August 20, 2014

Did Parkinson's disease or its Meds Play a Part in Robin Williams' Suicide?

Robin Williams' suicide has generated many comments about its possible connection to his long struggle with depression and substance abuse. When his wife discussed Robin's PD diagnosis after his death, a new wave of comments followed.

As a person with Parkinson's, I have some thoughts -- and facts -- to add to the discussion about the role of Parkinson's in his demise.

Parkinson's Disease and Depression
The data on PD and depression are inconsistent. But it's likely that 40-50 percent of people with Parkinson's (PWPs) will have depressive symptoms in their lifetimes. In fact, depression can be a non-motor symptom of PD, often occurring before any of the more typical movement difficulties. I lost my sense of smell -- another non-motor symptom -- more than four years BEFORE my PD diagnosis. But it's depression that occurs most frequently as a non-motor symptom of the disease.

In most cases, the depression is mild to moderate, and treatable with talk therapy, antidepressant meds, or both. In my case, the serotonin booster 5-HTP has kept depression at bay.

Suicide rates among PWPs are low, perhaps lower than in the general population.

Newly diagnosed PWPs experienced higher rates of depression, anxiety, fatigue and apathy than a healthy control group, according to a study published last week in the journal Neurology. Most of those patients were not treated with antidepressants during the two-year study.

Researchers from the University of Pennsylvania School of Medicine examined 423 newly diagnosed PWPs and tracked their mental health over two years. There are also psychological reasons why PWPs might become depressed, but their brain pathways are affected by the disease, said U of P professor Daniel Weintraub.

At the beginning, 14 percent of the PWPs were diagnosed with depression, compared with 6.6 percent in the healthy control group.

During follow-up, the PWPs experienced a slight increase in frequency and severity of depression, while the condition among healthy study subjects decreased.

In 2008, a Howard University study estimated that PWPs are ten times less likely to commit suicide than their non-affected counterparts.

Parkinson's Meds in Williams' Depression and Suicide
Lots of media attention followed actor Rob Schneider's tweet:
Now that we can talk about it. #RobinWilliams was on a drug treating the symptoms of Parkinson's. One of the SIDE-EFFECTS IS SUICIDE!
In addition to being unfounded, this comment is terribly ironic. Williams portrayed Dr. Oliver Sacks in the film Awakening, which chronicles the monumental discovery 50 years ago of levodopa, the gold-standard med used by PD patients (me included). I haven't seen any other reports describing what -- if any -- PD meds Williams was taking. But we can assume Schneider was referring to levodopa.

The Mayo Clinic's respected website -- one of my most frequent and trusted sources -- lists many possible side effects, but not suicide or depression, in its report on Levodopa.

A broader Google search on "suicide and levodopa" finds no other support for Schneider's tweet.

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I've have some thought of my own about Robin's suicide, but nobody can really know what motivated him in his long struggle with depression and substance abuse. The speculation is intense; I'd love to see him do a take-off on all the comments and wild media attention.

The majority of marijuana users never develop the inclination to stick needles in their arms. Similarly, the majority of depressed individuals -- and substance abusers -- don't kill themselves. One does not necessarily lead to the other.

Bottom line:  When it comes to suicide, there isn't any data suggesting that PWPs are at any higher risk than others. Nor is there any evidence connecting levodopa to suicide.

But Williams did belong to a group with one of the highest suicide rates in the world, according to the Centers for Disease Control. While suicide rates for most groups have been declining, the rate among Americans 45 to 64 has jumped more than 30 percent in the last decade.

If you slice that data even more finely, the rate has jumped by more than 50 percent among white, upper-middle-aged men -- Robin's group.

Williams might well have become a terrific spokesman for Parkinson's awareness. From my perspective, that may be the greatest loss. 

To see Robin Williams at his best, watch his 2009 interview with Charlie Rose.

1 comment:

Anonymous said...

In response to your current post about Lewy Body Dementia I would say you need to look into this again because this not an either or situation. You can certainly have LBD and NOT Parkinson's, but you can also have BOTH, as did my husband. The question is whether Robin Williams also had a dopamine deficit.