She has a long history of depression, but due to financial constraint, has stopped following up in private clinic and gone to the general hospital. After few months she came back to us, not being well, but still not that bad, able to smile and chat with others a little bit.

Few days later she made a call to us, saying she’s feeling really low in mood, not having any interest, she didn’t know what to do with herself, still regular with med, but didn’t think it was helping with her problems. Nothing happened in particular that led to her mood being that way, she said. Her medication was adjusted. Couple days later I rang her again, she took the extra dosage, but remained the same, not happy, lacking drives and interest. She did try, she went out for group exercise with friends, but she kept feeling her mind was somewhere else. She was told to come back so that she could get a better review and a medicine regime that helps with her current condition better.

She didn’t come back for review. She never called us again. About 3 or 4 days later I called her house numbers again (which I usually did), somebody else picked up, saying she is no longer here. At first I didn’t get it, I thought she was just away. Then this lady said the patient committed suicide yesterday. I sent my condolences and ended the call.

Lacking interests and drives is one very important suicidal risk factor. They try to get engaged in something, but they don’t find their mind with them. It isn’t them, it’s their illness.

I used to think as long as they find some pleasurable things to do they will get better. Sometimes it just isn’t that simple, maybe it isn’t just the behavioural intervention or medicine alone, they need cognitive, behavioural and pharmacological interventions all together.