Is feeling “too happy” or having things “too good” a risk factor for treatment-resistant depression?

 

Many people in our country, or I should say in this world, have been shocked and devastated by the recent celebrity suicides.  Many wonder how can someone whose life looks so perfect be depressed?  Well people are starting to recognize that anyone, no matter how successful, how rich, how attractive, etc can experience severe depression.

Many of our well-known adages acknowledge the fact that anyone can be vulnerable to depression.  We have heard from a young age that “money can’t buy happiness.”  Or perhaps your mother or grandmother always told you, “don’t judge a book by its cover.”  Well mom and grandma were probably right all along.

Feeling Misunderstood

Many who suffer with severe depression feel significantly misunderstood.  They think that no one can understand the depth of their pain as they “don’t look sick.”  Perhaps this feature of feeling misunderstood is actually heightened in people with success and fame.  When everyone looks up to you and gives you TV ratings and buys your products, these successful people feel it is difficult to find people to empathize with their suffering.  This causes further isolation which exacerbates their depression.

Falls Down the Happiness Scale

Is it possible that success makes a person more vulnerable to depression?  Or is achieving a “higher level of happiness” a risk factor for more severe depression?  I don’t have any statistics on this but I have seen many scenarios in my practice that makes me wonder about this possibility.  I am sure many of us have also seen examples similar to this in own lives.  For example, most everyone has gone through at least one heartbreak in their lives.  It is almost one of those rights of passage in being a human being.  The pain felt after a breakup can be very intense, almost unbearable, for some people.  Sometimes the person suffering the heartbreak will say they were just fine before they met the person.  Losing the relationship did not just bring them back to that prior “happiness level” they had prior to meeting this person.  Rather, being in the relationship made them so happy that losing the relationship caused them to go through a steep fall on the “happiness scale.”  So the fall from this extreme happiness to the pain of the heartbreak is a much greater fall in “happiness levels” which subsequently creates much more severe emotional pain.

Similarities to Patients with Bipolar Disorder

Some theorize that the reason that many Bipolar patients experience such extreme, treatment-resistant depressions is that they are also falling so far down the “happiness scale” when they fall from mania to depression.  So perhaps their depression is not “worse” per se than the depression of someone with unipolar depression, but it feels worse as the fall down the “happiness scale” is so much steeper to them.

Similarities to Patients who have received Ketamine Treatment

I have had several patients transferred to me who have had their severe depression treated with IV Ketamine, a newer treatment for treatment-resistant depression.  I have seen patients who have had success in resolving their depression with ketamine.  But in more of the cases I have seen from patients who have been treated with ketamine is that they experience resolution of their symptoms of severe depression at the time they receive the IV ketamine,  but they eventually become depressed again and they will tell you the that depression is more severe than it was prior to the ketamine treatment.

These patients often say that the ketamine worked “too well.” These particular patients explained to me that they never knew how happy they could feel until they were treated with ketamine.  So, they explain, that when they fall back into depression after the ketamine impact has faded, their depression feels much worse as they have fallen from a happier place and the fall was much steeper, therefore much more painful. 

I can’t say that these few patients represent the impact of ketamine treatment on all patients but their experiences do provide some insight.  We don’t really have any “happiness scales” and there are not any actual measures of a “happiness level” to guide us in understanding the true depth and pain of a person’s depression.  These recent celebrity suicides have clearly raised awareness that we cannot assess happiness or depression based on outward appearances. 

Raising Awareness. What can we do?

The world has experienced pain in watching these recent suicides.  How can we be so oblivious to the pain of others?  What can we do to help?  Some method of helping are the simple lessons from mom and grandma. “Don’t judge a book by its cover.”  Also, take the time to actually listen when someone tells you about their emotional pain.  Another important goal is raise awareness in your communities for the need to keep funding suicide prevention hotlines.  Many patients I have seen over the years have utilized these suicide hotlines and it probably really was a life-saver for them.

Additionally, support funding for research into mental health.  Some of our misunderstanding and lack of empathy comes from simply not understanding these mental illnesses well enough.  There are actually great strides being made currently in the area of mental health research.   We need to continue supporting this research to further advance our understanding of these conditions.

We have much more evidence now of the underlying physiology and biology of depression than we had previously.  This research has led to new opportunities to actually monitor changes in the underlying biology to the severity of these conditions.  The opportunity to use such objective data in monitoring mental illness and follow severity of the condition and response to treatment will guide us in better management of these painful conditions so that people do not have to become so severe that they are willing to go to such great lengths to escape the pain.  This objective data will also help to reduce the stigma of mental illness as people will recognize it as a “real disease” leading to more empathy to the people suffering such severe pain.

We all have opportunities to be supportive and empathetic to individuals suffering mental illness.  These people are all around us, in all domains of life.  We just need to be sensitive to it to recognize it.  Making efforts to understand the pain of others and show empathy will go a long way in helping minimize the severity of their pain.