Op-Med is a collection of original articles contributed by Doximity members.
Many people in our country, or I should say in this world, have been shocked and devastated by the recent suicides of Kate Spade and Anthony Bourdain. Many wonder how someone whose life looks so perfect can be depressed. Well, people are starting to recognize that anyone, no matter how successful, how rich, how attractive, etc. can experience severe depression.
Many of our well-known adages acknowledge the fact that anyone can be vulnerable to depression. We have heard from a young age that “money can’t buy happiness.” Or perhaps your mother or grandmother always told you, “don’t judge a book by its cover.” Well, mom and grandma were probably right all along.
Many who suffer with severe depression feel significantly misunderstood. They think that no one can understand the depth of their pain as they “don’t look sick.”
Perhaps this feature of feeling misunderstood is actually heightened in people with success and fame.
When everyone looks up to you and gives you TV ratings and buys your products, it often means it is harder to find people who can empathize with your pain. This causes further isolation, which exacerbates their depression.
Falling Down the Happiness Scale
Is it possible that success makes a person more vulnerable to depression? Or, is achieving a “higher level of happiness” a risk factor for more severe depression? I don’t have any statistics on this, but I have seen many scenarios in my practice that make me wonder about this possibility.
I am sure many of us have also seen examples similar to this in our own lives. For example, most everyone has gone through at least one heartbreak in their life. It is almost one of those rights of passage in being a human being. The pain felt after a breakup can be very intense, almost unbearable, for some people. Sometimes the person suffering the heartbreak will say they were just fine before they met the person. Losing the relationship did not just bring them back to that prior baseline “happiness level” they had prior to meeting this person. Rather, being in the relationship made them so happy that losing the relationship caused them to go through a steep fall on the “happiness scale.” So, the fall from this extreme happiness to the pain of the heartbreak is a much greater fall in “happiness levels,” which subsequently creates much more severe emotional pain.
There are similarities to the person who achieves great success and then realizes it is not what they imagined it would be. They may at some point feel the joy of their success and achievements, but these positive emotions may fade when the reality of success does not live up to what they dreamed it would bring to their lives. Perhaps the momentary joy of achieving success is so significant that the emotional pain of a reality that doesn’t match their dreams may lead to a very steep and painful fall into despair.
Similarities to Patients with Bipolar Disorder
Some theorize that the reason that many bipolar patients experience such extreme, treatment-resistant depressions is that they are also falling so far down the “happiness scale” when they fall from mania to depression. Perhaps their depression is not “worse,” per se, than the depression of someone with unipolar depression, but it feels worse as the fall down the “happiness scale” is so much steeper to them.
Similarities to Patients Who Have Received Ketamine Treatment
I have had several patients transferred to me who have had their severe depression treated with IV Ketamine, a newer treatment for treatment resistant depression. I have seen patients who have had success in resolving their depression with ketamine. But, in more of the cases, they eventually become depressed again. Sometimes they will tell you the that depression is more severe than it was prior to the ketamine treatment.
These patients often say that the ketamine worked “too well.” These particular patients explained to me that they never knew how happy they could feel until they were treated with ketamine. So, they explain, that when they fall back into depression after the ketamine impact has faded, their depression feels much worse. They have fallen from a happier place, and the fall was much steeper, therefore much more painful.
I can’t say that these few patients represent the impact of ketamine treatment on all patients, but their experiences do provide some insight. We don’t really have any “happiness scales,” and there are not any actual measures of a “happiness level” to guide us in understanding the true depth and pain of a person’s depression.
Raising Awareness. What Can We Do?
These recent celebrity suicides have raised awareness on how we cannot always gauge happiness or depression based on outward appearances. How can we be so oblivious to the pain of others? What can we do to help? Some methods of helping are the simple lessons from mom and grandma, such as “Don’t judge a book by its cover.” Also, take the time to actually listen when someone tells you about their emotional pain.
Another important goal is to raise awareness in your communities for the need to keep funding suicide prevention hotlines. Many patients I have seen over the years have utilized these suicide hotlines, and it probably really was a lifesaver for them.
Reducing Mental Health Stigma
Hopefully, increasing our overall understanding of the underlying physiology of these mental health conditions will also reduce the stigma that has been associated with them. Some people who stigmatize mental illness don’t view these conditions as “real diseases.” If we can utilize objective data in the management of psychiatric conditions, understanding and acceptance may become more commonplace. Stigma, then, can fade as well, since objective data will show these diseases as being more “real.”
We all have opportunities to be supportive and empathetic to individuals suffering from mental illness. These people are all around us, in all domains of life. We just need to be sensitive to it in order to recognize it. Making efforts to understand the pain of others, to not judge, and to show empathy will go a long way in helping minimize the severity of their pain and hopefully reduce the number of tragic outcomes like the world has witnessed recently.