NYT: Midlife Suicide Rises, Puzzling Researchers

By PATRICIA COHEN
Published: February 19, 2008

Shannon Neal can instantly tell you the best night of her life: Tuesday, Dec. 23, 2003, the Hinsdale Academy debutante ball. Her father, Steven Neal, a 54-year-old political columnist for The Chicago Sun-Times, was in his tux, white gloves and tie. “My dad walked me down and took a little bow,” she said, and then the two of them goofed it up on the dance floor as they laughed and laughed.

A few weeks later, Mr. Neal parked his car in his garage, turned on the motor and waited until carbon monoxide filled the enclosed space and took his breath, and his life, away.

Later, his wife, Susan, would recall that he had just finished a new book, his seventh, and that “it took a lot out of him.” His medication was also taking a toll, putting him in the hospital overnight with worries about his heart.

Still, those who knew him were blindsided. “If I had just 30 seconds with him now,” Ms. Neal said of her father, “I would want all these answers.”

Mr. Neal is part of an unusually large increase in suicides among middle-aged Americans in recent years. Just why thousands of men and women have crossed the line between enduring life’s burdens and surrendering to them is a painful question for their loved ones. But for officials, it is a surprising and baffling public health mystery.

A new five-year analysis of the nation’s death rates recently released by the federal Centers for Disease Control and Prevention found that the suicide rate among 45-to-54-year-olds increased nearly 20 percent from 1999 to 2004, the latest year studied, far outpacing changes in nearly every other age group. (All figures are adjusted for population.)

For women 45 to 54, the rate leapt 31 percent. “That is certainly a break from trends of the past,” said Ann Haas, the research director of the American Foundation for Suicide Prevention.

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Beyond Blue: Lincoln's Blueprint for Success

Therese Borchard writes in "Beyond Blue"

The reason why Lincoln's story inspires so many people comes down to hope, says Shenk, author of "Lincoln’s Melancholy." In the Winter 2007 Issue of the John Hopkins Depression and Anxiety Bulletin, Shenk was interviewed about the incredibly thorough and absorbing book that took him seven years to research and write.

From Shenk's quotes, I learned even more about the man who earned the equivalent of a Nobel Peace Prize, Purple Heart, and three Olympic Gold Medals in the mental health competition.

"The essential question that Lincoln grappled with during his lifetime was how do you have hope in the face of great suffering," Shenk explains. "That question never ceases to be relevant for him. To me, Lincoln was a man who suffered more than anyone in his circle of contemporaries, and a man who achieved more than anyone in his circle. And the reason he was able to succeed all came down to hope."

Shenk mentions a troubled young woman Lincoln counseled. The wise man didn't tell her that she would recover immediately from her depression. He asked her to acknowledge hope, "to let a crack of light into her life, to know that it would not always be as dark as it was now. He advised her that if she could only keep a piece of that awareness in the midst of her great suffering, then her whole experience would change."

Hope, yes. But how did he get there? How did he move past his sadness and anxiety?

I don't think he did completely.

Shenk believes that for his entire life, Lincoln feared that he would go insane. (Knowing that is worth at least two trips to the shrink for me, because I have the same worry, as do most people who have ordered off a psych ward menu.) "The two main things Lincoln did to cope with his depression," says Shenk, "were to articulate his suffering, through poetry especially, which helped him cut straight into the heart of real life. He would also tell jokes, spending much time laughing and making others laugh." I wonder if our president knew the one about Santa getting seduced by a sexy blonde in lingerie.... Well, maybe he had more class than I do.

Shenk divides Lincoln's "blueprint for a successful life with suffering" into three stages:

First the melancholic leader acknowledged his pain. He sat his problems down for a long interview and examined every square inch of them. He asked them how long they intended to stay with him, and when they said forever, he wrote up some rules.

"Very well," he told them, "but there are curfews and you are not allowed to do A, B, and C." Then he strapped a harness around each wild invisible body. According to Shenk, Lincoln learned to live with his pain and adapted to the pain on its own terms.

Finally, Abe turned to a cause greater than himself. "Listen guys," he told his problems, "not only are you going to abide by these rules, you are going to chip in and help me do a few things around here because I know what you are capable of." He channeled his suffering to make it work for him.

"Looking back at Lincoln's life," says Shenk, "what we can learn from him that can help us get through our own struggles with depression or other forms of mental illness boils down to a simple sentence: 'And this, too, shall pass away.'"

How interesting. Those are the very words that kept me alive, the phrase my mom repeated to me almost every day of my 18-month darkness. For Lincoln, it certainly passed. And it will for me too if I ever get stuck again.

Learn more about Abraham Lincoln and his depression at Shenk's website: www.lincolnsmelancholy.com.

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NYT: Reports of Gunman’s Use of Antidepressant Renew Debate Over Side Effects

By BENEDICT CAREY

Steven P. Kazmierczak stopped taking Prozac before he shot to death five Northern Illinois University students and himself, his girlfriend said Sunday in a remark likely to fuel the debate over the risks and benefits of drug treatment for emotional problems.

Over the years, the antidepressant Prozac and its cousins, including Paxil and Zoloft, have been linked to suicide and violence in hundreds of patients. Tens of millions of people have taken them, and doctors say it is almost impossible to tell whether the spasms of violence stem in part from drug reactions or the underlying illnesses.

“It’s a real chicken-and-egg sort of situation,” said Dr. Jane E. Garland, director of the Mood and Anxiety Disorders Clinic at BC Children’s Hospital in Vancouver, British Columbia.

Dr. Garland said some people could and did become agitated and unpredictable in response to the drugs, usually just after starting to take them or soon after stopping.

“But it’s hard to make a case for a withdrawal reaction here, because Prozac comes out of the system gradually,” she said.

The girlfriend, Jessica Baty, said in an interview on CNN that Mr. Kazmierczak took Prozac to battle anxiety and compulsive behavior but that it “made him feel like a zombie and lazy.”
She said that in the days leading up to the shooting he was not behaving erratically, as university officials had suggested.

Much of the debate over the side effects of antidepressants focuses on erratic behavior like the cautious college student who stabs herself or the good husband and father who buys a gun and shoots himself.

The drug labels warn about agitation and severe restlessness, and display a prominent caution that the medications increase the risk of suicidal thinking and behavior in some children and young adults.

Psychiatrists said Monday that stopping an antidepressant could cause effects like lightheadedness, nausea and agitation as the brain adjusted. Among the most commonly prescribed drugs, Prozac is the least likely to cause withdrawal effects because it stays in the system longest, the doctors said.

“A small dose of Prozac is what you might use to block withdrawal symptoms when you take a patient off one of the other drugs,” said Dr. Donald Klein, an emeritus professor of psychiatry at Columbia who has consulted with drug companies.

Sara Bostock, of Atherton, Calif., whose daughter committed suicide shortly after taking Paxil, acknowledged that the interaction between drug effects and underlying emotional distress was hard to untangle.

Ms. Bostock wrote in an e-mail message, “As an observer and suicide survivor, my main wish is that medical professionals, regulatory authorities and other scientists will examine closely the entire medical and treatment history of the perpetrators of these violent incidents in which innocent people are victims.”

She is a founder of ssristories.com, a Web site that has tallied 2,000 news reports of violent acts in which people were thought to be taking antidepressants or had recently stopped them.

“If it weren’t for us, many of these stories would be lost to oblivion forever,” Ms. Bostock said.
Psychiatrists say the debate on such side effects, particularly suicide in the last four years, has driven many patients from drugs that could help save their lives. The psychiatrists emphasize that patients should be closely monitored for changes in behavior when starting or tapering off a medication.

Advocates on both sides agree that catalogs of violent acts are not enough and that news reports are incomplete. Only more thorough investigation and careful tracking of drug side effects, they say, will clarify the links between drug treatment and violent behavior.

Dr. Michael Stone, a professor of clinical psychiatry at Columbia, maintains a database of 1,000 violent crimes, including mass murders, going back decades. In many cases the accused had stopped taking drugs for schizophrenia, Dr. Stone said.

“I only have a handful of cases,” he added, “where the person was on an antidepressant.”

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Beyond Blue: Because of, Not In Spite of

Therese Borchard writes:

Last week's post on the Newsweek happiness article provoked many interesting comments. I especially liked this insightful one from Beyond Blue reader Mia:

Such a great discussion here. And I really love the distinctions being made: "medicine" vs "drugs" and "sadness" vs "depression." And how I love Dr. Kramer's over-and-over-and-over insistence that we're talking about a disease here people -- not simply a deeply felt negative emotion. Is there a tendency to throw pills at things too quickly in this society? Perhaps. But people seem to forget that one of the reasons drugs are prescribed -- and one of the useful applications of drug samples from pharmaceutical reps -- is to help diagnose the problem in the first place. Is it "sadness" or "fatigue" or "depression"? Sometimes I can't even tell, but recently -- in my usual weary dreary battle to slog through the winter -- I added Prozac back into the mix of other meds, vitamins, and alternative-med therapy (had half a bottle left after weaning myself off them early last summer), and dang, I felt so GOOD for the first time in many months. (And I wanted to cry, then, NOT because I was sad but because I was happy and relieved...if I was sad, then it was because I waited so long to think about trying it, all the beating up of myself I was doing and the half-life version of myself that I was giving to my kids.) My point: Sometimes it's the taking of the meds -- and getting (or not getting) the expected/desired response -- that helps pinpoint the malady, even sorting out when "depression" is emotional upheaval vs chemical upheaval.

I don't know about anybody else, but more than once in this whole sadness-vs-illness debate I've found myself wishing for a different word than "depressed." When people say, "How depressing!" or "Man, I'm sure depressed" they're not talking about the same kinds of things that have most of us turning to SSRIs. And maybe that in itself contributes to the confusion and the ignorance, of having my mom, for instance, say to me that she wished my sister could "pull herself together" so that she could "get off all those d*mn pills." Maybe if chemical depression was called something like Peter Kramer Syndrome, like Lou Gehrig's Disease or Tay-Sachs, people would finally "get it"??? Get that ingesting the right chemical, in manufactured pill form -- to address the body's inability to manufacture it on its own (much like insulin for the diabetic) IS IN ITSELF part of "pulling yourself together." They're not mutually exclusive realities!

God bless the people who can do this on their own, with talk-therapy alone or a right mix of alternative therapies -- I applaud you, I envy you, and sometimes for months at a time I can BE you. But sometimes that SSRI is exactly the crutch I need -- and I use the term "crutch" on purpose, because even tho it has a negative connotation, a crutch used properly is an effective and needed tool when you're in danger of falling and hurting yourself, or of causing further damage when a healing part of your body is still vulnerable.

My own problem with depression -- and this is where the people around you are so important, to help you get a reading on what's going on with yourself -- is that I don't always recognize when a new or deeper episode is creeping up on me. Usually, a major depressive episode happens so gradually that I don't notice it. (It's like that adage that if you throw a frog into boiling water, it knows enough to jump out. If you put a frog into cold water and gradually turn up the heat, it will of course stay put and get cooked.) Once major depression settles in and is firmly rooted, I typically lose my ability to be the good and vigilant advocate of myself that I'd be in the case of other health problems.

Instead of thinking "Oh crap, my neurotransmitters are petering out again, better go see the doc" the tendency instead is to do just about everything OTHER than that -- work harder, guzzle more caffeine to work harder, wallow in self-hate, subject myself to overly critical people who feed into that self-hate, more work and more caffeine and less sleep, and voila your chemical imbalance shuts you down just like a washing machine that aborts the the spin cycle whenever its balance is off. (I heard a great quote at a retreat recently that may apply here: "Your mind can play tricks on you, but the body never lies.") After a while, how can you reasonably expect yourself to haul your sorry butt into a doctor's office when you can't even manage the basics like remembering to eat, take a shower, or changing your clothes?

Because our obsessively optimistic society -- control your own destiny, pull yourself up by your bootstraps (assuming you have bootstraps, which the untreated depressive doesn't) -- can't figure out what to do with the likes of us, because our reality simply doesn't "compute," doesn't fit their model and belief system, we need to be removed from the landscape of the American Dream somehow, just as surely as Native Americans who got in the way of land-grabbing westward "progress." And so if our depression becomes too bothersome to be written off as mere emotional travail (trivializing the disease), then we're "put on a pedestal" (romanticizing the disease) like Poe and Van Gogh in the name of great art. To which I respond, like Dr. Kramer: That's not BECAUSE OF depression -- that's DESPITE depression. Kinda makes you wonder what other great works of art Van Gogh might have evolved to, as his techniques matured, had he not killed himself. I mean, duh! Had he survived depression, we might be thinking of "Starry Night" as his early/immature work instead of his crowning glory!

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CNNMoney:Bummed out? Bad time to shop

A new study says incidental emotions can influence the prices at which individuals buy and sell.

NEW YORK (CNN/Money) - Think you paid too much for a little gift you bought yourself after a tough day at the office? A new study suggests your emotions may have pushed you to a bad decision.

According to a study by researchers at Carnegie Mellon University, sadness propels people to spend more for an object than they would have otherwise paid and to sell items at a discount. Disgust, on the other hand, depresses both buying and selling prices.

"We're showing for the first time that incidental emotions from one situation can exert a causal effect on economic behavior in other, ostensibly unrelated situations," Jennifer Lerner, an assistant professor of social and decision sciences and psychology, said in a press release.

During the study, participants were asked to watch scenes from movies that elicited either sadness or disgust. The first group watched a clip from "The Champ" in which a boy's mentor died while the second group viewed a scene from "Trainspotting" of a man using a filthy public toilet. After watching the scenes, participants wrote about how they would feel in similar situations in order to solidify their emotions.

Participants were then asked to buy and sell highlighter pen sets to one another. The disgusted group, on average, were willing to sell the pens for $2.74 compared to the $4.58 price emotionally neutral participants -- a group who watched a documentary -- asked for the same item. The price that disgusted participants paid for the highlighers, $2.98, also lagged behind that of the control group, $3.53.

People who were sad were willing to sell the pens for $3.06 but were willing to buy them for $4.57.

The results led researchers to conclude that sadness pushed participants to try to change their circumstances, which translated to a greater willingness to buy new things or sell items that they own, while disgust caused people to refrain from spending and to rid themselves of things they had already purchased.

Researchers say the implications of the study could be used to decode consumer spending patterns following highly emotional events such as the September 11 terrorist attacks. The study, however, doesn't prove that retail therapy is a valid treatment for the blues.

"We didn't focus on how they felt after they bought things. Instead we focused on what led up to the buying decision," Lerner told CNN/Money.

Lerner and her team are currently planning an experiment that will test the correlation between an individual's emotional state and their investment decisions.

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The Last Psychiatrist: What Else Causes Suicide?

from The Last Psychiatrist:

In which I take the semiotic logic of medication induced suicidality to its inevitable, silly end. Using nothing more than a Volvo. And without lawyers.

With the recent news that anticonvulsants double the rate of suicide, I got to thinking: isn't Klonopin (clonazepam) an FDA approved anticonvulsant?

Sure, it has different pharmacology than the other 11 studied, but Lamictal, Lyrica, Depakote, etc are equally different. So if we're going to pretend that we never had to take pharmacology in med school, if we're talking class effect, then Klonopin gets the warning.

Which may mean that all benzos should get the warning, since, well...

But why stop there? Antidepressants carry the warning across pharmacology. SSRIs, TCAs-- even Seroquel has the warning ONLY because it's now an "antidepressant" for bipolar disorder. Again, the FDA would like us to pretend that doctors had every M, W, F 9am-10am off in med school. We're not postulating the pharmacology is the cause, since they are all different-- we're saying it's a class effect. Ok, well, what else is an antidepressant?

Well, a number of medicines not FDA approved. Lithium, even though that's supposed to reduce suicide. CBT or other therapies? They must ultimately act on some biological pathway, right?

...inevitably, there can only be one conclusion: psychiatry causes suicide. You are all on notice.

And so, reductio ad absurdum, let's all stop this nonsense.

read the rest ...

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The Scotsman: There's Nothing At All Funny About Depression

By JANEY GODLEY

STAND–UP comics are often prey to depression. Take John Cleese, Stephen Fry, Paul Merton, Tony Hancock, Kenneth Williams and Spike Milligan as examples.

It does seem that being funny in public equates to being sad in private.

My daughter Ashley went round a bunch of local comics in Glasgow asking them about their lives and deduced that the majority of them have had disturbing childhoods or horrific incidents in their lives that led them into standing up in public and telling jokes.

I myself have never shied away from talking about my difficult childhood and sexual abuse, though I have never suffered from depression.

I am very lucky. It takes a lot to get me feeling down. I tend to deal with an issue in my own way and get on with solving the problem. Not everyone is so fortunate.

Being free from mental health issues is a wonderful feeling, especially when I read an article about the amount of comics who have become suicidal due to the pressure they feel.

People deal with life very differently. From what I understand about depression it can strike anyone at any time. It must be really debilitating and make a person feel so helpless that they can delve deep into their own dark hell. Suicide can be the result.

Depression is on the increase in Britain and the statistics show that this mental illness is affecting more young people than ever before – and yet the government is trying to get some claimants with depression off Incapacity Benefit.

Mental health groups are fighting this policy. The government is making sly assumptions that some young people coming forward with the condition are feckless work-shy scroungers and intend to question them further, to determine who really should be at work.

Depression is indiscriminate. It affects all classes, ages and ethnic groups in the UK.

People who suffer from this condition are unable to work. Though their limbs are fine for lifting boxes and their legs can manage stairs, the very thought of having to deal with the world outside their door can stop them from getting out of bed. That is disabling when it comes to holding down a job.

Self-esteem is eroded and the very core of your soul is shaken when a depressive episode takes hold.

My mother suffered from depression and that affected our whole family and the people who lived around her. Families are often torn apart and marriages suffer terribly when this condition takes hold. I recall coming home from school and being scared of her frightening moods. I was terrified she would harm herself.

Sir Winston Churchill called his dark depression "the black dog", yet he managed to contribute to society in the darkest times of the 20th century while suffering from his awful illness. No-one called him a shirker, nor did they belittle his condition.

The government should be supporting young people who suffer from depression and other mentally disabling conditions. We have thousands of young men and women currently fighting in war zones and the high numbers of military personnel who report back home with various mental issues will need this country's attention, not its derision.

David Freud, great-grandson of Sigmund Freud, is an investment banker who has been hired by James Purnell, the new Work and Pensions Secretary, to shake down the current system.

This is the man who saved Euro Disney and his idea is to get big companies to create jobs for people currently claiming sickness benefit and he will use a "carrot and stick approach" by paying the company money for keeping people in a job for more than three years.

That carrot theory might have worked with Thumper in Disneyland, but enticing companies with cash to get sick people to work is a false economy. Just pump the cash into the NHS and let the private sector decide who they want to employ.

My opinion is this: the majority of people claiming Incapacity Benefit through depression are going to be vigorously examined. The result of this scrutiny will be that some people will be refused Incapacity Benefit and shunted into a lower benefit bracket to save the government cash or they will be forced to take jobs through Mr Freud's scheme.

There are barely enough secure jobs for able-bodied people let alone satisfactory work for those who are living with depression or any other mental illness.

Depression is a killer. Ask The Samaritans. Ask the homeless charities. Just don't ask Gordon Brown. To him and his equally depressing chums – it's a myth.

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