Independent information from epidemiological, clinical, biological, and phar­macological research impels formulation of the hypothesis that suicidal tendency represents a behavioral characteristic typically concentrated in specific subgroups of major depressives. Epidemiologically, the tendency for suicide attempters to repeat self-destructive acts is a rule rather than an exception. Clinically, suicide proneness has been shown to be associated with delusional depression (40). When major depressive suicide attempters were biologically compared to nonattempters, it was found that the patients in the former group had: a different genetic makeup (48); critically lowered CSF concentrations of 5-HIAA (7,52) and possibly HVA (34); increased chances for higher 17-OH-corticosteroid urinary concentration (10); lowered MAO platelet activity (9); higher melatonin plasma levels (4); ce­rebral ventricular enlargement (28,35); and augmenting average evoked responses (2). Further, in post-mortem studies of specific brain areas suicide attempters present either subnormal 5-HT concentrations (7) or supranormal densities of 5-HT 2 receptors (38,50). Pharmacologically, a history of suicidal behavior seems to have predictive value for a poor response to lithium therapy (45,46). Assuming suicide proneness as a marker of a distinct subgroup of major af­fective disorders, we analyzed the distribution of autoaggressive antecedents among definitely nonanxious major depressives. Previous suicidal behavior was indeed specific to the anxious depressives. Fourteen of the 15 patients composing our group of suicide attempters also were definitely anxious depressives whereas the relationship between anxiety-no anx­iety in the group of 60 nonattempters was exactly 1 (x 2 = 7.59, p = 0.006; odds ratio = 14). Since the information on suicidal behavior was collected after the cases were classified as anxious or nonanxious, the observed association cannot now help us to deal with the issue of whether suicidal behavior represents a consequence of collapsing anxious defenses. What we can say is that anxiety and suicidal behavior may have generally common or similar pathogenetic determinants and a partially interchangeable functional significance, for example, the patient’s attempt to alleviate his suffering from depression.

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