Dr James Schaller

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The Prevention of Suicide Begins Now: A Testimony to Michael

We have an extremely high level of success in treating Major Depression. In fact, as of this time, we only have one patient still struggling with active depression - though even he was fine for years. He merely developed many serious medical problems, which challenged his body.

So my general approach and belief is that biological depression (another free article topic on this site) can be prevented. And it can be successfully treated the rest of your life.

Since I work with a number of exceptional and open physicians, we share losses. One we shared was the loss of Michael.

He had mild depression for so long he felt that was "just the way life is." The world has no reds and blues, he felt, because he looked at life with a grey lens. Yet he was reasonably successful in his business and marriage. Then one winter he started to feel much worse and was finding it hard to work, enjoyed nothing in life, was irritable, felt like a failure and had sleep and eating changes. He was also more nervous than usual.

He was treated by a good family doctor with Zoloft.

He got a bit anxious because the pill dose was still too high for someone with anxiety and he stopped it. He did not seek further care, believing, "This is just how these things work. I tried medication and it failed." He came to see me at the insistence of a friend I had helped.

He was obviously expecting our work to be a complete loss of time and money. We quantified his depression with a brief questionnaire to see how bad it was. He resented these, and I had to sell them - "they help me to see improvement on retesting, and help you to get insight into your problem."

His depression scale was a 44. Normal is 0-10. He was a hurting puppy and anxious.

Simply, we offered him a number of treatments, met every week for 10 weeks, and then his score was 3. Going from a 44 to a 3 is as good as it gets.

He was very happy and excited. "I have never felt so good. I am better at work, less afraid about work, and my wife is very pleased with the change.

Then it started to get dangerous. Listen closely.

We agreed he would send me a scale monthly by fax. He did not.

We agreed he would see me no less than every season. He did not.

When he felt better, he decreased and stopped his medications and saved them. Surprisingly, he did not relapse. Not right away.

Unfortunately, he regarded biological major depression as a mole - cut it off and you are done. Meaning, treat one bout and it is gone.

He also regarded the medicine as an enemy he must defeat. He seemed to feel shame about the medication. "If I take it, I am flawed, a loser and I already feel poorly about myself. So decreasing the medication will make me feel less flawed."

Likely, Michael felt poorly about himself when he did not take the medication. Meaning, he had it reversed. If you start getting depression you will feel more like a loser and flawed. The solution is not to bag the treatment - you modify the treatment. If you start feeling like a loser with an identity in the gutter, it often is one symptom of depression.

He ignored my letters and calls for a follow up appointment. All I got was, "I am doing fine. I see no point."

One point he forgot was that medication levels fall as time goes on. Your liver makes enzymes to chew up a medication and the level goes down in the blood on the same constant dose. Your starting dose usually needs to be increased as your liver gets used to the medication.

Medication is not all or none - the dose must be tailored to each person carefully. And like a tailored dress or suit, the dose may have to tailored again as you change, and lose or gain weight.

And when you are feeling well, you need to look at future kinks in your armor that would make you vulnerable to relapse.

He decided to transfer his care back to his intelligent family doctor, who had an office right down the street.

I got a call 6 months later that he wanted me to see his older brother - his "best friend" who had cancer. I left two available times, despite not really having the openings with 2 days notice, and received no call back.

His brother died in October and this understandably hurt Michael badly. I sent a sympathy card, and hoped Michael would get himself plugged in again with me, and not just work 80 hours a week at his job. I knew he had a good family doctor, but after so much time had passed, I suggested a brief check-in with me was wise.

Never heard from him again.

His family doctor and I got a call from the coroner on New Years Day.

Michael had taken his life by suicide.

Why am I writing this testimony?

Michael was a sweet man. I liked him a great deal. He leaves behind a family. Thankfully he had insurance for their needs. But they would prefer him.

Unfortunately he teaches those that are behind serious lessons:

  1. Major Depression isolates you and makes it hard to reach out for help.
  2. Do not assume a past dose will be the correct dose in the future.
  3. Do not self medicate. If you like medical TV shows like General Hospital, fine, but do not pretend to know it all. Internet research and book reading is good. But it is only a start.
  4. If a doctor says you need to be seen at a certain frequency, just do it. There is a reason for the frequency.
  5. Do not assume that if you feel fully normal, that you do not need to be monitored to maintain your recovery. You need some monitoring.
  6. If you have suicide in your past blood relatives, in your past, or current suicidal thoughts, only get treatment from a qualified psychiatrist. You are at higher risk to die.
  7. If you are only getting 10-minute HMO medication checks, and want more time, get more time. See someone privately who will give you what you need to live. And if you must stay with a shorter session in an HMO please get to the point if you are suicidal - tell them. And ask for a prompt follow session because you are suicidal.
  8. Major Depression, I believe, is likely 100% treatable. That does not mean the first medication will work, or even the second, but there are many new treatments. And at times we can combine medication, natural hormones and nutrients to achieve full recovery.
  9. Be careful in saying your depression is due to external things like a divorce, death of a loved one or work trouble. These things can feel like an elephant on your chest, and make the biological depression manifest. But "pull yourself together" or "it is all because of your tough times," is a nice 1940's view of the brain. It is not faithful to reality in the third millennium. We know major depression is present in 1/5 woman worldwide, aged 14-44. It is the number one illness in this group. But it afflicts many other groups, including 1/10 men.

In my heart I offer up an affectionate and caring salute to Michael. He was a victim of a demon that blinded him and shut out his hope. Let us hope his blindness and great suffering may allow others to see and to stop the suffering of biological depression.

If you have read this perhaps you can be part of the solution and pass this along to those who might be in need or have loved one's in need.

James L. Schaller, MD, MAR

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