August 12, 2014
News Review From Harvard Medical School -- Robin Williams Dies in Apparent Suicide
Comedian and actor Robin Williams, who had fought substance abuse and depression, was found dead in his California home August 11. The Marin County sheriff's office said Mr. Williams apparently hanged himself with a belt. Mr. Williams, 63, had been "battling severe depression," his publicist said in a statement. After starring in the TV show "Mork and Mindy" in the 1970s, Mr. Williams had an honored film career. He created memorable characters in "Good Morning, Vietnam," "Aladdin," "Dead Poets' Society" and "Mrs. Doubtfire," among others. He won an Oscar in 1998 for playing a therapist in "Good Will Hunting." Mr. Williams struggled at times with addictions to cocaine and alcohol. In 2006, he checked himself into a rehab center to be treated for alcohol addiction. He said at the time that he had fallen off the wagon after 20 years of sobriety. Three years later, he had major heart surgery. Surgeons replaced a faulty aortic valve. Earlier this year, Mr. Williams checked into a rehab center again. It was described as an effort to "fine-tune" his commitment to sobriety. The New York Times wrote about Mr. Williams' career and death.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Based on what has been reported, Robin Williams was depressed and committed suicide.
It might seem paradoxical that someone with such success and so much humor to share could be depressed. But that is often the reality. A person can hide the sadness behind jokes and smiles. But he or she is hurting terribly inside.
Symptoms of depression might be triggered by unfortunate events. Most often, though, depression happens for reasons we are just beginning to understand. Clearly, genetics plays a major role.
I want to believe that if he had sought treatment for depression, Robin Williams would not have taken his own life. Without treatment, a severely depressed person can feel so awful and hopeless that he or she believes the only solution is dying.
This suicide, like any suicide, raises many questions. Did Mr. Williams convince his family that his depression was not that bad? Did he resist getting professional treatment despite urging from family and close friends? Did he start to use alcohol, cocaine or other drugs again to self-treat the depression? Did he actually start depression treatment, but too quickly concluded that it wasn't helping?
What Changes Can I Make Now?
Today depression remains a clinical diagnosis. That means it's based on symptoms. There is no blood test, genetic test or scan to diagnose depression.
A good screening tool for depression is to ask yourself these two questions:
- During the last two weeks, have you felt depressed or hopeless?
- In the same period, have you felt little interest or pleasure in your usual activities?
But if you are depressed, you may not even recognize these symptoms. So a family member or friend may need to be asking the questions.
If the answer to either of these is yes, seek help. Start with your primary care doctor, or reach out to a mental health professional.
Depression isn't the same in everyone. And feeling sad might not be the main symptom.
Here are some of the other symptoms:
- Trouble concentrating or remembering things
- Sleep changes (can't sleep or sleep too much)
- Anger or irritability
- Appetite or weight changes (can be either more or less)
- Reckless behavior, such as excessive alcohol use or reckless driving
- A feeling of worthlessness
- Thoughts about harming yourself
There may be reasons other than depression for these symptoms. But depression is a common cause.
If you do start an antidepressant, realize that it may take a few weeks to work. And the first drug chosen is successful only 40% of the time. Stay in touch with your doctor often. Report it right away if you feel worse or consider hurting yourself.
What Can I Expect Looking to the Future?
Of course, we need to respect the Williams family's privacy. But perhaps in the future family members or close friends would be willing to share what was going on the days before his death. These details might help others facing similar challenges in trying to help a loved one who doesn't acknowledge depression or resists getting professional help.