Actor and comedian Robin Williams' apparent suicide focuses attention on the challenges of treating depression and other psychological disorders, even among those who have access to money and professional help.
Mental health experts expressed concern Tuesday about how Williams' death at 63 in his California home would affect people facing similar struggles. Depression or other types of mood disorders strike one in five American adults during their lifetimes.
"I get concerned about people wondering if people as promising as him with all these resources available can't make it, what are the chances for them?" said Patricia Arean, a UCSF clinical psychologist and psychiatry professor.
Effective medications and other treatments are available, even for the most severe depression, mental health experts said. But the approach to finding which of them works best can be a hit-and-miss, frustrating experience for patients and cause a delay in recovery.
"Unfortunately, what happens is that people don't know enough about their own illness to know if they're not getting better," Arean said. If not, they need to move on to a different form of therapy.
While Williams was open about his long-term battle with alcoholism and cocaine addiction, he was less public about his mental health issues or what treatment he sought. His publicist said Monday, the day Williams died, that the comic actor suffered from severe depression.
White men's risk
Health experts say Williams' battle with addiction as a form of self-medication fit with a common profile of someone battling depression, and being a white man older than 60 put him at a higher risk of suicide.
"A white male over 60 with alcohol abuse is our prime candidate for suicide, no matter how famous you are," said Dr. Laura Davies, a psychiatrist who treats people of all ages at California Pacific Medical Center in San Francisco.
While suicides among women start to drop after age 60, that's not true of men. Older white men have the highest rate of suicide of any age and ethnic demographic in the U.S. at about 29 per 100,000 overall.
Davies said treatment for depression is effective, but people have to seek help.
"We can treat it with medicine, we can treat it with therapy," she said. "But we can't treat it if we can't talk about it."
Even so, there's room for improvement in treatments, said Dr. Winston Chung, medical director of inpatient psychiatry at California Pacific Medical Center. He said researchers need to better understand the biology of mental health issues to reduce the stigma and produce more accurate treatments.
Chung said more research and money needs to be put into finding biological markers and genetic traits for mental health problems.
"With cancer, you can see the cells under the microscope. In depression, you can't see it. There's no broken bone, no radiological finding," he said. "We need to have concrete evidence, not unlike the cancer cell. Something we can see and reliably associate with mental health issues." Read Full Article
Such research could help determine why some people respond better to one medication than another or why some patients are resistant to treatment, said Lea Williams, a Stanford clinical psychologist and psychiatry professor who specializes in depression.
As medical research gets better at determining which cancer tumor will respond better to therapies, the same biological understanding has to happen in mental health, she said. Depression, like other illnesses, isn't about willpower.
"They're all complex diseases," she said. "But, with depression, there's still that idea that it's something you can fix yourself just by trying."
Chung said it may never be clear what kind of emotional problems plagued Williams. But he said someone suspected of having a bipolar disorder may project the manic, on-top-of-the-world energy that Williams displayed as a way of avoiding negativity and pain.
"They say a mature psychological defense is humor," Chung said. "Maybe it's not a mistake that those people with such intense sadness would be able to master humor so well."
The National Suicide Prevention/Crisis line is (800) 273-TALK (8255)
Sources: Mental Health Association of San Francisco, Chronicle research