You Rock!...

Hats off to three of my colleagues who, as I type, are walking in the 20 mile "Out Of The Darkness" Suicide Awareness/Prevention Walk here in Seattle! These three dedicated mental health professionals each raised over $1,000 dollars and began their trek around 7:30PM this evening...they will be walking with a few hundred others until 5:00AM this morning...from dusk until dawn...out of the darkness.

I just left Husky Stadium around 1:00AM and can happily report all three remain in good health and spirits...continuing the remaining 9 miles of their distance, with a hopeful hot bath and pampering at the end of their journey.

You ROCK, ladies!!!

And while on the subject of suicide, here are excerpts from an interesting article in the BMJ...the information is now 10 years old, but still applicable to current Multiple Sclerosis statistics correlating depression and suicide with MS:

Mental illness leaves patients at risk for harming or killing themselves, none more so than major depression, with which a 15% lifetime prevalence of suicide has been consistently noted. Less clear is how these figures translate when applied to patients with neurological disease, particularly those conditions known to be associated with a high risk of comorbid depression.

An example is multiple sclerosis, the leading neurological cause of disability in young and middle aged adults. Depressive symptoms of sufficient severity and duration to warrant a diagnosis of major depression affect up to half of patients during the course of their illness. This is three times the prevalence reported for major depression and psychiatric comorbidity in community based samples, and it also exceeds that for other neurological disorders.

...a Medline search of all published data, which shows that patients with multiple sclerosis were generally more likely to attempt or commit suicide than patients with other common neurological disorders, and a Canadian study of 3126 patients with multiple sclerosis who were followed longitudinally at two clinics between 1972 and 1988. Comprehensive databases kept track of virtually all patients within the respective catchment areas, each of whom received at least a yearly follow up examination. Suicide accounted for 15% of all ascertained deaths during this 16 year period, proportionately 7.5 times that for the general population matched for age but not sex.

With these statistics, it is surprising that the treatment of depression in multiple sclerosis has received scant attention.

While the past decade has undoubtedly brought a greater awareness of the neurobehavioural sequelae of multiple sclerosis, the risk remains that clinicians may yet miss a treatable cause of morbidity and mortality. The measure by which disability is assessed remains the expanded disability status scale, which affords little weight to psychopathology. Attention remains largely focused on more easily discernable and quantifiable evidence of disease, such as how far patients can walk unaided, the degree of cerebellar disturbance, or measurements of visual acuity. The paucity of studies of treating depression related to multiple sclerosis attests to this. The problem is compounded by new treatment modalities such as interferon beta-1b, in which physical improvement may be offset by a potentially deleterious effect on mood.

While it is premature to conclude that depressed mood represents a core symptom of multiple sclerosis, it has taken psychiatrists and neurologists almost a century to realise that Charcot's astute observation of altered affect in the disorder he helped define demands prompt and careful management.