievement of a harmonious and genuine doctor-patient relationship.