This article first appeared in the St. Louis Beacon, June 17, 2009 - St. Louisan Mary Walker (not her real name), 79, seemed in good spirits the last time she had dinner with her children and grandson in 2007, just one day after attending her grandson's soccer game. But the next day, her children got a shocking phone call: Their mother had killed herself with a fatal overdose of prescription medication.
"They would have never guessed this would happen," says her psychologist Dr. Jothika Manepalli, who used a pseudonym for the patient when discussing her patient's case.
Walker was in good physical shape. The depression that plagued her for much of her life -- she had attempted suicide many years before -- was under control. Her healthy-but-depression-prone profile fits that of many of the senior citizens who make up the disproportionate number of elderly suicides. While those over 65 account for just over 12 percent of the U.S. population, they commit nearly 17 percent of all suicides, according to the American Association for Suicidology . About 84 percent of elderly suicides are men.
For those over 85, the numbers jump even higher, especially for white men. Their suicide rate is two and a half times higher than the incidence among all men. There are no data for those over 100, like 102-year-old St. Louis philanthropist I.E. Millstone, who was seen leaping from the Daniel Boone Bridge into the Missouri River May 16, less than two weeks after he delivered a speech at the Jewish Community Center. His body was found in the river June 2.
WHEN DEPRESSION TIPS TO SUICIDE
Walker had been depression-free for a full year before her death. She was doing so well Manepalli only saw her every two months. Manepalli, who specializes in treating mood disorders in senior citizens, says she can make a good guess at the details of Walker's downward spiral, starting with a return of hopelessness.
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"She probably started having those deep-down depressed feelings again, and started having sleep problems; she probably thought, 'I've taken medicine for so long I thought it was cured and it is coming back again,'" Manepalli says.
After a suicide, a family undergoes what's called a "psychological autopsy," an examination of what happened and why they missed the signs. When people seem to get better after a period of despair, ironically, they may be more likely to commit suicide.
"When patients are depressed, they may have vague feelings about suicide," Manepalli explains. "But once they improve and have their energy back, they may start rationally planning their suicide."
WARNING SIGNS OF SUICIDE
Surprisingly, older people who are sick or in great pain rarely kill themselves. "The most common reason for suicide is not having a terminal disease but being significantly depressed," says Dr. George Grossberg, a geriatric psychiatrist with Saint Louis University.
Sometimes families mistake depression for Alzheimers. Or they don't see that the normal sadness or grief that's associated with losses or life-changing events, such as death of a family member or retirement, has developed into depression. Families should get a doctor's evaluation for depression, Grossberg (right) says, if their older loved one meets any of the following criteria:
- Seems depressed
- Has a family history of suicide
- Has tried to commit suicide before
- Recently lost a spouse or significant other
- Is isolated and lacks social support
- Is abusing alcohol or taking more of a sleeping or anxiety medication than is prescribed
"The main thing to look for is change," Grossberg says. "Are they cutting back on activities, exercise, not eating or sleeping well, not as social as they used to be?"
When someone seems depressed, ask them if they've thought of a specific strategy to kill themselves, Grossberg advises.
"If anyone has a suicide plan that seems cogent they need to be hospitalized immediately," Grossberg says.
SUICIDE'S IMPACT ON FAMILIES
Calls to more than a dozen agencies and professionals turned up no spouses and only one adult child who would discuss their loved one's suicide. That's doesn't surprise Steve Estopare, associate executive director of the Eastern Missouri Mental Health Association, who says the stigma around suicide is much greater in older people and is another reason families may not have seen it coming.
"Twenty to 50 years ago, suicide was not discussed as much as it is today," Estopare (right) says. "Older people haven't garnered the knowledge of suicide and its warning signs or risk factors.
While suicide can take many forms -- some older people actually starve themselves to death -- 72 percent choose the quickest method: killing themselves with firearms. Such was the case with the father of Katie Misuraca of St. Charles County. Her father was physically healthy and had several of the classic warning signs: alcoholism, isolation and a prior attempt to take his own life as well as that of his then-wife. He'd recently made of list other men he'd known who died at 63 -- his own age when he killed himself.
In July 1997 Misuraca got a phone call at work from her sister, telling her the grim news.
"I was devastated; I literally fell to the ground and curled up in a fetal position and heard guttural screaming coming from inside me," Misuraca remembers.
Now, 12 years later, Misuraca counsels others whose family members commit suicide. She's forgiven her father but she's still angry that he escaped being the primary caregiver for his own parents and aunt, a burden that was left to Misuraca.
NEW LIFE AFTER A SUICIDE ATTEMPT
Another of Manepalli's patients, who suffers from bipolar disorder, is living proof that there is a way out of suicidal thoughts. Five years, ago the 79-year-old woman's husband walked in on her just after she'd slit her throat. Prompt emergency care saved her life, and a tracheostomy restored her breathing. Her mental health began to return after electroconvulsive therapy (ECT), also known as shock treatment, and continued therapy.
Today, she takes seriously Manepalli's advice to deal with depression like any other chronic condition.
"Just like you take care of your high blood pressure or your diabetes, you have to take care of your depression. Call the doctor, get ECT or have your medication adjusted," Manepalli says.
Now that Manepalli's patient understands that feelings of depression will ultimately subside, she's enjoying her life again. The suicide survivor wants others to understand that taking your life is never the answer, and often expresses that to Manepalli by saying: "If only other people could know what I know now."
Nancy Larson is a freelance writer in St. Louis.
