I’d known Paul for a number of years, a hard working doctor with extensive experience in the Armed Forces and the NHS. He was married with two children and on the surface it seemed as if life was going well. Nice house, a holiday home in Spain, no financial worries, no apparent marital problems and two fine, healthy boys. He was an outdoor pursuit junkie, not only heavily into rock climbing, hill walking and sailing, but also gentler activities like shooting and fly fishing.

The ONS figures show the number of adult male suicides in the UK is rising and is greater than that for females. The 2013 figure for the UK suicides is in excess of 6000, with a rise of 4% in male suicides, whilst that for females is static. Middle aged men are most at risk and from an occupational perspective doctors, dentists, agricultural workers and ex armed forces personnel top the list. Other demographic factors are also important, such as where in the UK one is living. The North East beats the South East hands down.

Although I never actually worked with Paul, we often ended up talking about the stresses of general practice, either over a few beers in the pub or sharing a boat whilst fishing. In retrospect, I missed the warning signs. When chatting, he seemed to have poorly developed defence mechanisms to deal with those stresses associated with general practice – patient management, time management and workload, staff employment issues including the inevitable disputes, health and safety, complaints and inspections. Couple this with low self confidence and his perception of his personal performance and the (then) newly introduced appraisal system. He told me that it all made him feel depressed about the future. But I didn’t know he had battled for years with recurrent depression. Worse still, it transpired that for many years he had not been registered with a general practitioner, so avoiding seeking help. He had sufficient insight to know when he was ill, so he would resort to self medication with antidepressants. There would have been a supply, usually returned unused medication from patients to plunder. No chance for psychotherapeutic intervention; he’d never discussed it outside of his family.

Just before Christmas 5 years ago, he told his family he was going on a climbing trip, booking himself into a hotel 200 miles from home. His knowledge as a doctor helped in his suicide planning and subsequent realisation of that plan.

Ranging widely in severity, depression is a common but serious disease. Left untreated severe cases may include significant appetite and weight loss, sleep problems and frequent thoughts of death or suicide.

Symptoms of severe depression?
Alcohol or drug abuse
Insomnia or excessive sleeping
Irritability
Loss of interest in activities that used to be enjoyable
Hopelessness
Persistent thoughts of something bad happening
Thoughts of death or suicide or suicide attempts
In very severe cases, psychotic symptoms (such as hallucinations or delusions)

What are the warning signs of suicide? According to the National Suicide Prevention Lifeline, they include:
Talking about wanting to die or wanting to kill yourself
Looking for a way to kill yourself, such as searching online for methods or buying a gun
Talking about feeling hopeless or having no reason to live
Talking about feeling trapped or in unbearable pain
Talking about being a burden to others
Increasing use of alcohol or drugs
Acting anxious or agitated; behaving recklessly
Sleeping too little or too much
Withdrawing or feeling isolated
Showing rage or talking about seeking revenge
Displaying extreme mood swings

Don’t “Man up” in November, men need to talk more. The Movember Foundation is a truly global charity founded in 2003 and is aimed at improving men’s health, with an emphasis on mental health, prostate and testicular cancers and physical inactivity. Their main aim is to “stop men dying too young”. Please visit https://uk.movember.com for details of their funding strategy and to find out more about how you can get involved. – Malcolm Hickey and Sally Gordon