A major risk factor for veteran suicide is depression. We have written about this and especially about how psychedelic medicines show promise in both treatment of depression and reducing suicide risk. A practical consideration regarding depression and its treatment has to do with associated physical ailments. A question that was not answered until recently has to do with patients who have physical heath ailments as well as depression. Much research into the treatment of depression is done on subjects with no complicating illnesses. However, in the real world, people with long term chronic pain, traumatic brain injuries, recent heart attacks, etc. get depressed too. Do antidepressants help in these cases? Are they dangerous?
Effectiveness of Antidepressants in People With Physical Ailments
The question of how well antidepressants work in people with physical illnesses as well as depression was addressed by physicians in Germany and Denmark. They did not do any new research but rather they researched studies going back decades. They only considered studies of depression in which people with other illnesses were not excluded. Their results were published in JAMA Psychiatry.
As noted by the head researcher, about one in five people with severe physical health issues also suffer from depression. Many times their conditions and/or the medicines they need to take reduce the types of antidepressants they can safely take. What the doctors found across years of research studies was that physicians were able to successfully treat depressed people with physical problems as effectively as those without concomitant physical ailments.
Depression and Suicide Risk in Veterans With Physical Illnesses
A survey conducted by the Pew Research Center found that one in ten veterans suffer a serious injury during their time in service. Those with serious injuries were more than twice as likely to have trouble readjusting to civilian life. They were about twice as likely to suffer from PTSD and depression. And these veterans were more likely to have other serious physical illnesses. Because so many wounded veterans suffer from ongoing physical ailments related to their time in service and also suffer from depression, the research carried out by the German and Danish doctors is important.
Safety of Psychedelics in Treating Depression in Patients With Other Illnesses
While the German and Danish doctors reviewed many studies going back decades there much less research published for treatment of depression with psychedelics and only in the last few years. As such we do not have the sort of evidence based on widespread usage of psychedelics like is available for other antidepressants. Nevertheless, studies published regarding psilocybin and MDMA have not shown any serious side effects in any of the patients involved. That having been said, once psilocybin has been approved by the FDA, there will be post-approval studies. This is always done and often produces information that was not available initially.
How Does Depression Affect Physical Illnesses?
When we look at depression and chronic diseases it is a bit like which came first, the chicken or the egg. Hurting all of the time, having disabling conditions wears on a person and can lead to clinical depression. But many depressed people have more aches and pains than their life experiences would normally cause. Physical symptoms are common in major depression and include joint pains, limb and back pains, fatigue, poor appetite, and stomach problems. A primary care physician will tell you that many times major depression presents in their office as a physical complaint.
Recognizing Depression
In order to treat depression and reduce suicide risk it is necessary to recognize depression. This is especially the case when a person does not say they are depressed but rather talks about their aches and pains, stomach problems, or poor appetite. Depressed veterans tend to isolate so their family and friends will often not have much contact with them. When the only subject of conversation on rare occasions has to do with how much they hurt there can be a temptation to keep the conversation short and leave them to their complaining. This is, however, exactly the time to consider if this individual is depressed and at risk suicide. It is exactly the time to talk with them more and draw them out so that you get an idea of how their life is going and if the issue is depression and not just being grumpy over their physical problems.
