Mood Swings

A psychiatrist surveys the mind and the wider world

Not "Depression": Manic-Depression and Robin Williams

A deadly disease, whether we accept it or not

Was it “depression” that killed Robin Williams, as most media reports say? Or depression mixed with alcohol and drugs.  But “depression” isn’t a diagnosis or a disease; like fever, it’s a set of symptoms that can happen in various diseases.

The disease was manic-depression, or bipolar illness, as some reports acknowledge; depression occurred as part of that disease, and, in all likelihood, it led to Williams’ suicide. Alcohol and/or drugs may have precipitated the timing and the exact end, but the disease which afflicted him, over and over with repeated mood episodes, was manic-depression. 

“Depression” is somewhat acceptable; manic-depression is still mostly taboo. Even mental health clinicians, including many on the PT site, downplay or denigrate it. 

But it exists; it provides great gifts; and it kills. 

The gifts: creativity in mania certainly helps comedians and actors;  the mind runs in a million different directions, and new and funny and smart ideas pour out.  Williams was a walking manic episode in many of his interviews and skits.  Sometimes a person can have mild to moderate manic symptoms all the time, as part of his or her personality, called “hyperthymic” temperament, the opposite of “dysthymic” temperament.  In keeping with the stigma and discrimination against bipolar illness, dysthymia is well-known and part of the DSM nosology; hyperthymia was never included in DSM systems, and is little known among mental health clinicians, much less the larger public.

Many persons with manic-depressive illness have hyperthymic temperament all the time – so they’re creative and productive and funny, and sometimes famous – and then they have repeated depressive episodes, usually lasting weeks to months, usually happening once a year or two – and, in about one in ten persons, leading to suicide.

So Robin Williams’ “depression” should be called what it was:  manic-depression. And we need to start taking this bipolar illness more seriously and respectfully, and acknowledging its existence, and treating it correctly –rather than misnaming it and mistreating it (as happens with “depression”, where antidepressants often worsen the bipolar illness, sometimes leading to suicide), or, worse, simply ignoring it. 

Tragedy is sad if not preventable, but truly terrible when a cure exists, such as lithium, which is proven to prevent suicide in multiple gold-standard randomized studies.  And, more importantly, it is the ONLY medication proven to prevent suicide in randomized studies. 

The cure exists; the diagnosis can be made. The real tragedy is that we pretend the diagnosis doesn’t exist.  

Williams, Philip Seymour Hoffman, Amy Winehouse - and in the past, Kurt Cobain and others.  

The tragedies will never end –as with all medical tragedies, like the millions of women who died in childbirth for millennia – until scientific and medical professions take a disease seriously. Only then can it be identified - and cures given.  

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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