Williams' death puts depression in spotlight

Aug. 18--Since Robin Williams' death a week ago today, some have wondered how a person of his wealth and stature -- someone who had previously been treated for depression -- could commit suicide. After all, doesn't everybody sometimes get the blues or down-in-the-dumps?

What the celebrated actor endured and what anyone else being treated for depression faces is more extreme, the experts say.

"It's a clinical condition that leads to some degree of impairment and can be mild, moderate, or severe," said Dr. Daniel Rapport, associate professor of psychiatry at the University of Toledo Medical College, formerly the Medical College of Ohio.

"In the most severe cases, it can lead to psychosis or be associated with complete disability: people stop eating, don't drink, don't take care of their basic needs, and need to be hospitalized" to resume functioning normally, he said.

In fact, clinical depression is different from what people casually refer to as "depression." Clinical depression is not your occasional sadness or disappointment, said Dr. Rapport, whose area of expertise is mood disorders such as depression and bipolar disorder.

"There are people who get so depressed and so detached from the world [that] they see suicide as a way to escape their misery or to escape a life they no longer see as worth living," he said.

According to the U.S. Centers for Disease Prevention and Control, nearly 10 percent of Americans could be diagnosed as depressed. Dr. Rapport explains that depression is a very serious illness.

"Even people with moderate depression are frequently suicidal. When people have clinical depression, up to 80 percent can have (suicidal thoughts), and they may have plans to harm themselves but may not have intent to harm themselves," he said.

Concern for one's family and the effect suicide could have on one's children are some reasons why those diagnosed as depressed do not follow through on suicide, the clinician explains. Moreover, people's moral or religious values may prevent them from taking their lives. Additionally, Dr. Rapport says there are others who "because they are afraid of dying, they wouldn't kill themselves."

"Frequently, patients will say, 'I would never do it,' " he said, adding that this response occasionally is not enough to keep a person from moving toward that tragic end.

Those who can't understand how Williams, who seemed to have the world at his finger tips, could feel so hopeless might consider this explanation from the UTMC professor:

"Two things come to mind. This was complicated by his drug and alcohol use. Apparently, he wasn't using drugs, but alcohol makes everything worse. It interferes with your judgment and can mimic depression," he said. "Being actively alcoholic makes everything much worse, so his judgment and insight were badly distorted, impaired so that he wasn't really thinking straight."

Dr. Rapport said that when depression is left untreated, the risk of suicide is about 15 percent. When it is treated, the risk drops to between 1 percent and 2 percent, he said. But why would a successful actor take his life?

"I have no idea," Dr. Rapport said, refusing to pretend that he had answers to the Williams tragedy. "I never spoke to him. I read a little about him. This was his third marriage. But without having an in-depth conversation with someone, you cannot understand why they would do this, and the truth may never come out."

Among the signs to watch for in someone contemplating suicide are negative, pessimist, and morbid thoughts.

"They express feelings of hopelessness, helplessness, worthlessness, excessive guilt," he said. " 'I'm a burden to my family. People would be better off without me. I would be better off dead.'"

There may be other changes in the person's behavior, such as in appetite and sleeping habits.

"They don't go to work, they stop bathing, and then suicide thoughts become very prominent in their minds and if they are not attached to someone or don't have a spiritual connection, then they lose hope and they become totally demoralized, and [think] 'what's the point of this?' and death is actually their escape."

The best response to such signs is to get professional help, Dr. Rapport said. He speaks highly of the services available locally, such as Rescue Mental Health Services, also referred to as Rescue Crisis, and the Toledo police department's Crisis Intervention Team of officers who respond when residents are in mental health crisis.

"Lucas County is one of the best counties in the United States, in my opinion, because we have Rescue Crisis and we have a police force that has a special unit, CIT, and they understand how to evaluate and manage people who are in psychological crisis. These people will evaluate you and get you the help you need," he said.

"We are a very generous community because we pay for this through our taxes and many counties in the United States don't. The people who work at Rescue Crisis are wonderful, too. They do a tremendous service to this community," he added.

Dr. Rapport further explained that while grief serves a purpose, depression does not. A grieving person transitions from suffering from a loss to reorganizing her or his emotions in order to move to the next stage of life.

"Depression has no purpose. It may be triggered by grief or loss, but it serves no purpose. It doesn't lead to a new place in your life. It's just suffering," he said.

Contact Rose Russell at: rrussell@theblade.com or 419-724-6178.

___

(c)2014 The Blade (Toledo, Ohio)

Visit The Blade (Toledo, Ohio) at www.toledoblade.com

Distributed by MCT Information Services