Letter to the Editor: About Depression and Suicide

By Robin Norman (Lucido)
Los Alamos

In the aftermath of yet another adolescent suicide, I felt compelled to respond to some of the commentary I have heard throughout the community of Los Alamos regarding suicide, depression, and mental health.

It was 8 months ago that I lost my little brother to depression and suicide. The horror, sadness, and shock I have experienced over the past several months was amplified when I heard that another young person had died and another family shattered by the horrific illness that is depression.

Major depressive disorder is a complex and sinister disease fraught with social stigma and isolation. The recent editorial published in the Los Alamos Daily Post, various Facebook posts, and general rhetoric in the community clearly demonstrate a lack of understanding about mental illness.

Anyone would acknowledge the absurdity of advocating for more love and less pressure to prevent cancer. No one would insinuate that an individual could cure himself of leukemia. Until we acknowledge that a disease cannot be “loved away” or that too much pressure causes fatal illness depressive disorder will continue to be a deadly disease.

I am currently studying medicine in physician assistant school and it has been a comfort to me in my own grief to understand what exactly causes an individual to become so sick.

As the community grieves yet another tragic death, it may provide some relief to understand the mechanisms behind the disease. Also, understanding the physiological and biological processes of depression should help dispel the myths associated with the disease.

While much more research needs to be done, current general medical consensus is that a number of identified causes play a role in major depressive disorder. The following is a brief synopsis of a few of the more established causes of depression, and explain some of the physical signs and symptoms displayed by individuals suffering from the disease.

One cause of the disease involves the dysfunction of neurotransmitters, chemicals responsible for brain cell communication and function. In particular, a group of neurotransmitters called biogenic amines play a key role in depression. These neurotransmitters include serotonin, norepinephrine, and dopamine.

A primary function of serotonin is regulation of a person’s personality. There are also several serotonin receptors throughout the limbic system, the area of the brain responsible for emotions and memories. Norepinephrine is in part responsible for controlling the body’s response to stress, as well as regulating sleep/wake cycles and attentiveness. Finally, patients with depression have low levels of dopamine, which may alter mood expression and motivation.

A person who is suffering from major depressive disorder also has associated anatomical brain abnormalities, including dysfunctions in the hippocampus and anterior cingulate cortex, areas of the brain responsible for forming memories and regulating cognitive function and emotion.

Various abnormal neuroendocrine regulations have been found in patients with depressive disorder as well. The major neuroendocrine axes that are affected include thyroid, adrenal, and growth hormone axes. These glands, axes, and hormones are responsible for regulating almost every essential function in the body. A particularly important hormone affected is cortisol, a stress hormone that is increased in depressed patients.

Depression is a complicated disease and it is absolutely true that environmental and social factors play. This fact is similar to all chronic diseases: diabetes, heart disease, hypertension, and cancer to name a few. It is entirely false to claim that depression is caused by these factors alone.

Perhaps depression is so misunderstood because other prominent chronic illnesses are easier to detect or treat. Depression has no simple blood test that can determine how sick a person is. Certain treatments may work for some patients and not others. Above all mental illness is incredibly complex.

Typically, the disease progresses slowly and may seem interwoven into an individual’s personality. Usually the patient does not realize the extant of the illness.

Worse, because of the myths and stigmas associated with depression, many patients feel guilty or embarrassed by their disease. Oftentimes, family members and friends have no idea how sick their loved one is until it is too late to seek help. Maybe this too is what makes depression seem different from other illnesses, the element of guilt in thinking one could have done
more if only one had known, or the pain in knowing how much a loved one suffered and the failure to realize they were sick.

However, to insinuate that depression is caused by a lack of love, or that a family or patient can wish away his or her illness is ignorant and damaging. No one can cure a fatally ill person by simply loving them more. What is needed in depression, as in any potentially fatal and complicated illness, is a team of medical professionals that understand the complexities of the disease and the best treatment. Only then can this terrible illness become manageable.

To anyone who wants to make a difference and prevent more suffering from mental illness, I would encourage you to learn more about the disease, educate others about the physical causes and devastating consequences of depression and other mental illness, and encourage policy makers to include legislation advocating for funding of new research and support for patients
with mental illness.

Of course all children, all people, need love and understanding. Sick people, those with mental illness, also need an end to the perpetuation of the falsehoods surrounding their deadly disease.