Emotional Health

Losing Hope: Understanding and Preventing Suicide

Imagine someone you cared about was seriously ill with a disease that is often fatal. He or she would probably seek the best treatment they could find and follow their doctor’s orders to the letter. If, for some reason, they failed to do this, you and others who cared would urge them to get help, and then, if necessary, drag them to a doctor so they could get the appropriate treatment.

This week we have been shocked by two suicides of vibrant celebrities at the peak of their careers. Kate Spade and Anthony Bourdain both seem to be exemplars and people who have a lot to live for—friends, family, and rewarding careers. Unlike most of us, they also had fame and wealth.

And surely they had access to good medical care.

We are all asking: what happened? No amount of talent and good fortune is an antidote to serious depression. And where there is suicide, (with very rare exceptions), there is always depression. For far too long, this mental illness has not got the “respect” that other diseases have. This is despite the fact that depression is,  according to the World Health Organization,  “the leading cause of disability globally, costing the global economy as much as $1 trillion annually with no country on the planet immune.”

The New York Times further reports:

“Bourdain’s and Spade’s deaths happened in a week when newly released government statistics revealed a staggering increase in suicides by Americans of more than 25 percent from 1999 to 2016, when nearly 45,000 Americans took their own lives. Experts worry that this trajectory reflects a breakdown in social bonds, in community. It’s unclear how or if Bourdain and Spade fit into that picture.”

Not included in these statistics are the thousands who have died by passive suicide as the result of the opioid epidemic. While many people start out taking painkillers prescribed by a doctor, users regularly identify depression as one of the chief factors that led them to start abusing drugs. We are in a mental health crisis, one that is poorly understood and even more poorly addressed.

Though reports vary, it seems that Kate Spade was undergoing treatment for anxiety and depression. It has also been said that she resisted hospitalization, —the only safe way to help someone in a suicidal crisis—for fear of stigma.

A person with suicidal impulses is in so much pain that they cannot think clearly. They have no hope, so their motivation to do things that may improve their lives is impaired. Low energy and feelings of worthlessness also keep people from taking action. They are literally driven crazy by a mood disorder—they may be  “oriented” to reality and not psychotic in the usual sense, but their sense of self is so distorted by the disease that rational decisions are difficult.

Suicide, to them, seems the rational solution. The New York Times quotes  Robert Gebbia, the head of the American Foundation for Suicide Prevention:

“Research shows that the decision to attempt suicide is often made quickly, in an impulsive way. . .You may be thinking about it over time, but that moment when you actually make an attempt is a very short window. If you could make it harder to make that attempt by not having access to the means, often what happens is the feelings will pass, it gives people time for someone to intervene and get them help, so that is a really important preventative step that can be done. And there’s good research to support that.”

One of the myths about suicide is that people who talk about it rarely do it. Not everyone who kills himself lets on about their plan, and some will explicitly deny it, especially right beforehand. But those who do give hints should always be taken seriously. And most people who kill themselves have given some indicators of how much pain they are feeling. If someone feels so bad they want to die, that is a serious emergency in itself even if they don’t attempt suicide.

One obstacle to overcoming depression is that it is a complicated illness, with many causes, and no one treatment fits everyone. Accurate diagnosis is crucial, and it can take several different trials to find a medication that works. Different types of medications target various brain mechanisms and work in different ways.

But new drugs are being developed all the time. And developments in DNA testing has shown promising results in assessing what drugs might work best for a particular individual.

Another problem is that many psychiatric illnesses don’t respond to drugs right away—they can take weeks to work effectively. I remember treating a seriously depressed woman who still hadn’t improved after the usual trial of six weeks on a particular medication. She was in terrible pain, and I called her very experienced psycho-pharmacologist to inquire if we should try something else. She said that we should wait rather than start all over again. Sometimes, she said, it takes eight weeks. Sure enough, after another fortnight the patient began to improve.

Still, eight weeks is a terrible amount of time to have to wait when you are in such torment. Imagine if someone walked into an ER with kidney stones and was told they would start to feel better in 6 to 8 weeks. But there are hopeful developments in this area as well. Research is being conducted to study the effects of the drug Ketamine, which has been shown to be rapidly effective for those with treatment-resistant depression. It has not been approved yet for this use, but some people are being prescribed Ketamine “off-label”  (meaning it is a drug intended for another use) though it is very expensive.

Other new treatments include the use of magnets to stimulate the brain, called transcranial magnetic stimulation or TMS. It is non-invasive and has negligible side effects. It works by stimulating nerve cells in the area of the brain that controls mood, and has been approved for use by people who have not responded to other interventions and has shown promising results.

The most important thing is not to give up. Your friend or family member has lost hope and with it the ability to care about herself, and you may have to do it for her. This may require you to be both pushy and suspicious. Don’t take their word for it if they say they are not actively suicidal. One way clinicians assess risk is to ask the person if she has a “plan.” Someone who has a definite course of action in mind and has the means to carry it out is at great risk. The statistics show that in areas where there is easy access to guns, like states with relaxed gun control laws, the suicide rates have risen even more quickly than elsewhere.

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  • mickey monroe June 11, 2018 at 12:20 pm

    Thank you, thank you, thank you so very much. The video of Dr. Nuland, magnificent, inspiring, superlative. Your text about suicide, thank you some more.