As with the vast majority of suicides that become known to us, in the days after the initial news was broadcast, the preventable tragedy of someone's suicide begins to drift away, that is, until the next suicide occurs. News reports tell the tale of mental illness - a scourge that tempers one's will to live - and then all of sudden, later in the investigation, the use of medications in managing the mental illness is discovered. The tale, however, never tells the tale from an alternate and equally viable perspective: Had the medication made the depression worse and chronic?
The most recent high profile cases that were covered by many news outlets were Anthony Bourdain, Kate Spade, and Chris Cornell. Anthony Bourdain's news coverage almost always cite his history of drug use and his struggle with depression, alluding to the relationship between the two, yet opioids and psychotropic medications get very little broad coverage on the real risks involved in a person's initial use and, more importantly, in one's chronic use. For example, two weeks passed since Kate Spade's suicide before one major news source - TMZ - reported on June 21st, 2018 about the presence of anxiety medications in Kate Spade's room, but no alcohol or illegal drugs, at the time of her death. Chris Cornell had anti-anxiety medication in his system, as the autopsy revealed, but the conclusion held by the coroner was that it did not contribute to his death. Directly yes. But, indirectly? No one is discussing the repeated correlation between suicide and psychotropic medications in the media. Hell, psychologists as a group are less likely to talk about it, let alone caution against it.
Psychologists, as all professionals who manage medical information, agree to obtain informed consent from our patients before we begin therapy or an evaluation. Informed consent ensures the patient understands all the possible risks in getting a procedure done, whether its psychological testing or participating in surgery or, for the purpose of this post, taking medication. Here is the problem. There are stated risks for all medications, but the degree of risk is very often clouded in poorly done industry-supported research or prescribed by physicians who are not properly trained in nuances of newer medications or who are not provided with information that conflicts with the industry marketing points. Further, as with the case of Kate Spade, the long-term effects of anxiety and depression medications on the psyche continues to be uncertain, and the preliminary evidence suggests a negative impact.
The ethical responsibility of the psychologist (and LPC's) is to provide our patients with the best available information so the patient can make the best choice for himself/herself or their child. Can the best choice be made in the absence of research results that fail to support the utility of a medication over placebo? Negative research results are difficult to find, but do exist (i.e. PubMed). Without this information, mental health professionals, nevertheless, will defer to the physician, who will almost never tell the patient to stop taking psychotropic medication when the range of medications attempted have never worked, other than creating an emotionless, fraction of the person. Is our ignorance, as mental health professionals, of the research on medication inefficacy sufficiently protect us from our ethical responsibility to our patients? The answer is more likely than not to be no. Don't assume that the pamphlet given to the patient was read or understood.
A recent article written in the Wall Street Journal by a practicing "Nutrition Psychiatrist" outlined the foods that promote calmness and protect against depression. There is no argument about food's ability to promote health, and, if fact, people actually stop feeling depressed and anxious, unlike the psychotropic medications that only "manage" the illness. Isn't it our duty to promote health for our patients? Most importantly, there is nothing in the literature that states that someone who ate a balanced diet with the appropriate nutrients suddenly decided to end their life.
This post was produced as a response to another story I heard first hand from a spouse whose partner, without a history of suicidal ideation or attempts, was prescribed an anxiolytic and antidepressant and, one month later, took a gun and left the spouse alone with two children. So, to anyone who is struggling with anxiety and depression, before you make the choice to spin the barrel with medications, seek help with changing your lifestyle (i.e. social, interpersonal, nutritional, familial). It may be a lifesaver.
Feed Your Head: Foods That Target Depression and Anxiety, July 26th 2018, by Kathleen Squires, in the Wall Street Journal