Comptroller's depression falls in common pattern

April 16, 1994|By Scott Shane | Scott Shane,Sun Staff Writer

Taking an overdose of antidepressant medication is one of the most common methods of attempting suicide and is reported nearly three times a day in the Baltimore area, the director of the Maryland Poison Center said yesterday.

But the newer, safer antidepressants of the kind Baltimore Comptroller Jacqueline F. McLean was taking rarely result in death when taken alone, said Dr. Wendy Klein-Schwartz, who heads the center at the University of Maryland School of Pharmacy.

Even the safest antidepressants, however, can suppress the central nervous system when ingested with tranquilizers and alcohol -- as Mrs. McLean reportedly did. The combination can interfere with breathing and result in a coma or death, Dr. Klein-Schwartz said.

Mrs. McLean's attorneys yesterday said she has suffered from depression for years, has been hospitalized three times for the illness in recent months and has been taking a number of antidepressant and other psychoactive medications. They said the overdose Thursday night was her third suicide attempt.

Her illness is among the most common of psychiatric diagnoses, and the facts surrounding her situation form a pattern familiar to any practicing psychiatrist.

"Probably between 5 and 10 percent of the American public experience a major depressive disorder during their lives," said Dr. J. Raymond DePaulo, a psychiatrist who specializes in studying and treating depression and is director of the Affective Disorders Clinic at Johns Hopkins Hospital.

Depression is strongly influenced by both genetic and environmental factors, and a setback at work or home can bring on a depressive episode, Dr. DePaulo said. But depression as a psychiatric diagnosis should not be confused with sadness over passing troubles, he said.

"All of us have our up and down moods," said Dr. David Mallott, a University of Maryland psychiatrist. "But we don't feel this tremendous sense of inner pain and hopelessness."

Symptoms include not only such feelings, but also apathy, numbness, anxiety and sleeplessness.

Depressed people can often disguise their feelings, so co-workers and casual acquaintances may have no idea that the person is ill, Dr. Mallott said.

A history of major depression is the most accurate predictor of suicide and can be documented in 60 percent to 90 percent of all cases, Dr. DePaulo said.

Psychiatric patients often reach for their medication when they become suicidal. Of 4,130 suicide attempts by poisoning reported to the Maryland Poison Center in 1992, about 1,000 involved antidepressants, Dr. Klein-Schwartz said. That comes out to nearly three a day.

According to her attorneys, Mrs. McLean may have taken a combination of any of five medications. Three -- Zoloft, Paxil and trazodone -- are in the newer, relatively safer class of drugs. The fourth, Trilafon, is used to treat psychosis or anxiety. The fifth, Klonopin, is a Valium-like tranquilizer.

Dr. Klein-Schwartz said that none of those drugs is extremely toxic by itself. But all can depress breathing and other functions of the central nervous system, as can alcohol.

Mrs. McLean's blood alcohol level was .122, indicating a high degree of intoxication, her attorneys said.

Mrs. McLean apparently called a former fellow patient to say what she had done. Doctors say calling for help after attempting suicide is not uncommon.

"It may be a very ambivalent message they're sending: 'I'm in pain, but I want help,' or 'I'm trying to kill myself, but I want you to take me to the hospital,' " Dr. Mallott said.

Mrs. McLean's suicide attempt came a week after her release from Sheppard and Enoch Pratt psychiatric hospital in Towson, and her attorneys said her two previous suicide attempts also came shortly after she was discharged from the hospital.

That, too, is a common pattern, Dr. Mallott said. "For anyone released from the hospital, those first few days going back out into the community and trying to resume a normal life pose the highest risk of relapse."

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