SIOUX FALLS, S.D. (KELO) — On Wednesday, Feb.15, Pennsylvania Democratic Sen. John Fetterman checked himself into Walter Reed National Military Medical Center to undergo treatment for clinical depression.

In the hours following the announcement on Thursday, support for Fetterman and decision to openly address his depression came in from colleagues such as New York Rep. Richie Torres, who wrote about his own past hospitalization for depression, and South Dakota Sen. John Thune, who said “The more open, transparent people can be, the better our understanding is.”

That understanding of depression and its effects is an essential part of improving outcomes for those who live with it, especially in places like South Dakota, where the state’s suicide rate has been rising for the past decade.

From 2012-2021, there were 1,689 deaths by suicide in South Dakota, according to a report by the DOH.

In that period of time, the suicide rate has climbed from 16.2 per 100,000 in 2012 to 22.6 in 2021.

Of these deaths, the vast majority occurred in men, who are more than 3x more likely to die by suicide than women.

None of this minimizes the impact on suicide on women in South Dakota, of which more the 350 died within the time period of 2012-2021. Rather, this serves to illustrate the increased rate at which men die as a result of suicide.

“It’s often more difficult for men than women to identify and accept those symptoms,” says Dr. Wallace Jackmon, a clinical phycologist, social worker and the Clinical Head of Psychology at Avera.

Jackmon sat down Friday afternoon with KELOLAND News for a discussion surrounding the topic of depression.

“Men in our society have kind of been indoctrinated into ‘pulling yourself up by your bootstraps’ and ‘elbow grease,’ so sometimes it’s a little bit more difficult for men to admit that they might need a little bit of help,” Jackmon continued.

According to Jackmon, men in general may be less likely to seek treatment early for depression, which can play a factor in outcomes. But, he points out that the primary factor in the increased rate of suicide among men is not that men experience depression more than women, but because of the methods men often use to attempt suicide.

“Men typically are going to use more lethal means, such as guns or hanging themselves,” Jackmon said, being sure to note that this is not always the case.

Indeed, this fact is bourn out by data. According to the DOH, between 2012 and 2021, 56% of men who died of suicide used firearms as their method, as compared to 27% of women.

While it is still often difficult for people, and often especially men, to seek treatment for depression, Jackmon says that things are changing in terms of the collective acceptance of the condition.

“I’d say in the last 10 years it’s become much more acceptable for folks to admit they need some counseling, or have anxiety issues, or past trauma issues or depression,” Jackmon explained. “Overall — the stigma associated with seeing a clinician for any type of psychological psychiatric condition is on the decrease — which is welcome news.”

Of course, it is not just a division of sexes that stands out when the suicide rate in South Dakota is examined. In South Dakota, Native Americans are statistically at a much higher risk. While from 2012-2021 the majority of suicide deaths in South Dakota were among the White population, the mean rate of suicide among Native Americans was actually much higher per capita, with a rate of 43.8 per 100,000 as compared to 17 per 100,000.

We explored this increased risk among the Native population, here.

Suicide is, of course, among the worst possible outcomes for those suffering depression, but it’s not the only outcome.

“Often folks think of clinical depression as folks just being sad,” Jackmon said, “but there’s much more to it than that.”

Jackmon says that diagnostically, there are nine primary symptoms clinicians look at in diagnosing a major depression, “one of which would be a depressed or irritable mood, accompanied with anhedonia, which means an inability to experience pleasure,” he explained.

When it comes to treatment for depression, there is outpatient treatment, where a person may simply visit a session or two, and inpatient treatment, where the person is admitted to a facility.

According to Jackmon, inpatient treatment usually occurs when a physician feels the patient is at risk of harming themselves or others.

We asked Jackmon about his thoughts on the impact that results from high-profile persons, such as Fetterman, publicizing their experiences with depression and other disorders.

Speaking from his own clinical work, Jackmon thought back to those he’s treated and their reactions to the realization that figures such as Robin Williams had suffered from depression.

“Clients will come into my clinic speaking about that — some are surprised or shocked,” said Jackmon, though that’s not the most common reaction he noted. “They’re relieved, or pleased that those folks had the courage to come forward and share that information with other people.”

Robin Williams, who died by suicide in 2014, may be a good example for what Jackmon describes as the phenomenon of psycho-social stress. Surely, someone like Williams had everything going for them, right? Maybe, and that could have been part of the issue.

“It seems on the outside that they’ve got everything going on, but that’s still a stressor for them, Jackmon explained, clarifying that it’s not just the bad things in life that can create stresses that lead to depression and anxiety. “The bar is higher, so that puts much more stress on you — getting a brand new job with higher pay will be a stressor for you because now the bar is higher.”

Depression is treatable. “Generally speaking, the outcomes are positive if folks find the right providers,” Jackmon said. “Major depression and most mood and anxiety disorders, we can treat very, very easily, and the outcomes are strong.”

There are a number of treatments for depression.

“On the psychological end, there’s hundreds of different types of therapies people can provide, but research supports four or five as being the best,” said Jackmon. “One would be cognitive behavioral therapy (CBT) — CBT is kind of the gold standard from the psychological therapy end.”

Medication is also a treatment method used by many, and Jackmon also described behavioral activation as another.

“Getting out of your house; getting some sun; finding some fun, enjoyable activities, preferably with other people who are supportive. That’s paramount,” said Jackmon. “In combination with that is exercise –generally speaking, just behavioral activation in and of itself is going to lead to people feeling better.”

Perhaps the most important thing Jackmon thinks people need to understand about depression is how it is not just sadness. “We all are sad some time in our life. That doesn’t mean that we’re clinically depressed. We could be clinically depressed and possibly not even be sad. We might just be irritable and snarky,” he said. “Investigate it a little bit more — and then seek help. Ask folks for help.”

If you are experiencing thoughts of suicide or emotional distress, you can get help by calling or texting 988, or by visiting the S.D. Suicide Prevention website, here.