Physical pain can affect suicidality and depression, of course, can affect one's desire to commit suicide.* Both of these are seen in chronic illness. Those with a chronic or acute illness that causes great pain can cause a person to want to take their life and, of course, we know that about half of all people with bipolar disorder attempt suicide -- mostly because of depression. (Physical illnesses may, themselves, lead to depression as well but we'll skip that possibility right now.) I might suggest, however, that physical pain and depression** affect feelings of suicidality differently.

Physical Pain and Suicidality

First off, my physical pain and suicidality.

Recently I've had headaches -- like, a lot of them. I've had headaches most days for about four months now. These headaches can range from mild-moderate to moderate-severe. Sometimes pain medication helps with the pain and sometimes it doesn't.

Regardless, though, I know that when I wake up, I'm likely to have a headache that day. I would say this qualifies as a chronic (although short-term) pain condition. This does not compare to severe chronic pain conditions, of course, but it's a chronic pain condition nonetheless.

And what I've noticed is this: even though I know I'm going to be in pain every day, and even though I know I might have to take pain medication, and even though I know that pain medication might not work, in no way does this ever, ever cause a suicidal feeling in me. I do wish to escape the pain -- particularly during a nasty headache where pain medication isn't working -- but that escape plan does not include suicide.

Depression and Suicidality

Depression, however, is a whole other story.

Not only does depression cause acute suicidality as a symptom, but I would suggest it causes long-term suicidality too. When I think about waking up every day with horrific depression, it absolutely makes me want to kill myself to escape. One more day -- just one more day -- feels absolutely unbearable with depression. To me, depression and suicide walk hand-in-hand.

Suicide Attempts in Chronic Pain vs. Bipolar Patients by the Numbers

Chronic pain conditions are a risk factor for suicide.

• Chronic pain patients are at double the risk of suicide compared to others not in chronic pain, with a lifetime prevalence of attempted suicide from 5-14%.

Bipolar disorder has a high rate of suicide and suicide attempts.

• Approximately 11% of people with bipolar disorder die of suicide and there is a lifetime prevalence of attempted suicide of 25-50%.

Depression vs. Physical Pain and Suicide

When I think of bipolar disorder I think of it as a chronic pain disorder. I know, it's not what people typically think of as a chronic pain disorder but if you live with it, you know how painful it is and for many of us, the pain is as chronic as you can imagine -- even with the best depression treatments we can find.

It is interesting to me that I'm not finding them equivalent on my desire to die, however. While my depression has a much higher pain level than my headaches, I would still expect to see a similar response on some level as pain is pain. Lay there with pain you can't help going on over and over and the cause of the pain wouldn't seem to matter. The only thing that matters is that it exists.

But this is not my experience. My experience is that my body, brain and mind are much better equipped to handle the physical pain than they are to handle the pain of depression. The physical pain seems easier to separate myself from. The mental anguish seems to embed itself inside me and become part of my every breath. It seems there is no way to separate myself from the depression pain that becomes a part of my soul.

And I wonder if this is due to the away these two pains attack you. Depression pain attacks your brain directly. Depression is in there, changing your neuropathways and neurochemicals every second of the day. Depression is taking a baseball bat to your brain.

Physical pain isn't doing that. Physical pain attacks the site of the pain -- in this case my head. Now, having your head in pain is no piece of cake, but stepping out of your head, cutting off that piece of your body, psychologically, seems much easier than cutting off the pain actually in your brain.

Take Depression Pain Seriously

This is not to suggest that living with physical pain is easy and it's not to suggest that one type of pain is "worse" than another. It does suggest, however, that depression pain is an absolute bitch and should absolutely be taken as seriously as standard physical pain is.

Depression pain and physical pain and real and dangerous. We need to remember that.

* Yes, I'm using the term commit suicide. When one commits and action -- any action, that fits. This is not a judgment.

** This is not to say that depression pain isn't physical. It absolutely can be. For the purposes of this article, however, these two types of pain are separated.