Monday, March 30, 2015

Depression is *not* Psychosis

After the horrible #Germanwings tragedy, the media is aggressively pushing depression as the cause, and the word "suicide" appears in almost all related headlines. A few quick points:

(1) One of the very first things that mental health professionals ascertain, when confronted with a troubled person, is whether that person is (a) a potential harm to themselves, or (b) a potential harm to others. That's one of the first steps in assessment because those are two very different branches of behavior, requiring very different treatments;

(2) Depression and suicide are very different from the kind of psychotic behavior apparently exhibited by this pilot. It is wildly unfair to the many people who occasionally struggle with anxiety / depression to confuse them with psychosis;

(3) Partly because of (2), many who could/should get treatment for depression will be disinclined to do so, and that is a real shame. Stigma kills. It really does;

(4) Depression is treated in very different ways than psychosis and other issues tending to lead to harm of others. In fact, medications used for one may even worsen the presentation of the other, in some cases;

(5) Some of the SSRI medications widely used to treat depression can [rarely] induce psychosis, and for that reason, the SSRI industry (yes it has become an industry) really needs to insist that these are used in combination with person-to-person therapy;

(5b) I find it outrageous how casually certain medications are prescribed, typically by doctors with little mental health experience and usually without any regard to patients' access to supportive counseling, socialization and exercise habits;

(6) Many, many young people have depressive or even suicidal thoughts from time to time. It's really not that uncommon in our hyper-anxious, fast-paced world... and we shouldn't treat anxiety / depression like some taboo topic. My experience is that those young people who disclose and verbalize their thoughts and anxieties are far more likely to recover (although this is, to some extent, a tautology);

(7) In this case, it seems that this pilot faced the loss of his job if his condition(s) were revealed to his employer. Cosistent with (6), this tends to correlate with a poor outcome. Also, if he were perchance experiencing depersonalization as a [fairly common] side effect of his treatment, this might well have exacerbated or promoted the behavior. I.e. incomplete treatment might even be the cause of the tragic behavior. That is scary to me, given how widely and casually these medications are now prescribed.

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