The suicide of comedian and Academy Award-winning actor Robin Williams has focused attention on a mental illness that affects as many as 25 million American adults in any given year. Yet, only half of those suffering from major depression ever seek help, resulting in what many believe are preventable tragedies.
Untreated depression is the leading cause of the estimated 30,000 annual suicides in this country. Many of these deaths can be blamed on the lack of understanding — and the stigma — related to mental illness.
“There has been a very slow acceptance by lay people, and even some in the medical profession, that depression and bipolar disorder are brain diseases,” said Dr. Charles Nemeroff, chair of the psychiatry department at the University of Miami’s Miller School of Medicine. “There’s also this view that somehow it’s a weakness of character.”
Williams, however, had been seeking treatment for depression, according to Marin County Sheriff’s Lt. Keith Boyd. About a month ago, the actor had entered rehab to deal with a new bout of depression. At the time his publicist said the actor had made the decision because he needed to recharge after working for 18 months without a rest.
But Nemeroff warned that treatment isn’t always perfect. “We’re good at treating depression and bipolar disorder. What we’re not very good at is mapping a patient to a specific treatment that’s going to be optimal for them.”
Depression — also known as clinical depression, major depressive illness, major affective disorder and unipolar mood disorder — goes beyond the temporary feeling of sadness everyone experiences at some point. It’s a serious emotional and biological disease that affects a person’s thoughts, feelings, behavior and even physical health. It lasts a lifetime, with periods of wellness alternating with recurrences. Long-term treatment is required to keep symptoms from returning.
“It’s not something that people can pull themselves out of,” said Catalina Jacobs-Fernandez, a psychologist at Baptist Health.
Alcohol and drug abuse may coexist with depression, often serving as a form of self-medication. “Men usually tend to deal with depression in two ways, through substances, like alcohol, or they tend to overwork and isolate themselves via their work,” Jacobs-Fernandez said.
Scott Poland, a professor and co-director of the Suicide and Violence Prevention office at Nova Southeastern University in Fort Lauderdale, said that there are typical behavioral clues before someone commits suicide: loss of energy, lack of interest, feelings of hopelessness, poor concentration and changes in sleep and appetite.
“If somebody says, ‘My family would be better off without me,’ it’s a big warning sign,” Poland said. “We need to pay particular attention when someone’s made a suicide attempt, even if it’s minimal.”
Myths about depression and its treatment persist. Many people, for example, fear being “hooked” on an anti-depressant, though research has shown medication can be effective. “If you were dealing with something like leukemia we wouldn’t be having this conversation about side effects,” Nemeroff said.
Mild to moderate depression can usually be controlled through medications or psychotherapy, but both together are more helpful, particularly for severe depression. Mental health experts also recommend that loved ones learn to recognize the signs of depression and to treat any threats of self-harm seriously.
“When people seek help, they’re more likely to go to loved ones before they come to a center,” said Claudia Lifland, outpatient behavioral health supervisor with Memorial Healthcare in Broward County. “There’s something to depression that causes the person to isolate.”
What’s more, some studies have shown that suicide “clusters” can spring up after a famous person has committed the act, said Nova Southeastern’s Poland. Switchboard of Miami noticed a spike in calls to its Suicide Prevention Lifeline between 5 p.m. Monday and 11 a.m. Tuesday.
Calls to the English-language help line doubled from a typical 100 calls to about 200, said Amy Crismond, Switchboard’s community relations and development manager. Though there were more calls in Spanish as well, the increase wasn’t as dramatic.
“We’re pretty confident that it’s related,” Crismond said. “It’s always a trigger [in calls] when a well-known figure commits suicide.”
Williams dealt with substance abuse and depression throughout most of his adult life, and he often made references to it in interviews and comedy routines. His quick wit seemed to hide the dark thoughts and habits he had battled for decades. In 1982, when friend and fellow comedian John Belushi died of a fatal drug overdose, Williams quit cocaine and alcohol cold turkey.
“The Belushi tragedy was frightening,” Williams told People magazine in 1988. “His death scared a whole group of show-business people. It caused a big exodus from drugs. And for me, there was the baby coming. I knew I couldn’t be a father and live that sort of life.”
In 2006, after 20 years of sobriety, he relapsed. After a family intervention, he sought treatment at Oregon’s Hazelden Springbrook Center. He later joked, “I went to rehab in wine country to keep my options open.”
Earlier this year, he had been in rehab at the Hazelden Addiction Treatment Center in Lindstrom, Minnesota.
For more information on depression, visit these websites:
National Institute of Mental Health: www.nimh.nih.gov
National Alliance on Mental Illness: www.nami.org
The American Academy of Child & Adolescent Psychiatry: www.aacap.org
Anxiety & Depression Association of America: www.adaa.org
Depression and Bipolar Support Alliance: www.dbsalliance.org
SYMPTOMS OF DEPRESSION
If several occur at the same time, interfere with daily life and last longer than two weeks, professional treatment is needed.
• Persistent sadness or irritability
• Extreme changes in appetite, energy and sleep
• Difficulty focusing and remembering
• Agitation or actual physical slowness
• Lack of interest in usually enjoyable activities
.• Feelings of guilt, worthlessness, hopelessness and emptiness
• Recurrent thoughts of death or suicide
Source: The National Alliance on Mental Illness