These new stresses may be sufficient to act as triggers for continuing brain chemistry alteration, or they may simply prevent the resolution of the difficulties which may have triggered the initial alteration, or both. Therefore, depression must be thought of as a potentially fatal illness. Friends and relatives may be deceived by the casual way that profoundly depressed people speak of suicide or self-mutilation.
Depression can shut down the survival instinct or temporarily suppress it.
Therefore, depressed suicidal thinking is not the same as the suicidal thinking of normal people who have reached a crisis point in their lives. Depressive suicides give less warning, need less time to plan, and are willing to attempt more painful and immediate means, such as jumping out of a moving car. Again, relatives and friends are likely to be astonished by how quickly such an impulse can appear and be acted upon. It can be either a psychological or a physical event. Men's hormone levels fluctuate as deeply but less obviously.