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Posts tagged ‘depression’

Robin Williams Cause of Death

There can be no doubt that we lost a great talent when Robin Williams died a couple of weeks ago.  We all know that he took his own life but I feel that explanation of why Robin Williams died is grossly insufficient.

There are only four ways to die.  Suicide, Homicide, Natural Causes and by Accidental death.   Saying that Robin Williams committed suicide is like saying that someone who died of a heart attack died of natural causes.  Both statements are true but we would not be satisfied with ‘natural causes’ as an explanation for the death of a loved one.

Depression is like many other chronic illnesses.  For most people who commit suicide, it is the end stage of the disease but not everyone who has depression dies from it.  Similarly, many diabetics and heart patients die from other causes.  Arthritis is seldom fatal but it is a chronic disease that makes life miserable for those afflicted.

Depression and suicide in the elderly are common but you might not know it from reading clinical records.  The PH2 is an accurate brief screening but somehow it just isn’t working in home health.  It is a frequent occurrence that we read charts of patients discharged from the hospital after having a life changing cardiac event,  are in great pain, can’t do anything for themselves and report zero to one day of feeling down or depressed.  Amazingly, they have not lost interest in doing things.

Depression as a comorbidity increases healthcare costs of other illnesses by 50 percent.   Primary care physicians have roughly a one in two chance of missing depression.  Elderly white males are especially prone to depression and commit suicide more than the general population.  Remember, many of these men were raised to be tough, have gone to war for us and worked to take care of their families long before it was ‘okay’ to expect a woman in the home to contribute financially.  They are not okay with being ‘weak’ and they do not think of the pain of depression as a medical problem.

There are some diseases like Parkinson’s that seem to trigger depression more than others.  Cancer, heart disease, Alzheimer’s Disease and arthritis are others.  Medications used to treat one illness can cause or exacerbate the illness of depression.  Your patients are at risk simply by virtue of the fact that they are your patients -confined to the home (isolation), sick and are usually taking multiple medications. 

There is no gadget like a glucometer to assess for depression but, it is worth your time to assess for depression; not just on admit but frequently throughout the episode depending on the patient’s risk factors.  More than 80 percent of people with depression can be treated successfully but many never even realize they have an illness.

Consider that every 90 minutes an elderly person commits suicide.  We have seen glimpses of how Robin Williams’ family is hurting now.   Multiply that by 19 families per day.  That’s a whole lot of tragedy.

Countless more are suffering from depression that won’t be terminal.  You can do something about that.

The Williams family has one advantage that many survivors do not have.  Robin Williams was obviously loved by his wife and children, had many good friends and the insight to seek help.  As with other illnesses, sometimes the disease wins no matter what efforts are taken.  Imagine those families that do not recognize depression as an illness, who do not have the insight to seek help and can only see how predictable a suicide was in hindsight. 

Below are some good resources for depression.  If you find something good, send it to me or post a link on the Haydel Consulting Facebook page so we can all benefit.  Depression is a complicated, tragic disease and more than most health care professionals, you are in a position to do something about it.

Geriatric Mental Health Foundation
7910 Woodmont Avenue
Suite 1050
Bethesda, MD 20814

American Association for Geriatric Psychiatry
7910 Woodmont Avenue
Suite 1050
Bethesda, MD 20814
(301) 654-7850
American Association of Retired Persons
Program Division
601 E Street, NW
Washington, DC 20049
(888) 687-2277
National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
(800) 969-NMHA
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
(800) 950-NAMI
Depression and Bipolar Support Alliance
730 N. Franklin, Suite 501
Chicago, II 60610
(800) 826-3632
National Institute of Mental Health – Public Inquiries
6001 Executive Blvd.
Room 8184, MSC 9663
Bethesda, MD 20892-9663
(866) 615-6464 (toll-free)
American Geriatrics Society
The Empire State Building
350 Fifth Avenue, Suite 801
New York, NY 10118
(212) 308-1414

That Horrible Thing on Everyone’s Mind

I have been consciously avoiding the news this weekend.  I understand and am deeply saddened by the events in Connecticut like everyone else.  Sadly, there is nothing that I can do.  One more card from a stranger isn’t going to ease the burden of a small town that experienced 28 senseless and violent deaths in one day.  The pain is unimaginable and the fact that we can’t do anything about it frustrates us.

The truth is, when we focus so intently on a single thing, everything else in our lives is pushed to the shadows.  The Sandy Hook shootings are very important.  Make no mistake.  There are lessons to be learned and studies will take place and hopefully policies will be changed.  But not tonight and I am pretty sure the real lessons will not come from people on the news channels shouting over each other about gun control, access to psychiatric services, etc.

If you are reading this, you are likely a healthcare worker or work closely with health care workers.  As such, we are in a unique position to take the information we already have and put it to use in very important ways. As a professional, you can even make it a point to learn more about mental health issues.

We talk about healthcare politics a lot.  Gun control seems to be a very popular topic.  We talk about access to mental health care.  But what I have noticed in my work lately, is that we ignore mental health.

I see Zyprexa in a med list with no psychiatric diagnosis.  I see patients assessed as having no signs and symptoms of depression in the past 14 days even though they have just been released from the hospital status post open heart surgery.  If I am reading charts in areas I frequent, I will notice that a young person is living in an assisted living facility and ask why?

Sometimes I see reference to ‘drug seeking’ behavior as though the patient isn’t behaving properly.  I see enough written skillfully to read between the lines when a patient’s medications are being stolen by relatives.

These issues are not grounds for denials and I cannot recall any state deficiencies related to lack of a diagnosis related to Zyprexa.  I would certainly see a denial if a patient with high blood pressures went an entire episode without them being addressed.

So, it isn’t just ‘us’.  We have a culture that overlooks mental illness as being unimportant.  There is no lab test for it.  Patients with mental illness are often on Medicaid and we all know how undesirable a boatload of Medicaid patients are.  The interventions for psychiatric conditions are vague and the language used to describe psychiatric symptoms is strange to us.

Our patients are hardly likely to go on a shooting spree.  That is not the point.  My point is that if we, as health care workers, do not recognize, acknowledge and do our very best to treat mental illness, we are failing the patient.  That is true even if you are not a psychiatric nurse.  Patients admitted for any reason should have their primary diagnosis plus all diagnoses that affect their ability to participate in or respond to their plan of care addressed.

I’ve started you out by uploading some ideas taken from the internet on rational behavioral therapy that you can discuss with your patients who are depressed.  It sounds much more complicated than it is.  Don’t get me wrong – I love a good antidepressant as much as the next person but it is not enough to simply ignore depression while you wait for the meds to kick in.

As long as we continue to pretend psychiatric illness does not exist, we can hardly complain when others do the same.

You with me on this one?

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