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
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4 thoughts on “Madison Holleran: we must increase the dialogue about depression

  1. Thank you Dr. Wexler for this excellent article. More needs to be written about the problem of suicide in our youth, even the one’s that are so successful are at risk. As you know I lost my own daughter to suicide 4-11-13 and no one even knew she was depressed.

    • I am truly sorry for your loss, Rhonda! Please do not lose contact with Dr. Wexler or ensure you have been referred to a psychiatrist of high standing/regard amongst her or his peers.

      Everyone grieves differently, so don’t try forcing anyone else’s path and/or expectations on to yourself (& don’t let anyone else do the forcing). Take everything at your pace and by your your path, but never take it on alone! Rhonda, just speak up and let your family and friends know what you need! Most, if not all, will feel so much better knowing they are of some help to you.

      I am still taking it one day at a time and begrudgingly, I have survived the loss of my own daughter; but not without help from others and not without pain, confusion, guilt, anger, good days, bad days….

      Please be kind to yourself!


  2. You must remember, though, that just like drug addiction, a person must WANT help. My mother committed suicide at the age of 61. I went with her to her last doctor’s appointment. She was offered resources to get help; I offered her help; my father offered her help. She was already on medication for 8 years prior to her suicide, and in the end, suicide was still the outcome.

    • I am so, so sorry for your loss. It is a tragedy your mother was not able to get the help she needed.
      I have to say I have not found suicidal ideation to be equivalent to addiction. With addiction, the substance is activating the reward center in the brain; it is giving the user a feeling of euphoria. When we say a person has to “want help,” we mean that person needs to have a sufficiently high level of motivation for the patient to feel strong enough to give up that feeling of euphoria. Getting someone to that level of motivation can be tricky, to say the least.
      There is no evidence that suicidal ideation resulting from depression is giving the person euphoria or affecting the reward center. A person may have a feeling of relief at the thought of suicide, but it is not a feeling of euphoria, it is a relief from severe pain. What I have encountered is that suicide results when inadequate care is offered. Either it is a level of care that is not sufficient to the intensity of symptoms, ie, the patient is receiving therapy with no medications, or outpatient care when hospitalization is needed, or patient is receiving therapy or medication that does not target the specific symptoms. We still have a long way to go in making adequate care accessible to everyone who needs it.
      I hope you have people in your life who can comfort you in your life. I hope also that you are able to get help if you experience depression.
      Dr. Wexler

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