By now, few members of the human race have not heard the news about comedian Robin Williams, who took his own life the morning of Aug. 11. We don’t pretend to know Williams, but those who reach us through audiovisual media have a way of reaching our emotions, and so we feel a pang at their passing, whatever the circumstances.
Suicide seems unique in the grief it imparts to the loved ones of the deceased, but Williams’ demise gives us a moment to reflect on suicide and medical science’s efforts to treat the underlying conditions. So far, it seems medical science has made little headway against the principal root causes if the numbers are any indication.
‘Treatment-resistant’ no misnomer
According to this report by the American Foundation for Suicide Prevention, CDC numbers suggest suicide rates are pretty much flat over the past three decades, and took nearly 40,000 lives in 2011, good for 10th on the list of leading causes of death in the U.S. The report also suggests Williams was in the age group with the highest suicide rate, those between the ages of 45 and 64 (he was 63). Despite the dramatic nature of young suicides, those over the age of 84 had the second highest rate, so clearly this is not primarily a disease of tragic youth.
One does not have to do much reading to see that suicide attempts stem from a variety of factors, but severe depression and “bipolar” states seem to play a huge role. Drugmakers have been pounding away at these for decades, but they are tasked with developing a molecular entity capable of getting past the blood-brain barrier intact enough to render assistance without adding enough side effects of sufficient severity to turn the patient off. Not a small order.
A number of devices have arisen to step in where pharmaceuticals have stumbled, but the layperson (meaning yours truly) might not understand how difficult it is to develop a device that would put a stop to depression. According to this story, St. Jude Medical seemed to be on track for its Broaden trial for DBS treatment of depression, but it appears that deep-brain stimulation carries the technical challenge of locating the very precise spot where the electrodes must be implanted. That’s no cakewalk, either.
Cyberonics of Houston won an FDA nod for its vagus nerve stimulator for treatment-resistant depression last year, but the FDA announcement remarks that only 20-30% demonstrated a benefit at one year. FDA has done all it could to reclassify cranial electrotherapy stimulators into class III, but the pushback from secretaries of Defense and others finally nudged the agency into leaving CES devices in class II. Still, many of these CES devices are effective for only about 30% of patients.
Consequences condolences will not alleviate
We’ve all lost a loved one, many of us more than one. The loss of a parent, sibling or dear friend to heart disease, cancer and car accidents can take a year or longer to adjust to, and the loss of a child or significant other far longer than that. But God help the soul who has to stare at the ceiling night after night, struggling with what might have been had one little event – the touch of a loved one or a fortuitously-timed phone call – might have steered other events in a different direction.
That kind of thinking might fail to understand how relentless disorders of affect are, but to bury a very dear and fragile someone who took their own life is undoubtedly a unique kind of Hell, one we should all pray we never have to experience firsthand.