Shining a spotlight on depression
The tragedy of Robin Williams' apparent suicide will have touched a chord with so many of us, but none more than the families and friends of people living with depression. Depression may be seen often among comedians - Peter Cook, Ruby Wax and Spike Milligan have all spoken about their battles with depression, and Tony Hancock too took his own life - but they don't have a monopoly. Clinical depression is common - about one in four women and one in 10 men will have at least one episode in their lifetime which is severe enough to need treatment.
But even more people - in fact everyone - suffers from 'depression' in the way in which the word is used today - I have patients telling me that they're 'depressed today' because their football club lost a friendly last night. This overuse (or rather abuse) of the word matters, because we forget just how serious the real thing is. Everyone suffers the odd setback which makes them feel down for a day or two, but to class this as 'depression' risks dismissing or downplaying a very real and potentially deadly illness. 'Real' depression - the medical variety - is categorically not something you can snap out of or overcome with willpower alone.
When doctors talk about depression, we're talking about a clinical condition that can have an overwhelming - and sometimes fatal - effect. Even within the medical term, there is a wide range of severity. At one end of the spectrum, you could have mild clinical depression which could last for weeks or months, but which still allows you to live a fairly 'normal' life, going to work and coping with day-to-day activities. At the other end, severe clinical depression can virtually paralyse you, keeping you a prisoner in your own home and carrying a high risk of suicide. To make matters more complicated still, some people suffer from a single episode, while some have repeated or long-term bouts of depression needing lifelong treatment.
Depression is an equal opportunities illness - money, love, career success or fame are no protection. To an extent, there is a relationship between the severity of your depression and your risk of suicide, but even this isn't clear-cut. We know that some groups are more likely than others to kill themselves - men more than women, young (under 25) and middle aged (40-45) more than those in between. People with a history of drug and alcohol abuse (Robin Williams had spoken publicly about both) are also at higher risk.
There are lots of tools used by doctors to identify people at high risk of suicide. But they aren't foolproof. A diagnosis of high suicide risk, like that of depression, depends on the answers someone gives their doctor. Newspaper headlines often run stories on 'benefits scroungers' who have fooled their doctors by giving all the right answers to be diagnosed with depression in order to avoid work. The same can be true of suicide. Some people will admit to feeling hopeless or suicidal, or to making plans to end their own lives. Doctors can often - but not always - help them. But some people finally decide they have run out of choices, and may hide their feelings to avoid healthcare professionals or family trying to stop them. Again, the doctor relies on what the patient tells them. There is no blood test or body scan for depression or suicide risk.
Being aware of what to look out for, and having rapid access to high-quality psychiatric services, can stack the odds in the patient's favour. But sometimes, as in Robin Williams' case, no amount of help is enough.