The mainstream media is focusing on the fallout of another high profile suicide. The information disseminated is similar: the number of suicides in the nation, the impact of depression, the silent suffering of individuals. All these areas are significant to report and repeat, but the conversation on the reasons for suicide is sparse, other than depression. The quick answer to the question in the title is "We don't know."
One area of information that is difficult to find is on trends among people who completed suicide who were using psychiatric medications or were withdrawing from the medications at the time of their suicide. Rarely does the public question whether medications treating a mental disorder is insufficient to manage depression or psychosis or whether the medications produce the reaction of self-injury. The question is not only that why a person ended their life but how they got there in the first place.
By all practical assumptions, Kate Spade appeared to be successful and everything going her way. This part of anyone's life - money and fame - is either directly or indirectly mentioned in articles, and tends to follow anyone with a high profile who committed suicide. Hers is no different. She had sold her company for millions, and was involved with beginning another company with her husband. Seems exciting. She also has a smart and talented 13-year old daughter. Seems then like she is deeply anchored in life. So, the self-destructive reaction to her unknown situation seems extreme and uncharacteristic to our culture's narrative of success breeds happiness.
The problem is complicated and I will only touch upon one area that is under-reported. The conversation on the possible dire and dramatic side (direct) effects of psychotropic medications needs to continue, and greater emphasis on the effect of impacting serotonin and dopamine levels has on suicidal thinking, as well as homicidal impulses. The relationship between medications and suicide/homicide is higher than expected, as prominently discussed with the effects of Paxil on adolescent suicidal impulses.
As psychologists and other mental health professionals know, when a depressed person suddenly begins to exhibit more pleasant behaviors and thoughts, there is care to consider that the person may have decided to take his/her life. We spend enough time with our patients to observe this possibility when it arises and discuss the possible connection between his/her happiness and suicide. However, we do not prescribe medications. The prescribing physician should also include clear and full disclosure of the impact these medications have on thoughts of suicide and homicidal impulses and what these thoughts may look like in their mind at the time. Psychologists and other mental health professionals should also be the first line of treatment before people consider taking a medication because we have more time to review the typical and atypical reactions to medications with the patient before they begin a regimen.
Let me make this clear. I am not saying that Kate Spade was taking medications before, or at the time of her suicide, but her high profile suicide should give us pause to consider all possible scenarios leading to a suicide attempt in order to address the precipitant suicidal ideation, especially those medications that have research support of a relationship but little public discussion on the frequency and duration of such episodes.
Consequently, greater communication between medical professionals who prescribe psychotropic medications (i.e. non-psychiatrists) and the mental health professionals who treat these patients. Yet, without a profit motive, these practices will, unfortunately, remain secondary to mental health patient care. Second, all mental health professionals should become better aware of medications, their reactions, and the latest, non-pharmaceutical supported research (i.e. PubMed) on more recent trends in the effects of these medications on impulses.