Robin William's death: The enduring stigma and mystery of depression

Celebrated Hollywood actor Robin William’s death, suspected to be suicide, turns the global spotlight on depression and suicide yet again. Apparently, the actor was struggling with depression, drug abuse and alcoholism for quite some time.The question everybody seems to ask is that why did Robin Williams, who had access to first world resources, including money, family and the best possible medical help, succumb to depression and commit suicide?[caption id="attachment_1662683" align="alignleft" width="380"] Hollywood actor Robin Willams was found dead at his residence early Tuesday morning. Getty Images[/caption]This situation even led to some judging him because they thought his suicide, apparently a culmination of his depression, was an act of cowardice. Indian actor Kamal Haasan’s reaction to the news of his death nearly pointed to such a conclusion. He said, "I like him for his talent. If the alleged story about his suicide is true then I dislike him for ending his life before his due date of expiry."This is the problem with depression. Different people perceive it differently and very few seem to understand it well. It’s a complex state of mood that folds in itself diverse, and possibly disruptive, mental states. It could completely throw one’s life out of balance and put one in perennial suffering even as for the people around, life can be absolutely normal.One loses interest in life and in things that once excited one, and in extreme cases finds life a perpetual struggle that death alone can put an end to. The causes for depression can be certain life events, non-psychiatric and psychiatric, but the consequences, although with varying severity, are similar - chronic personal suffering, and in many cases, suicidal thoughts.Although the suffering is intensely personal and severe, depressed souls are not alone. In America, where there is considerable awareness and medical support for the illness, antidepressants are the third most common prescription drugs. In countries such as India, where there is poor awareness of the condition and the possibility of treatment, and stigma on anything that is connected to the mind, the access to treatment is pathetically lower although it’s relatively cheap.In her remarkable 1994 book titled Prozac Nation, which was named after the wonder drug Prozac, American author-columnist Elizabeth Wurtzel wrote about her struggle with depression and how anti-depressant Prozac transformed it once she began treatment. Before anti-depressants, she was living in “a computer program of total negativity... an absence of affect, absence of feeling, absence of response, absence of interest.” She floated from one “suicidal reverie” to the next. But once on Prozac, her life changed in a few weeks.In a 2012 essay titled Post Prozac Nation in New York Times, doctor-author Siddhardha Mukherjee (who wrote the much acclaimed “Emperor of Maladies”) vividly describes the state of play on depression and anti-depressants.He looks at the basic premises of brain chemistry that once explained depression while presenting more evidence to show that it is still inadequate or incomplete, including the working of drugs such as Prozac and Paxil. The effect of the drugs makes sense in a lot of cases, but is completely confounding in may others.Although millions pop anti-depressants such as Prozac, Paxil and Zoloft, the science behind depression and the efficacy of the drugs is not black and white. “The latest research suggests that serotonin is, in fact, central to the functioning of mood, although its mechanism of action is vastly more subtle and more magnificent that we ever imagined,” he says.What is serotonin and its connection to depression and how does drugs such as Prozac work on that?Serotonin is a brain chemical that is found to be linked to depression. The anti-depressants either increase the availability of serotonin or send more signals across the “mood-maintaining wire” in the brain.The key to a near-normal life with depression is medical attention and psycho-social support. All cases of depression may not need popping anti-depressants, but a modification of one’s life situations, family support and treatments such as cognitive therapy. Those who require drugs, need careful follow up besides conducive psycho-social environment.It’s a complex science and those around people suffering from depression need to pay attention. Siddhartha Mukerjee writes:

“We possess far fewer devices to look into the unknown cosmos of mood and emotion. We can only mix chemicals and spark electrical circuits and hope, indirectly, to understand the brain’s structure and function through their effects. In time, the insights generated by these new theories of depression will most likely lead to new antidepressants: chemicals that directly initiate nerve growth in the hippocampus or stimulate the subcallosal cingulate. These drugs may make Prozac and Paxil obsolete — but any new treatment will owe a deep intellectual debt to our thinking about serotonin in the brain. Our current antidepressants are thus best conceived not as medical breakthroughs but as technological breakthroughs. They are chemical tools that have allowed us early glimpse into our brains and into the biology of one of the most mysterious diseases known to humans”

Given this context, there is still a lot of approximation in the treatment for depression - some succeed while some fail, and hence families and friends need to constantly reach out. Perhaps, the treatment failed Robbin Williams, or his guilt and perceived sense of worthlessness, the commonly recurring emotions in people with depression, were too overpowering.