Major Depressive Episodes & Suicide
Approximately 12% of the world's population has experienced a major depressive episode (Bains & Abdijadid, 2023), with studies showing higher rates of depressive symptoms among artists and art students (Vaag et al., 2021). However, engagement in art likely does not explain the higher incidence of depression, given the proven therapeutic effects of art. It is more likely that people with depressive symptoms seek out art as a reprieve from their symptoms.
A major depressive episode (MDE) is a period of at least two weeks, characterized by persistent low mood, and/or a lack of interest/pleasure in activities one typically enjoys. Symptoms can include sadness, low sense of self-worth, and either too much or too little sleep, among others (DSM-V).
Suicide is intentional behavior aimed at causing one's own death. Suicide and depression often go hand in hand. People who struggle with depression may attempt suicide because they see death as the only possible escape from their struggle.
MDE Diagnostic Criteria (APA, 2013)
A person must meet at least five of the following criteria, and at least one criterion must be either 1 or 2.
1. Depressed mood: self-reported or observed by others. In children and adolescents this may present as irritable mood.
​2. Loss of interest in or pleasure in almost all activities: self-reported or observed by others.
3. Significant unintentional change in weight (> 5% monthly) or change in appetite. In children this criterion is failure to make expected weight gains.
4. Insomnia/Hypersomnia (insufficient sleep or excessive sleep).
5. Psychomotor changes (agitation or retardation) observable by others. In other words, either moving so restlessly or so lethargically it is noticeable by others.
6. Tiredness, fatigue, low energy, or decreased efficiency with which routine tasks are completed.
7. Sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely guilt over being sick).
8. Struggling to think, concentrate or make decisions: self-reported or observed by others.
9. Recurrent thoughts of death (not merely fear of death), suicidal ideation or action.
- There has never been a manic or hypomanic episode. This would likely result in a bipolar or cyclothymia diagnosis instead.
- Symptoms are not better explained by psychotic disorders such as schizophrenia, or the effects of substance use.
- Symptoms must persist daily, for most of the day, for at least two weeks.
Risk Factors, Protective Factors
There are a number of factors that can contribute to, or lower, a person's risk for a major depressive episode and/or suicide attempt.
Risk factors can include:
-Genetic Predisposition: If a person has a family history of major depressive episodes, the risk that they themselves might have an episode increases.
-Social/Cultural Attitudes: Living in a social or cultural environment that stigmatizes mental health may prevent somebody from seeking help for mental health issues.
-Racial/Ethnic Identity: Studies have shown that non-Hispanic Black adults in the US have higher rates of depression than their non-Black counterparts (Brody et al., 2018), explained at least partially by the distress of discrimination.
-Gender Identity: Reported depression rates for women are twice as high as those for men (Bains & Abdijadid, 2023). This may be explained partially by the psychological distress of discrimination that women face, and/or the stigma surrounding men and mental health.
Women attempt suicide at higher rates than men (Berardelli et al., 2022), but men die by suicide at higher rates than women (CDC, 2025).
Treatment: Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) is one of the most common treatments for major depressive episodes and other mental disorders. CBT emphasizes the interconnectedness of thoughts and behaviors. In the case of major depression, therapists use CBT to challenge depressed clients to think less negatively, and re-engage them in positive, healthy behaviors (Comer & Comer, 2018).
Neurobiology
Major depressive episodes are influenced by levels of the neurotransmitter serotonin in the brain.
Serotonin is known as the "feel-good" chemical. Normal levels of serotonin in the brain help a person feel calm, happy, and emotionally stable (Cleveland Clinic, 2022).
Lower levels of serotonin are associated with the development of depressive disorders.
Major Depression and Suicide in the Media: A.J. Soprano
A.J. Soprano (top) is a character from the television series The Sopranos. In the final season of the series, A.J. struggles with major depressive disorder after his fiancée breaks up with him. A.J's depression on the show is quite a realistic depiction of severe depression. He self-reports feeling depressed, he loses motivation to go to work or school, and spends little time outside of his room. He even attempts suicide by drowning. Also on display is the component of heritability. A.J's father, Tony (bottom), also exhibits depressive symptoms.
Major Depression and Art
Art therapy is a mode of therapy that emphasizes the therapeutic effects of art creation. It has proven effective as a tool for emotional regulation in people with MDD, through three facets (Lee & Choi, 2023).
1. Distraction. This step is fairly self-explanatory. Patients focus on their engagement in art instead of their low mood.
2. Positive Rumination. Rumination refers to patterns of thought that keep a patient hyperfixated on their negative emotions. Positive rumination seeks to shift that fixation to the positive thoughts and emotions surrounding their creation of art.
3. Art-Based Acceptance. Simply put, this facet is the expression of one's experiences and emotions through the medium of art. Patients create art that reflects their experiences, embracing their thoughts and feelings instead of ignoring or altering them.
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While not in a clinical setting, I have engaged in art for its therapeutic effects. Expression I (left; drawing, also pictured in background) and New Sincerity (right; collage) are two works I have created for the sake of emotional expression.
Works Cited (in order of appearance)
Bains, N., & Abdijadid, S. (2023). Major Depressive Disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430685/
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Vaag, J., et al. (2021). Anxiety and Depression Symptom Level and Psychotherapy Use Among Music and Art Students Compared to the General Student Population. Frontiers in Psychology, 12(607927), 1-8. doi.org/10.3389/fpsyg.2021.607927
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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​Brody, D. J., et al. (2018). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013-2016. NCHS Data Brief, 303. https://www.cdc.gov/nchs/data/databriefs/db303.pdf
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Berardelli, I., et al. (2022). Is Lethality Different Between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters. Title of Periodical, 19(20). https://doi.org/10.3390/ijerph192013309
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Centers for Disease Control and Prevention. (2025, March 26). Suicide Data and Statistics. Suicide Prevention. https://www.cdc.gov/suicide/facts/data.html
Comer, R. J., & Comer, J. S. (2018). Abnormal Psychology (10th ed.). Worth Publishers/Macmillan Learning.
Cleveland Clinic. (2022, March 18). Serotonin: What Is It, Function, & Levels. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22572-serotonin
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​Lee, M., & Choi, H. (2023). Art-based emotional regulation in major depression: Framework for intervention. The Arts in Psychotherapy, 83. https://doi.org/10.1016/j.aip.2023.102018