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Suicide Prevention

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SARA LOMAX-REESE:  Right now I want to welcome in studio Dr. Donee Patterson, who is a family physician at Einstein Department of Medicine; welcome Dr.  Donee.


LOMAX-REESE: And psychiatrist, Dr. Carissa Caban, welcome.

CARISSA CABA, MD: Thank you.

LOMAX-REESE: Today we are going to talk about something that is a little uncomfortable; very important, but Dr. Donee, why don't we start off with you.  You usually kind of select these topics with a specific point in mind.  Why are we talking about suicide today?

PATTERSON: I think that a lot of people don't realize how common suicide is.  It is a myth that suicide doesn't happen in the African American community and there are over one million people who attempt suicide a year and that is worldwide.  

LOMAX-REESE: That's not just in the African American community?  That is everyone all over the world.

PATTERSON: Exactly.  They attempt suicide and some people don’t realize that it is actually happening until it happens to someone close to you.  So we want to bring attention to this topic, not to be somber, but just to make sure that people understand the warning signs and they recognize the warning signs and they act on it and they don't wait until it's too late because it is something that definitely happens.  It is actually the third leading cause of death in youth between the ages of 15 and 24, so it's number 2 behind homicide and accidents, so it is the third leading cause of death and there are things that we can do to prevent this. 

LOMAX-REESE: Now Dr. Caban, I saw one of the statistics that said the highest suicide rate that the highest suicide rate is among men over 85 years old, is that correct?  That's a little strange.

CABAN: Those statistics are accurate for the population in the US.  It has been shown that it's very common for elder Caucasian men to commit suicide; however, the rates among African Americans are increasing lately.

LOMAX-REESE: If we zero in on the African American community, what is the demographic that is most prone to suicide?

CABAN: Actually there is a high rate among young African Americans.  I don't know the specific statistics, but for young people in the US, suicide is the third leading causing of death, like Dr. Patterson said, particularly for people between 15 to 48 years old.

LOMAX-REESE: Wow, so let's talk about the risks factors or signs and symptoms.  I know that depression is a major risk factor and so many people don't necessarily, and I think this is a cultural issues, a lot of people in the black community don't necessarily seek treatment.  Thy might just say I have the blues, or it's kind of downplayed, I will talk to my pastor, or I will talk to my girlfriends or whatever, but it is not necessarily seen as something that is deserving of actual medical treatment.  If you guys can kind of tell us the differentiation between like oh I don't feel so great today, I'm kinda blue and serious reasons for seeking medical treatment.  What are the signs and symptoms?  Dr. Caban?

CABAN:     In terms of diagnosing depression, it should be an episode of at least two weeks or more of several symptoms and the most common are the following: there must be psychomotor retardation or psychomotor agitation, basically a very noticeable change in the mood of the patient.  There is usually some kind of hopelessness or guilt.  There are changes in appetite, either eating more; if it's eating more it is atypical depression and usually the patient craves carbohydrates but there are a lot of patients that stop eating the way that they used to.  There is usually a lot of sleep changes, either insomnia or hyper insomnia.  A couple of other symptoms very important to point out that a lot of patients become anhedonic, that means that they stop feeling like they want to do the things that they use to want to do before.  They don't find pleasure in the activities or interactions that they used to get pleasure from.  Those are a couple of depression symptoms.


PATTERSON: I do want to point out that in teens, sometimes the presentation is different.  It can be something that just happened in the teen's life, like they broke up with a boyfriend or girlfriend or they had a loss of a loved one or something traumatic happened at school, so it doesn't necessarily have to fit the cookie cutter definition.  In teens, sometimes it is a little bit different, so you really want to pay attention to your teen when they are going through things and make sure that you ask.  There is a myth that if you ask someone about suicide that you are going to put the idea in their head, it's a lot condoms, some people feel like if you ask people if they need a condom or would they use a condom or do they practice safe sex, that will make them more likely to do that.  But we have to make sure that we are asking people.  That is one thing that we must emphasize, that if you even suspect that your child or loved one or neighbor or friend is feeling down or depressed, you should ask them about that and not ignore it because you think that they are just seeking attention.  It's very important people those people will often go on to actually commit suicide.

LOMAX-REESE: So let's play that out a little bit because by the nature of depression, it seems like you are kind of mired in a sense of hopelessness and you don't necessarily feel like seeking help is going to do anything really valuable.  If you were a family member or friend, what can you say that is going to inspire or motivate that person to really take that step to get help because that has got to be a major obstacle to being able to just get yourself to see a physician.  So what do you do as an outsider?

CABAN: I think one of the best ways to deal with this as a family member or friend is to show your support in any way you can and ask the question, like Dr. Patterson said.  There is a lot of people that frequently ask me how do you ask someone if they are suicidal because that might be offensive and it is very embarrassing for some people to do that.  I think that if you see that someone is going through a really difficult crisis or situation in their lives and you notice some of these symptoms, you can start by asking is it getting so hard for you.  Is it so difficult for you to go on right now that you sometimes feel like you don't want to go on or you don't want to wake up in the morning?  You can start by asking those types of questions instead of saying do you want to kill yourself?  Then go from there and see if the family member or friend has actually been thinking of hurting themselves.  

LOMAX-REESE: I didn't hear substance abuse as one of the risk factors for suicide, but I am sure it is and again, how do you navigate that line between somebody who is just using drugs and somebody who is using drugs in a way that is medicating depression and might lead down a path of suicide?  Dr. Donee?

PATTERSON: When we look at statistics of people that have committed suicide or had drug overdoses, sometimes those lines blur because we don't know if they were actually trying to kill themselves or they just accidentally hurt themselves, but there is a huge comorbidity between people who have drug and alcohol addiction and also other psychiatric issues like schizophrenia or some bipolar disorder so we need to get people help either way.  If they appear depressed, if they appear down, if they appear like they are withdrawing from you, they no longer like to do the things that used to make them happy, no longer eating, no longer sleeping, we need to get them help either way.  Also continue to ask them the question as well, are you getting so down that you don't want to live anymore or have you thought about hurting yourself.  We have to make sure that we break these stereotypes.

LOMAX-REESE: We are talking with Dr. Donee Patterson and Dr. Carissa Caban from Einstein and we are talking today about suicide and what some of the warning signs are and I guess we will talk about some of the treatment in just a minute, but if you have a question or comment, give us a call at 215-63-8065 or toll free 866-361-0900.  I wanted to touch on what happens to a family who has gone through something like this.  I was just reading an article by Clarence Page who is an award winning journalist in Chicago and he was writing right after Don Cornelius from Soul Train fame committed suicide and he was saying that it was something that was very close to him because his ex-wife committed suicide and she was an award winning journalist as well.  A lot of time there is not a whole lot of understanding of what the family goes through and the guilt and the shame and what the legacy begins to be for children who have that as part of their lineage.  Talk to us about that piece.

PATTERSON: It's a very difficult…it's a loved one that has lost, it's children that don't have their father or mother; it's sisters who don't have their brother or sister and parents that have lost a child.  It is very difficult and in addition to just grieving the loss of a loved one you have the added guilt that there may have been some red flags that you may have missed or the person may have been saying things to you and you just didn't understand that they were about to end it all.  There is the added guilt from that.  And there are statistics that say children of parents who commit suicide have an increased risk of committing suicide.  It may be some genetic component to that but also they are often depressed as well.  It is very mutilfactorial and it's very hurtful to the family.  We highly recommend that the whole family gets counseling.

LOMAX-REESE: Dr. Caban do you want to add anything to that?

CABAN: Yes. There is actually a component of anger in a lot of families that are recovering from suicides. Sometimes they feel really angry at the fact that the person didn’t seek help or didn’t tell them what was going on.  It is definitely a good idea to receive some kind of counseling and to watch out for the risk factors of depression and suicide amongst a family member.  Another great way to deal with this is family therapy, which I really stress in the community.  When you have the opportunity to refer the family to a therapist that can deal with the dynamics between all of them and how they are dealing with the suicide within the family, that’s great.

PATTERSON: We have to emphasize that this is something that spans all ages.  Your first question to us, you were a little surprised that an 85 year old man or woman might commit suicide.  You have to think about that; they have lost all of their loved ones; they often, by the time they get to be 80-85, they have outlived everyone.  Things are very different, computers are different and the microwave is different and they are very sad and they just feel like I have nothing else to live for and they just give up.  On the flip side, their very young children, not very common, under the age of 12, but there are 9 and 10 year olds that feel like they are so overwhelmed; they are being bullied, that they give up too and they commit suicide as well.  So in preparing for today, even myself, I always learn from speaking to people; I’m a physician, I have lots of access to medication around my house, I really should put those things up.  That is a wake up call for all of us.  We should put up, I mean, I don’t think my children are suicidal but you just never know what people can get into and we can all learn from this.  Phyllis Hyman, Philadelphia's own, committed suicide and she left a suicide note that just said “I’m tired” and that is what is happening to a lot of  people; they are just tired  and Donnie Hathaway, he jumped out of a 15 story luxurious hotel and they leave behind notes that say “I’m just tired; I can’t go on” and we have to give these people a reason to remember that their loved ones love them; their loved ones are supporting them and we have to be there for them.

LOMAX-REESE: But it sounds to me like it’s more than that because depression is not just an emotional disorder; there is a physiological component so a lot of times people think oh it’s all in your head, just snap out of it, everything is going to be fine, just get over it.  But it is much more than that and some people really have a chemical imbalance and Dr. Caban can you speak to the physiological aspects of depression that could lead you to have a distorted reality of what your life is.

CABAN:     Definitely.  There is a lot of research right now about depression and other mental/psychiatric disorders.  There is actually genetic variants having been shown to have to do with the cause of depression, but the most common theory is a deficiency of serotonin, which is a neurotransmitter which is most commonly associated with mood disorders in the prefrontal cortex, which the part of the brain that processes all executive functioning; the way that we make decisions.  Most of the medications that we use are SSRIs.  There are other types of medications that are in the market now that attack different kinds of deficiencies of neurotransmitters but serotonin has  been found, if there are low levels of serotonin in this part of the brain and you can use a medication to increase those levels, there is a lot of patients that benefit from that.  

LOMAX-REESE: One of the things that I have heard from friends who have taken these medications is that it is very difficult to get it right; to find the right mix that is going to work.  When we come back from the break I want to see if you can talk a little bit about side effects and if there are, just like when we talk about heart disease and hypertension and all of those things, there are things that we can do in terms of changing our diet, changing our stress levels, all of those thing that are a little bit more natural and holistic.  Are there some things that can address and help address depression as well?  We are going to come back and we are going to talk about treatment and prevention and all of those things.  We are talking about suicide today with Dr. Donee Patterson and Dr. Carissa Caban.  Don't go away.

LOMAX-REESE: And we are back.  You are listening to our special segment with the Einstein docs.  We are talking today about suicide; prevention, warning signs, all of those things; myths.  We are talking with Dr. Donee Patterson who is a family medicine physician from Einstein and Dr. Carissa Caban who is a psychiatrist with Einstein.  Right before we went to break I was asking you about holistic approaches and also how difficult it is to actually get a treatment regimen together that really works; that is not going to deliver a lot of negative side effects.  Dr. Donee?

PATTERSON: Everything man made has side effects and I often say that this show is not about the medication.  We are just trying to highlight suicide and talk about some risk factors and encourage people to get help. I treat depression and Dr. Caban treats depression all the time and about 80% of cases, people really have successful treatment and it is not necessarily difficult to pick a medicine if we are going to use medicine for that person.  Depression is a chemical imbalance as Dr. Caban was saying and it would be just like if you had an infection, you might take an antibiotic.  Sure, we want to do things to prevent getting the infection in the first place, but it is a chemical imbalance and sometimes it needs to be treated.  Sometimes people just need counseling and they do very well in counseling.  Then other times medication is needed.  There are some over the counter remedies to help people relax and to help people to focus better.  There are some over the counter things like St. Johns Wart and we are very cautious about telling people just to use over the counter medications for depression because they may actually miss the diagnosis and then they will be taking St. Johns Wart and it may trigger a bipolar episode, so we really want people to work with their physician and if they chose to use over the counter medicine, talk to their doctor about it so that they understand the risk and the benefits.

LOMAX-REESE: Unfortunately a lot of doctors don't know about alternative treatments.

PATTERSON: So you have to find a doctor who does, you really do.


CABAN: It's great that you asked that question.  I have a lot of patients that have major depressive disorder and other kinds of mood disorders that have not necessarily been on a medication their whole lives.  There are a lot of patients that have these diagnoses because of severe childhood trauma; a lot of stress in their lives and multifactorial conditions that predispose them to have psychiatric disorder, so we don't treat all our patients with medications.  In terms of how to choose a medication that is why I stress out that we really need to have an open communication with the patients and talk to them about how they feel because we basically chose based on different side effects.  Some side effects are actually helpful for the patient.  For example, there are medications that are taken before bedtime that cause mild sedation or moderate sedation and helps them sleep better.  So that is one of the ideas that I want to give.  There are other common side effects like some abdomen pain the beginning of treatment or …


CABAN:     Decreased libido, which is less desire to have sexual relationships, but that is not necessarily true for every case.  However, in terms of what you asked about holistic and alternative medicine treatments, the most important thing is to help the patient find a way to have a healthier lifestyle and there is a lot of ways to do that.  I spend a lot of time with my patients speaking about nutrition guidelines, what are they eating.  Most of the patients have comorbid physical illnesses that have to be treated and addressed, like chronic pain for example.  Giving patients a chance to have meditation and learn how to relax, get them to learn to do breathing exercises and improve their lifestyle in general and having stronger relationships with their family is sometimes more helpful than a medication.

PATTERSON: I might even at times take people off medications because I feel like their medications are causing depressing.  For example, beta blockers, common blood pressure medicine, and I sometimes will take people off medications so it is not always about adding medicines, it is often about taking away some things or taking away that stress or replacing that stress with something positive that can sometimes be very helpful.

LOMAX-REESE: Excellent.  We are talking with Dr. Donee Patterson and Dr. Carissa Caban about suicide today; a very important and very somber topic but there are ways of addressing it.  One of the things that is always kind of looming in the background are myths.  Myths associated, and we kind of started right at the outset, addressing one, that black people don't commit suicide, that has been one of those that has swirled around for a really long time.  But there are other myths around suicide, particularly as it relates to the African American community.  Dr. Donee?

PATTERSON: There are several.  For example, that the African American woman is never going to crack under pressure and she is totally resilient and it doesn’t give those women any wiggle room to feel down or to feel depressed so they often feel that they have no way out and often commit suicide.  Then on the flip side, men are macho and they never can show their feelings so they often bottle it up.  I do want to emphasize that there is a difference between teen girls and boys in the fact that teen girls are more often to attempt suicide, whereas males, they more often actually succeed in the suicide attempt. 

LOMAX-REESE: Is that because one is being done with a handgun and one is with pills?  Is it the mode? Why is that?

PATTERSON: Females are more likely to use pills or try to slash their wrists, or to drink something whereas men are more likely to use a firearm.  Another thing we can talk about is fire arms in the house.  W really have to…if you are going to have a fire arm which I suggest against, but if you are going to have a firearm you have to have a safety lock; you have to keep the bullets separate; you have to make sure it is away. That is a whole other big issue in Philadelphia is gun safety.

LOMAX-REESE: Absolutely.  I was going to bring that up, the whole murder suicide piece that happens, like Sandy Hook and all of the access to handguns, but Dr. Caban, do you want to add anything?

CABAN: I wanted to point out that is not only among teens.  In the US over half of all suicides are completed with firearms and that is an important factor considering the recent debate in gun control and how we are trying to address this as a society.  Another thing I wanted to point out is how determinant the stigma is among African American community, particularly females.  That perspective about the African American woman as holding the family together and having to always be strong and never crack up, I see that a lot with my patients.  They struggle with that because they feel like they can't tell anyone that they need help or they need support.  It is alright to want to have some help or support somethings and they feel like that they just don’t have the room to do that.

LOMAX-REESE: Maybe part of it is they don't feel like anybody is going to help them.

PATTERSON: That is probably true.

LOMAX-REESE: So what's the use of asking for help if no one is there to give it.  There is definitely something from a community standpoint that we need to address in terms of creating more support.

PATTERSON: Absolutely.  There is also a religious side where people feel like if they are gay or if they are promiscuous or if they are living unmarried with someone that they will not be forgiven. That is just another stigma, another stressor put on the person and church will say we are not going to forgive you if you are gay or we are not going to forgive you if you are drinking alcohol or doing drugs and it's just another stigma that the person feels heavy about and can go on and commit suicide.

LOMAX-REESE: So wow, this is pretty heavy.  Let's end today's conversation with something that is proactive, something we can do that allows people a sense of empowerment, even within the context of this very heavy topic.

PATTERSON:   It seems a little bit of an aside, but I want to make sure I tell people to remember head traumas.  The sports with head traumas, any risk behavior, because head traumas can lead to things down the line, like the athletics, like Junior Seau and other people that can actually lead to suicide.  I do want to leave on a positive note and say that suicide is preventable; pay attention; talk to your teens; make sure that they know that you care; talk to your loved ones.  Make sure that you are there for them when they are reaching out.

LOMAX-REESE: And Dr. Caban, any final thoughts?

CABAN: I just want to emphasize what Dr. Patterson said.  There are statistics that say that 80% of people that get treatment do recover and it's not about curing the patient, it's about recovering and becoming more resilient to deal with trauma and crisis.  If we advocate for people that need mental health treatment and we find a way to get them referred, we have a very good chance of decreasing rates of suicide in the US, so it's all about community.  We have to start becoming a society that is a community instead of individual human beings walking down the streets.  We have to emphasize how important it is to unite the people in the community.

LOMAX-REESE: Absolutely.  That is Dr. Carissa Caban and she is a psychiatrist with Einstein and we have been talking with Dr. Donee Patterson.  Dr. Donee, do you have any kind of gift card of special…?

PATTERSON:     We do, we do.  On Einstein's facebook page, Einstein Health, we have some very simple questions, if you were listening today if you answer you will become eligible for a ShopRite gift card and you can follow Einstein on twitter and we look forward to hearing more from you.  We want to hear your comments; we want to hear your feedback.  We hope that you are enjoying the shows because we have many more planned for you.

LOMAX-REESE: Absolutely.  Thank you guys for being here.  It was a very important topic.  You may have saved someone's life today.


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