Robin Williams - Depression’s Silent Clues

depression-silent-clueThe issues of depression and suicide have been in the national spotlight in recent weeks following the recent death of actor Robin Williams. The sudden loss of a talented actor and humanitarian has put attention on problems which are often unrecognized, leaving millions of people throughout the world feeling hopeless. Suicide is among the leading causes of death for people of all ages in the U.S., with suicide rates among males being four times greater than in females. (1)

The relationship between depressive symptoms and medical illnesses has been recognized for some time. Depression occurs in up to one third of people with chronic illness, making the incidence of depression in people with chronic health problems higher than in the general population. Depressive symptoms may present themselves at the time the diagnosis is made. In those who are already depressed, the diagnosis of a chronic, debilitating illness can complicate an already difficult situation. (2)

While the exact cause of depression is not known, it is believed to be associated with genetic, biological, environmental, and psychological factors. Depression is a disorder of the brain. Recent research using images from the magnetic resonance imaging (MRI) and other tests have shown that the brains of depressed individuals look different. (3)

Depression has a tendency to run in families, but it can occur in people without a family history of depression. A combination of genetic, environmental and other factors may work in concert leading to depression. There are a number of different types of depression. Major depressive disorder is one of the most common mental disorders in the United States. Each year about 6.7% of U.S adults experience major depressive disorder. Women are 70 % more likely than men to experience depression during their lifetime. The average age of the start of depressive symptoms is 32 years old. Depression can also occur in children and adolescents with 3.3% of 13 to 18 years old having had a serious depressive disorder. (3)

Many people with depression never seek treatment but with use of medication. Medications frequently used in treatment of depression include selective serotonin reuptake inhibitors (SSRI’s) and selective serotonin norepinephrine reuptake inhibitors (SNRIs) which help to correct chemical imbalances in the nervous system that contribute to depression. With medication and/or psychotherapy, and other treatment methods most people can be helped. Signs and symptoms of depression may go undetected or are attributed to other causes, particularly in those who are chronically ill.

Signs and symptoms include the following:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities once pleasurable
  • Lack of energy
  • Difficulty concentrating
  • Sleep disturbances
  • Overeating, or loss of appetite
  • Thoughts of suicide, suicide attempts
  • Unexplained physical symptoms (3)

Selective serotonin reuptake inhibitors (SSRI’s) include medicines such as CelexaLexaproProzac and Zoloft while selective serotonin norepinephrine reuptake inhibitors (SNRIs) include medicines such as CymbaltaEffexor XR and Pristiq.


(1) Understanding Suicide Fact Sheet 2010. Center for Disease Control and Prevention Web site.  Accessed August 26, 2014.

(2) Steele, L. & Steele, J. Symptom management. In: Lubkin, I & Larsen, P, eds. Chronic Illness: Impact and Intervention, 7th ed. Sudbury, MA: Jones & Bartlett; 2009: 389-431.

(3) What is depression? National Institutes of Mental Health Web site.
Nd, Retrieved August 26, 2014.

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