Up Close With Dr. E

When depression kills


There are three basic types of clinical depression: Cognitive, somatic and affective. Cognitive depressions are based on thinking patterns — I call them “bent thoughts” — which activate when an individual becomes depressed. These thinking pattern include: negative thoughts about self (“I’m not a good person”); pessimistic thinking (“I’m never going to finish my degree”); and self-fulfilling prophecies (“since I’m going to fail anyway, why try out for the golf team?”).

Somatic depressions (derived from the word soma, or body) attack basic body or biological functions such as sleeping, eating, sex drive and levels of physical activity. Affective depressions cause strong changes in feelings (“I just want to cry all the time”) and a change in activities which used to provide the person a sense of joy or happiness (“I no longer like to work in my garden or be with my friends.”)

Cognitive (thinking), somatic (body) and affective (feelings) depressions are classified by the areas they attack. A different way to look at depression is by severity. Depression can be divided into two basic groups — large or small — based on how severely it strikes. A major depression is the most severe form and is the focus of today’s article. Minor clinical depressions, also called dysthymia, will be the subject of next week’s column.

You will now read a story about a woman named Emily. Her story is a lesson about the power which Major Depressive Illness wields when it tried to take her life ... My cell phone rings, and I take the call. “Dr. Elghammer, this is your answering service. I have a patient on the line, Emily, she is in crisis. Can I patch her through?” “Yes,” I say.

Emily is a bright and competent professional, but her husband has been having affairs, which knocks her down. She says, “Dr. Elghammer, I have three bottles of Tylenol and I’m going to take every pill. I can’t go on anymore” (as a pharmacist, Emily knows exactly what doses of medications are lethal). I tell her, “I understand you want out of your pain, but what about your twin daughters?” She answers, “They would be better off without me — I’m a terrible mother.” “OK,” I say. “But your suicide will blow your kids hearts out and they will never be the same.”

Emily replies, “I don’t want to hurt my kids, but I’m not able to be a good mother anymore, and I feel they would be better off if they were raised by someone else.” I asked, “Who would raise them,” and she said, “My mom.” “No,” I said, “they would be raised by their dad, do you want that?” She cries and says, “I can’t think straight anymore.” I then asked her if she could come into the office with her two kids immediately, and she agreed.

Emily arrives at my office with her two children. She agrees to this plan: her brother will stay with her children while Emily’s mother takes her to a hospital, where Emily can be safe, and begin the process of recovering from an episode of MDI. Emily’s story illustrates the “Rule of Sevens”: Suicide and Major Depression.

• One out of seven patients with recurrent MDI commit suicide.

• 70% of all suicides have MDI.

• 70% of suicides see their primary care physician six weeks prior to suicide.

• Suicide is the seventh leading cause of death in the United States. (Stephen Stahl, “Essential Pharmacology”, 2002).

If Emily had suffered a cardiac life-threatening event, such as a heart attack, the red carpet of care would be rolled out and she would be treated with compassion. What color of carpet will Emily walk on, as a patient suffering from a major depression? How compassionate will her family, friends, neighbors, workplace or doctors be to her? Will she be told, “Pull yourself up by your own bootstraps?”

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.