Robin Williams, Depression and Suicide in Midlife
One doctor offers insights into why treating depression is tricky
Robin Williams’ suicide serves as a sad reminder that depression is out there, playing a hidden, but often tragically, powerful role in people’s lives.
This problem can be especially pressing for adults in mid- to late life: A Centers for Disease Control and Prevention report released last year found that the rate of suicide among 35-to-64-year-olds had jumped 28.4 percent between 1999 and 2010.
In addition, notes Dr. Harry Croft, a psychiatrist, addiction expert and a chief investigator at the research organization, Clinical Trials of Texas, substance abuse among older adults has hit “almost epidemic proportions.” Substance abuse, he continues, can exacerbate depression and major depressive disorder.
Williams openly admitted to struggles with addiction, and just recently sought treatment to maintain his sobriety. His wife has also said that he was battling early Parkinson's disease.
Williams’ death is a devastating loss. His family and friends are left to grieve, while fans mourn the loss of the great art he had yet to make. It gives all of us an opportunity to better understand depression and suicide among boomers.
Croft offers these four insights on depression in midlife:
1. Stigma lingers around treatment. Croft notes that treatment for depression doesn’t differ that much in midlife sufferers, but people in their 60s and 70s grew up with a lot of stigma around depression. so they may be less likely to acknowledge the disease or accept treatment.
“I don’t know what went on with Williams and treatment,” says Croft. “But there is stigma toward getting psychiatric hospitalization for depression — more so than with substance abuse. People 30 years ago didn’t want to admit they had a drug or alcohol problem,” he says, but now it is more acceptable. Hospitalization for depression and other psychiatric disorders has yet to be as accepted.
2. Substance abuse adds to the problem. Rates of drug and alcohol abuse are high among older adults, says Croft, and that can compound issues of depression.
Why is substance abuse increasingly common in older adults? It’s not clear, says Croft, “but it may be that there is more clinical depression. Situational factors — medical factors, loneliness, frustration, guilt — may also play a role. Whatever it may be, substance abuse worsens depression.”
3. The word "depressed" is imprecise and overused. Today, people use the word depressed in the broadest possible way: "I’m depressed because my favorite TV show was pre-empted" or "I’m depressed because my tomato seeds didn’t take off this year."
The word can refer to a “minor or temporary sadness” says Croft, and this generalized use can unintentionally minimize the very real disease. For people suffering clinical depression, encountering this usage and the advice that often accompanies it ("You’re depressed? I felt that way once, too, and I started eating healthier and I felt better. You should do that, too!”) trivializes their problem.
Major depressive disorder is a brain disorder, says Croft. “If you’re suffering from it, this advice may not work, or it may make you feel guilty because you already tried it and it didn’t work.”
4. Side effects can be trickier to manage in older adults. In talking with patients through his role as medical director of healthyplace.com, a website dedicated to providing authoritative information and support to people with mental health concerns, Croft has observed that older people often hesitate to tell their doctors about side effects or ineffective treatment.
“People over 70 grew up in a time when a patient was a patient, a doctor was a doctor,” says Croft. If they’re taking the doctor’s advice but not getting better, they may keep it to themselves, assuming it is somehow their fault.
People of all ages may hide how they’re really feeling from their doctors, continues Croft — perhaps especially when it comes to mental health. This may be due in part to the fact that psychiatric drugs are very individualized and if it takes a while to find the right treatment for a specific patient, the patient may lose trust in the doctor during that trial-and-error period.
"They think, ‘Well, this guy doesn’t know what he’s doing [because the medicine isn't working and/or the side effects are bad], so I’m not going to tell him what’s going on and I’m not going to take his advice anymore,'" says Croft.
Older adults may also feel more isolated in general. “They may not have the support system they used to have because it was at work and they don’t work anymore or their spouse has passed,” says Croft. This lack of support may keep some older adults from getting necessary treatments.
If you feel you are in crisis (whether or not you’re feeling suicidal) you can contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Trained crisis workers staff the phones 24 hours a day, seven days a week. Calls are free and confidential.
The Institute on Aging offers a 24-hour toll-free crisis line specifically for older adults. Trained staff take calls from those in crisis and people who feel lonely and want to talk. The number is 800-971-0016.
For comprehensive information on depression, suicide prevention and other mental health topics, visit the website of the National Institutes for Mental Health.