Depression type and depression severity in relation to risk of violent suicide attempt

Low levels of cerebrospinal fluid 5-hydroxyindoleacetic acid and a blunted thyroid-stimulating hormone response to thyrotropin-releasing hormone have been reported in depressed patients--in particular in those who have made violent suicide attempts. There are at least two conceivable explanations for these findings: The biological abnormalities relate to (1) disturbed aggression regulation or to (2) disturbed mood regulation (either type or severity). The second alternative presupposes that violent suicide attempts occur differentially in a particular depression type or differentially in severe depression. This study demonstrated that violent suicide attempts are "depression-specific," i.e., they relate to a particular depressive syndrome, that of vital depression, but not to the severity factor. Therefore, it is impossible to decide whether the biological abnormalities in depressed, violent suicide attempters relate to a particular type of mood disorder or to a distorted regulation of aggression.