Depression and suicide: timely support is also care

Emotional pain is not always visible. The sign of depression can be silence. Sometimes, it shows up as withdrawing from loved ones, a lack of perspective, dropping activities that once brought pleasure, or behavioral changes that seem minor to an outside observer. In September, suicide prevention awareness month, talking about mental health also means remembering that no one has to go through this suffering alone.

Suicide is a complex phenomenon with multiple determining factors. Depression can be associated with the risk, but it does not explain every case nor should it be treated as an isolated cause. When faced with signs of intense suffering, offering support, listening, and helping the person reach professional care can make a difference.

According to the Ministério da Saúde, depression in Brazil is a high-prevalence mental illness and the one most associated with suicide. An epidemiological study cited by the agency estimates the lifetime prevalence of the condition in the country to be around 15.5%. Studies also point to a prevalence of up to 20% among women and 12% among men.

When sadness requires medical attention

For Dr. Pedro Pierro, neurosurgeon and scientific director at Sechat, depression does not manifest in a single way. Situations of loss, such as grief, can cause sadness and withdrawal, but it is important to observe when suffering lingers, disrupts daily routines, or changes how people recognize themselves.

“Depression is often insidious. It starts slowly, beginning with a certain melancholy, a certain discouragement. And it can manifest in many different ways.”

According to Pierro, the condition is not limited to the well-known image of someone lacking energy or motivation to carry out daily activities. “It’s not just that person who doesn't get out of bed, doesn't shower, doesn't feel like doing anything. Depression can also come as a form of escape. Sometimes, a person showing excessive joy might actually be depressed. And that is an avoidance mechanism.”

The physician advises that seeking help should not depend on extreme deterioration. “As soon as someone realizes they are not their best version. That they are viewing the world in an overly pessimistic way. Especially when that is not part of their personality.”

Apathy, a lack of desire to go out, to get dressed up, and to perform routine tasks are also signs worth investigating. Pierro highlights that a medical consultation can help distinguish depression from other conditions that cause similar symptoms. “Sometimes it’s metabolic, sometimes it’s a thyroid issue, and the person feels depressed. But it’s not depression; it’s a metabolic problem.”

For Dr. Guilherme Nery, a physician working in cannabinoid medicine and psychiatry, early identification also involves paying attention to changes in daily life.

“The early signs are subtle, but they can make all the difference for early intervention. They usually start with changes in behavioral patterns, and the most visible signs are typically an increase in irritability and reactivity, intense hopelessness, lack of any outlook for improvement, social withdrawal, abandoning usual activities, increased alcohol or other substance use, significant agitation, impulsiveness, unusual goodbyes, giving away belongings which is above all a sign of planning… trying to watch for these signs is effective in prevention.”

The Ministério da Saúde advises that these signs should not be analyzed in isolation. Frequent remarks about death, hopelessness, isolation, and major behavioral changes require attention, especially when they occur together.

Exhaustion as a key warning sign

Depression can affect sleep, energy, relationships, and the ability to perform daily tasks. In his clinical practice, Nery highlights exhaustion as a recurring pattern among patients arriving in distress.

“In my clinical practice, one pattern consistently stands out as the most relevant: exhaustion. A cluster of symptoms related to anxiety, depression, insomnia, chronic pain, and the amplification of psychiatric disorders such as BD, Borderline, and PTSD fit here as physical and psychological distress and illness factors.”

According to the physician, sleep can play a central role in the therapeutic strategy to break this cycle. “Breaking this cycle by optimizing sleep is the tactic that seems most effective to me because, since cannabis is very effective at balancing people’s rest, this pattern can be interrupted. And the process of returning to better psychological functioning comes secondary to sleep stabilization.”

This statement reflects the specialist's clinical experience. The indication for medical cannabis, just like any treatment, must be individualized and determined after professional evaluation. It does not replace psychotherapy, psychiatric care, conventional medications when indicated, or emergency treatment.

Cannabis can be a tool, not an isolated solution

Medical cannabis has been studied and prescribed across different clinical contexts. For Pierro, there is research on its use for anxiety, pain, sleep, and depression, although the volume of evidence is not the same across all conditions.

“In anxiety, you can look at social phobia, generalized anxiety, from Professor José Alexandre Crippa, and you will see a lot of results with significant scientific robustness. In the case of pain, this new medicine coming out in Germany for lower back pain with a neuropathic component is a phase 3 study. Sleep as well; so we have quite a few studies for all of these. For depression, perhaps a bit less than the others, but we have them too.”

Flávia Gollop faced deep depression following the death of her husband, who was diagnosed with Alzheimer’s. She shared with Sechat that the conventional medications she initially took worsened her lethargy and that, later on, she began using medical cannabis oil under medical supervision. Read Flávia’s story.

Her journey does not represent a one-size-fits-all solution for people with depression, but it illustrates how treatment must consider the symptoms, history, and needs of each patient.

Nery explains that choosing a formulation depends on attentive clinical listening. “Cannabis compounds are powerful regulators of physiological processes. When we understand the source of the patient's dysfunction—which requires a thorough interview, connecting with your patient, and establishing a proper therapeutic rapport—we can determine which cannabinoid blends may be most suitable for each individual in their illness process.”

“We have to identify symptom patterns to consider which cannabinoids at what time of day. Seek care from professionals you trust, because the therapeutic relationship is more important than the substance itself. Cannabis will be a tool used in your therapeutic process, which goes beyond relying solely on cannabis for your transformation,” he adds.

Data from a follow-up of 698 patients with treatment-resistant depression over up to two years reported improvements in symptoms of depression, anxiety, sleep, and quality of life with medical cannabis used as an adjunct therapy. However, researchers highlighted the need for randomized clinical trials to confirm efficacy, safety, and the most appropriate formulations. See the study data.

Suicidal ideation is a psychiatric emergency

When there are thoughts of death, intention to self-harm, or immediate risk, the priority is not to start or adjust a cannabis product, but to ensure protection and emergency care. Nery reinforces that a care network must be activated.

“The safest approach for introducing cannabis is multidisciplinary follow-up, because all suicidal ideation is a psychiatric emergency. We must mobilize a professional and family support network for this individual and treat it with due attention.”

The Ministério da Saúde recommends speaking in a calm environment, listening without judgment, and encouraging the person to seek help. If there is immediate risk, they should not be left alone. It is necessary to seek an emergency medical service and contact trusted individuals.

CAPS, Unidades Básicas de Saúde, UPAs, emergency rooms, and hospitals can provide care. SAMU can be reached by dialing 192. The Centro de Valorização da Vida (CVV) provides free and confidential emotional support by calling 188, 24 hours a day, and also offers digital channels at cvv.org.br.

Official guidance on prevention, warning signs, and where to seek help is available on the Ministério da Saúde website and through the Setembro Amarelo campaign.

In case of immediate risk, go to a UPA, emergency room, or hospital, call SAMU at 192, or contact CVV at 188.