Mar 13

Madison Holleran: we must increase the dialogue about depression

by Dr. Micaela Wexler

On January 17, 2014, Madison Holleran, an accomplished athlete and student at U Penn, jumped to her death. She seemingly had everything going for her. She was popular; she had a family who was close and supportive; she was academically gifted, having earned a 3.5 GPA her first semester at an Ivy League university; and she was a talented athlete, running on the school’s cross country team. An hour before her death, she had been making dinner plans with friends.

“You can’t really understand why a girl who seemingly has everything going for her would want to end it,” her father said.

Her death shocked so many in her college community as well as her home town who reported there had been no clues, no warning signs. People all across the country have been saddened by her death, not only because this is a tragic loss to our society, but because her death strikes fear in so many that this could happen to one of their loved ones.

As a psychiatrist, I treat a large number of people who have been left permanently scarred by the death from suicide of a loved one. Several people have expressed the fear that if suicide could claim the life of someone “who had everything,” what is to keep their loved ones safe?

One of the reasons Madison Holleran’s death by suicide was so shocking is that relatively few people in her life were familiar with the facts of her depression. Those who were found themselves at a loss as to how to help her, and were not aware of the serious risk depression poses to those it affects. The stigma of mental illness is so great that people who struggle with depression suffer in silence and isolation.

As a society, we do not know how to help people with depression. Many people do not recognize that when a person has become irritable, is feeling unmotivated, has lost interest in things that were once enjoyable, is complaining of having low energy and not being able to sleep, that person is not being lazy or “needy;” that person is most likely depressed. That person is potentially in danger of losing his or her life to suicide.

There is not enough dialogue about depression for most people in the midst of their despair to know that there is treatment available that works, that will make them feel better. This was illustrated a while back by a patient who came to see me for his monthly follow up in the clinic. He was a college professor at that time, in his 50’s. He was (most likely still is) bright, witty, very popular with his students, and a joy to see in clinic. Two years earlier, he had become acutely suicidal, and his wife had the wisdom to bring him to me for an emergency visit. She was able to petition to have him admitted to the inpatient psychiatric unit against his will. Several months later, he again became suicidal, but at that time, he entered the psychiatric unit voluntarily.

One day, as I asked my routine questions about suicidal ideation, he said to me, “That first time, I just didn’t see how it was possible to feel anything but despair. There was just too much going on in my head for me to have anything resembling a rational thought. To me, suicide was rational. Then you put me on the mood stabilizers, threw me into those groups, and by the end of the week, I was feeling better. Suicide became a ridiculous idea. The next time it happened, I knew that I would feel better. I knew that this feeling of despair would go away , that as soon as I changed my medications and got some therapy, it would go away. I just needed to get to that place.”

As a college professor who had himself been suicidal, suicide among college students was something my patient thought about regularly. He mentioned it every month at his regular visits. “There has to be a way to let EVERYONE know that there is stuff that WILL make that desperate feeling go away, that there are medications, and that you can spend a few days going to groups and coloring and talking to people and you’ll feel better!”

For me, as a psychiatrist, the greatest tragedy of Madison Holleran’s death by suicide is that even though she was in an environment with so many resources and knowledge, the information about treatment and its effectiveness remained elusive to her and her family. As so many patients tell me, “that desperate feeling is so painful, you finally just snap and want to make it go away!” They always emphasize to me how important to their lives it is to know how to get treatment.

There is a way to make the pain go away. You don’t have to jump off a building or jump in front of a car. There are therapies and medications that really do work. Suicide is the SECOND leading cause of death among college students. This is a tragedy that should not be happening on college campuses. Information about depression and treatment should be ubiquitous.

All students and professors should know the warning signs for suicide: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

Mental health services need to be made truly accessible. Every student, parent and professor should know the numbers to call if someone they know is depressed. The number 800-273-TALK should be on everyone’s bathroom mirror and refrigerator. Substance abuse on college campuses needs to be addressed. We need to recognize that it is not a benign part of college life, but rather a potential warning sign of depression and a risk factor for suicide.

Need help? In the U.S., call 1-800-273-TALK (8255) for the National Suicide Prevention Lifeline.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

Early diagnosis beneficial in AD
Appointment information for Dr. Micaela Wexler:

Mar 04

SAD? Or just blue?

PeaceWinter2By Dr. Micaela Wexler

Are you feeling the post-holiday let down? After all the parties are over and the guests have left, many people feel anxiety, disappointment and depression. That is normal.

However, if you are feeling depressed, tired, weak, achy or ANGRY, you might be SAD
The “winter blues” might be something more: you might have SAD – Seasonal Affective Disorder. This is a type of depression that occurs every year during the winter months. It’s not just the “winter blues,” which is a feeling of mild disappointment and irritation most people get as they cope with the challenges of winter.

How do you know if you’re SAD and not just blue?
People with SAD feel the following:
- worthless, guilty, tense
- fatigue
- down and depressed
- arms and legs feel heavy, achy
- increased headaches
- irritable
- worried, increased checking behavior
- indecisive
- increased urination, heart palpitations, stomach aches
- difficulty focusing
- suspicious, paranoid, think co-workers don’t like them
- increased difficulty starting the day
- increased insomnia

These symptoms go on for at least two weeks at a time and can recur. They start in late fall and fade away in early spring.

It isn’t in your head. Well, actually, it is: it is caused by your hypothalamus, a part of your brain, secreting more melatonin when your eyes are exposed to less sunshine. So, if you’re having insomnia, don’t take melatonin. When light hits are eyes, melatonin starts to go down.

There is also a decrease in serotonin caused by a decrease in physical activity. An additional contributing factor is the disruption of your circadian rhythms by the change in weather, shorter days and change in routine. Many people first notice these symptoms following the time change.

SadWomanWexlerPsychiatryWomen are at higher risk, as are people with a family history of depression. Living far from the equator doesn’t help.

There are some dangerous symptoms you should not ignore:
- feeling suicidal, or feeling that life just doesn’t matter – get help right away
- irritability leading to behavior that is out of character: yelling at co-workers, engaging in physical fights or road rage
- social isolation that is out of character – missing the company holiday party even though you are known as a social person, for example

Why you shouldn’t ignore it:

- Decreased focus can lead to problems with work, increased debt, child neglect
- SAD can become major depression
- suspicious thoughts can cause irreparable harm: premature termination of a job or relationship. Many people file for divorce during these months.
- your immune system can become depressed

Treatment is easy and effective
- Increase physical activity – increases serotonin levels
- Watch your diet: beware of giving in to carb craving; eat more nuts and fruits – maybe this is why fruitcake is a traditional fruit at this time of year
- Eat more walnuts – have been shown to help make you less SAD
- Make home brighter
- Bundle up and step outside – nothing makes your home feel warmer than stepping in from the cold
- Light box therapy
Does light therapy work?

Yes. it is supported by at least two meta-analyses. It also works for non-seasonal depression. Most companies will your refund money in 30 days if symptoms don’t decrease.

What type of light works?

Bright sunshine in the morning works best – not available in the winter time
10,000 lux for 30 minutes
5,000 lux for 60 minutes

Light boxes – what to look for:

- beware of blue light – not proven to be effective, may cause macular degeneration
- light must shine in your face
- 10,000 lux – 30 minutes
- research shows the bigger the better, less lux requires longer exposure

Look at lux distance
- 22 inches: normal distance from computer when working
- 28 inches: distance from computer when you lean back in the chair

Dawn stimulators:
- require longer exposure
- effective – eyes more sensitive in the morning
- help reset sleep-wake cycle
- convenient – can use in bedroom

And, I can’t stress this enough, if you feel suicidal, please call 911 or go to the emergency room.

Early diagnosis beneficial in AD
Appointment information for Dr. Micaela Wexler: