02 Dec

An epidemic of loneliness and suicide: Are drugs the answer?

For those who read my intermittent blog posts, you know I am often inspired by articles in the Sunday NY Times.  Today is no exception.  But I must beg to differ with the author of “Can we stop suicides?”  Citing the horrific increase in reported loneliness, isolation and suicide in this country, the author paints a portrait of a single woman who has tried numerous times to kill herself. Failing once again and ending up in an emergency room, she is moved into a program where severely depressed patients are given a drug called ketamine—essentially an anesthetic used in Vietnam and  currently in use to anesthetize animals in veterinary clinics.  Sold on the street, unregulated and illegally, it can produce severe hallucinations and even brain damage.

Its controlled use for depression under medical supervision, and given intravenously,  has produced mixed results. Some patients get almost miraculous instant relief. Others get very little or none.  The patient featured is this article got better, but needs to return every month for another intravenous dosing. (Long-term side effects are unknown.)

My immediate response to this article was twofold.  One, why do we so often think that drugs are the answer to everyday social problems like isolation and depression?  Two, why did the author of this article not mention the obvious possible influence of all the attention this woman was receiving, with regular monthly appointments, and actual infusions?  The possibility of both placebo effect and the very real effect of having a medical team not only meet with her, but actually put fluids into her body, needs to be addressed.  In the analytic world this type of treatment is symbolically like returning to the womb with the life-giving umbilicus.  The powerful psychological effects of pushing any type of fluid into someone with the hope of cure are undeniable.

And for those who might be skeptical, there are numerous public health projects, particularly in New York, where emergency room visits have been drastically reduced or eliminated by simply supplying isolated, lonely patients who frequent the ER with regular home visits and health checks.  This type of program involving human contact, rather than drugs or hours waiting in the emergency room, holds more promise from my point of view.

This is not to say that some ancillary medications are not useful, or even essential, for some patients. But until there are controlled studies  definitively demonstrating the difference between depressed patients receiving ketamine versus those receiving a placebo, I am skeptical.  More importantly, I agree with those who say the rising tide of suicide and other “deaths of despair” cries  out for social solutions.  Needless to say, I believe those solutions include the availability of talk therapy.  And for many, it is a necessary starting place to reduce the sense of loneliness and the depressive symptoms that keep them from pursuing the elusive social connections they so desperately need.

 

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