As most of America now knows, Robin Williams struggled with depression. He also battled through a history of substance abuse, heart issues and cardiac surgery. Each increases the odds of depression. Depression and bipolar illnesses underlie the risk of most suicides.
By conservative estimates, 1 in 6 Americans has lifetime depressions, bipolar illnesses or related disorders, and an astounding 75 to 80 percent of deaths by suicide can be linked with these mood disorders. The multiple underlying causes of depression must be treated more effectively if we are to lessen the scourge of suicides.
If we listen and respond, that may be a powerful farewell message from Robin Williams.
Americans confront the horrors of an estimated 40,000 suicides annually. As a nation, we question why. We lament. Here at the National Network of Depression Centers, we lament as well. We know that effective and individualized treatments are needed to resolve underlying causes of mood disorders. Sadly, as a nation or globe we have not launched adequate efforts to attain them.
What is meant by individualized treatments? Most fundamentally, depression and bipolar illnesses have multiple causes so treatments must be tailored to the different causes if they are to be effective. Some are caused by genetically mediated changes of brain circuits and may involve different chemical messengers such as serotonin, norepinephrine, dopamine, glutamate or proteins that feed brain tissues. Other types of depression are linked with endocrine illnesses, substance abuse or head traumas. Some are set off by cancers, heart diseases or surgeries. Life stresses clearly play a role. Bipolar episodes can be set off by global travel and sleep disruptions.
The list is longer, but the point is made. Not all types of depression have a single cause, but because of knowledge gaps, we tend to treat them as if they do. The results are too often tragic.
To diminish suicides, we must first mobilize the steps that are at our disposal.
First, use the exciting scientific tools we now have, such as genetics, pharmacogenomics, brain imaging and others, and conduct long-term studies among thousands with depression and bipolar illnesses, not 10s or 20s.
Second, develop evidence-based clinical biomarkers, the laboratory tests that will enable us to differentiate one cause from another.
Third, emphasize public-private partnerships between academia, industry, biotech firms, the National Institutes of Health and foundation-funding agencies to develop new individualized interventions for the underlying causes.
And fourth, conduct the clinical trials necessary to guide clinicians of all disciplines who treat those who suffer.
The National Network of Depression Centers was formed to respond to these challenges. More than 500 members from 21 academic medical centers are united in efforts to advance the research and treatment of mood disorders and orchestrate a national action plan. The Bay Area, where Robin Williams resided, hosts two Centers of Excellence — one at UC San Francisco and one at Stanford University.
But the NNDC and its individual centers cannot do it alone. Williams' death raised public awareness. Had his depression improved and had he survived, he might have educated us, encouraged the needed research and clinical investments while simultaneously making us laugh. That opportunity is lost, but his untimely death now screams for a change of course. He would want us to join hands to help find the right treatments for the right people at the right time. Cancers and cardiovascular centers have followed that pathway with often-dramatic improvements. The time has come for us to do the same for depression and bipolar illnesses.
Dr. John F. Greden is the founding chairman of the National Network of Depression Centers (www.nndc.org) and executive director of the University of Michigan Comprehensive Depression Center. He is also a past president of the board of directors of the American Foundation for Suicide Prevention.