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When Depression Becomes Deadly

WebMD Health News

Editor's note: This story was updated on Aug. 14.

Aug. 12, 2014 -- The apparent suicide of Oscar-winning actor and comedian Robin Williams on Monday rocked the entertainment world.

Williams’ publicist said in a statement he'd been “battling severe depression,” according to media reports.

Millions of U.S. adults struggle with depression. Often, medication and psychotherapy help their moods and outlook.

For some, though, hopelessness reigns, even with treatment. About 39,000 suicides happen each year in America, many driven by depression, anxiety, or psychosis.

What makes depression deadly for some? And are there concrete warning signs to help loved ones intervene?

WebMD asked two psychiatrists to weigh in. Neither doctor was involved in Williams’ treatment.

For some, depression is a lifelong struggle. What makes depression so widespread and hard to treat?

"It is a lifetime issue for some, and we don't know why," says Lon Schneider, MD. He's a professor of psychiatry, neurology, and gerontology at the Keck School of Medicine of the University of Southern California. "The phrase 'battling depression' is quite true."

The disease is complicated, he says, and it can take many forms and courses. Someone with chronic depression, for example, "is in a major to minor depressed state most of the time," he says. Someone who has "recurrent episodes" might recover from a bout of depression, be in a relatively stable mood, then get depressed again. Many people have recurrent depression, he says.

"Depression is a very difficult illness to treat because it has genetic underpinnings with environmental stressors," says Scott Krakower, DO. He's the assistant unit chief of psychiatry at The Zucker Hillside Hospital North Shore-LIJ Medical Group. "The genetics are not entirely understood."

Those with fame, power and success aren't immune. "You could be having a really great life, a successful life, and be really depressed," Krakower says.

What other things might affect depression?

"Physical illness, especially chronic [long-term] illness, can worsen depression," Schneider says. In 2009, Robin Williams got heart surgery, although it’s not known whether this affected his struggle with depression.

Alcohol or other drugs can also affect depression, Schneider says. But, he adds, "I think one has to be fairly careful about a person who has alcohol or drug dependence in the past, and then [saying], 'Oh, that must have been it, alcohol must have contributed, cocaine must have contributed.’"

Williams had been open about his rehab efforts to combat alcohol and drug use. He reportedly made at least two trips to rehab centers, most recently earlier this summer.

"Much depression is part of bipolar illness," Schneider says. Bipolar disorder is marked by wide shifts in mood, energy, and activity levels. People diagnosed with it tend to have many more depressive episodes than manic ones, Schneider says. It wasn’t known if Williams had bipolar disorder.

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