Mood

The Perfect Mental Storm

From suicide to reckless behavior to physical illness.

Let's throw away the terms, depression and bipolar. Let's say the perfect mental storm, instead. A mood disorder isn't just a hurricane in the brain - it's a hurricane plus a Canadian cold front plus a storm at sea, all in disharmonic convergence, each element feeding off the other, generating hundred mile-an-hour winds and hundred feet waves that have more than one way of sending their unfortunate victims to the bottom.

We all know that the perfect mental storm is capable of sucking the life-force out of even the strongest of individuals, pummeling the victim's brain to anti-matter, and reducing one to the level of the living dead, on the brink of total death, as close to actual death without being dead. This is the destructive nature of the storm with which we are most familiar, one that can lead to suicide, up to fifteen percent for those who see no other way out. Thirty thousand Americans die each year by their own hand, according to official figures, but the true number is probably many times higher in the form of so-called accidents and deliberately bad lifestyle choices.

The other killer aspects of the perfect mental storm are just as real, but not readily apparent. Scientists are now beginning to uncover the links between depression and heart disease, depression and diabetes, depression and cancer, and depression and stroke - amongst others - and what they are finding suggests a cruel illness going to work in a variety of insidious ways, all with the power to kill.

According to a Montreal Heart Institute study, depressed patients with heart attacks are four times more likely to die within six months as their non-depressed counterparts. A Washington University study found that depressed people with newly-diagnosed heart disease are twice as likely to have a heart attack or require bypass surgery. A recent Johns Hopkins study concluded that those who are depressed are four times more likely to have a heart attack within fourteen years.

Ken Duckworth MD, Deputy Commissioner of the Massachusetts Department of Mental Health, advised any MDs in the audience at the 2002 NAMI conference that "you need to be thinking of [your patients] as if they already had a heart attack."

His epiphany came when as a young doctor working in a mental health facility someone came up to him and said, "Ken, you guys are getting fabulous at doing memorial services." A 1999 study his department initiated found that the risk for cardiovascular disease for people with serious psychiatric illness in Massachusetts ranged from twice as high to six times higher than normal, depending on age. Respiratory illnesses were four to six times higher and diabetes twice as high. For individuals between the ages of 15 and 64, the death rate is 1.4 to 3.3 times higher for Department of Mental Health clients than for the general Massachusetts population.

A Kaiser Permanente study discovered that those with diabetes were more likely to have been treated for depression within six months before their diabetes diagnosis. About 84 percent of diabetics also reported a higher rate of earlier depressive episodes.

As for cancer, a National Institute of Aging study found that chronically depressed people were 88 percent more likely to develop cancer. Meanwhile, those who experience major depression increase their risk of stroke by 73 percent, according to a two-decade study by the Centers for Disease Control.

And a study of 5201 men and women aged 65 years and older published in the American Medical Association's Archives of Internal Medicine reported that even milder forms of depression constitute a mortality risk factor in the elderly.

Mind you, no incontrovertible piece of evidence has been found linking the perfect mental storm to the swath of destruction in its wake, but an editorial in the same issue felt itself on sufficiently safe ground when it stated: "Suicide explains only a small proportion of the increase in mortality among the depressed ... "

Depression's True Kill Rate

The fact that we know nothing about the actual cause and effect moved the editorial writer to conclude: "Depression now demands the aggressive level of research in the next quarter of a century that smoking, cancer, and heart disease have received in the past quarter of a century."

Meanwhile, statisticians are engaging themselves in the exercise of figuring out depression's true kill rate. A 1998 study, The Global Burden of Disease, published by Harvard University Press, credited depression as the fourth leading cause of "disease-burden" in 1990 and will be the single leading cause by 2020. Bipolar disorder is not far behind.

But the perfect mental storm has many more lethal aspects. Because of the sense of hopelessness and isolation depression creates, not to mention sluggish cognition, the illness plays a key role in influencing reckless and destructive behavior. A recent meta-analysis of 25 pervious studies published in the Archives of Internal Medicine has found that depressed patients are three times more likely to be noncompliant with their medical treatment recommendations. Noncompliant behavior includes: not taking medication correctly, forgetting or refusing to follow a diet, not engaging in prescribed exercise, canceling or not attending appointments, and persisting in lifestyles that endanger one's health.

According to the article: "Noncompliance can result in exacerbation of illness, incorrect diagnoses, and patient and physician frustration. There is growing evidence that noncompliance has a consistently negative effect on treatment outcomes."

Talk about understatement.

We're not finished. A study in the British Medical Journal has found that teens with depression are more likely to engage in risky sexual intercourse, contract sexually transmitted diseases, and have sexual intercourse before age 16. The fact that depression was linked to these outcomes was of particular concern, according to the authors, as rates of depression are known to escalate from age 15 to 21 - the period when sexual activity also emerges.

Then there is the whole issue of depression and smoking, depression and alcoholism, and depression and drug use. The Surgeon General in his 1999 Report on Mental Health estimated 51 percent of those with lifetime mental illness also have a lifetime history of at least one substance use disorder. For people with bipolar, the Epidemiologic Catchment Survey reports 61 percent with a lifetime substance abuse disorder, more than five times the rate of the general population. According to a 2002 SAMHSA report, adolescents with depression are four times more likely to develop substance abuse disorders. Two-thirds of the one million youth who have contact with the justice system have one or more substance abuse and mental disorders. Kids using marijuana are four times more likely to report symptoms related to conduct or attention deficit disorders or to have dropped out of school, been in a fight, or been engaged in an illegal activity.

So it is that the perfect mental storm cascades upon our inadequate psyches from all points of the compass, threatening us from whichever direction we turn with death by suicide, death by medical complications, death by noncompliance, and death by reckless behavior. Our battered minds, in a state of severe distress, send out maydays which may never be heard as the animus within us succumbs to forces no one should have to bear.

Surviving the Storm

For those who survive, the feeling can be one of looking up at a pale moon-like sun breaking out from suffocating grey clouds. It is a time of subdued thanksgiving and quiet contemplation. The storm may yet engulf us, if not now perhaps a few hours from now or a few years from now.

In the meantime, though, we can take comfort in the knowledge of having emerged whole from one of the most destructive and terrifying phenomena in all of nature - the perfect mental storm. Of all things, it is an ordeal that has strengthened us, toughened us, and imbued us with a sense of hope and renewal. Depression is highly treatable, after all, and there are many ways to fight it, from the medications we take to changing our thought patterns to making the right lifestyle choices. And by attacking depression, we are helping remove ourselves from harm's way of all its other complications.

And so we finally reach a safe harbor, where we rededicate ourselves to reclaiming our lives - one day at a time, if it comes to that - with a new respect and profound sense of awe of what we are up against, but also with a new regard for the gift of life.

First published 2000, reviewed Feb 10, 2008

Also of Interest

Alcohol and Substance Use

Unfortunately, far too many of us have to contend with this.

Knowledge is Necessity

Home Mood Behavior Treatment Recovery Science Issues Famous Stories Populations Resources About