Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Sunday, February 20, 2011
Suicide, Brains, and Football
In yesterday's New York Times, Alan Schwarz wrote about the tragic suicide of football player Dave Duerson this past week. Schwarz notes that prior to shooting himself, Duerson texted family members that he wanted his brain examined for Chronic Traumatic Encephalopathy, a condition we've discussed before in our post Brains, Behavior, and Football.
Doctors, N.F.L. officials and even many players denied or discredited the links between football and such brain damage for months or even years. The roughly 20 cases of C.T.E. that have been identified by groups at Boston University and West Virginia University were almost always men who had died — most with significant emotional or cognitive problems — with no knowledge of the disease. Now, for the first time he knows of, Stern said, a former player has killed himself with the specific request that his brain be examined.
I'm left to wonder, did this former football player have this problem? Sometimes depression alone causes memory problems and sometimes people with depression worry that they have Alzheimer's disease, or any number of other illnesses for that matter. Treating the depression may help the memory problems, and may alleviate the fears of other illnesses. And we don't know much about the Chronic Traumatic Encephelopathy induced by repeated head injuries: is the course of the dementia altered by early intervention with medications? Does the depression respond to the usual treatments for mood disorders? Could Mr. Duerson have been saved, at least for a while?
Here's an article on the treatment of chronic brain injury with hyperbaric oxygen in animal models:
And here's an emedicine article on treatments for repetitive brain injuries (not necessarily specific to CTE) with medicine recommendations, but no mention of antidepressants or medicines to slow the course of dementia:
Here's a medscape article on CTE and dementia:
And, finally, here's a shout out to my friend and med school classmate Robert Morrison, M.D., Ph.D. whose paper for our public health class was published in JAMA back in 1986 as a state of the art review of boxing and brain injury: http://jama.ama-assn.org/content/255/18/2475.short
Is it worth it in the name of sports?
Could I ask a huge favor of the next football player who considers suicide? Instead of completing the act, could you have your depression treated and then write about the results? It would be an enormous contribution. Sure, it would be an anecdote, and not a controlled trial, but perhaps it would add something to the field. And we'd be happy to publish your story here on Shrink Rap.
My heart goes out to the family of Dave Duerson.
Posted by Dinah on Sunday, February 20, 2011
Labels: brain, dementia, depression, sports, suicide
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I am curious as to why psychiatrists such as yourself come across as always steering discussions of causes of memory loss in the direction of depression as the culprit?
Your point might make more sense if Mr. Duerson hadn't played football. Even then, I feel psychiatry wants to falsely blame all memory loss on depression but I digress.
Since CTE is well known for causing depression in former football players who were subjected to repeated blows to the head. I just felt like blaming memory loss on depression came across as trivializing the main issue even though obviously, your intentions were good.
Regarding whether Mr. Duerson was accurate about his condition, I think people usually are very perceptive and have a sixth sense about this. Obviously, it is very tragic that he saw no way out other than suicide.
By the way, you expressed similar type skepticism with Owen Thomas, a college football player who also committed suicide in a previous blog entry. According to this NY times article, http://www.nytimes.com/2011/02/20/sports/football/20duerson.html?ref=football
"There also is a question as to whether the disease derives from a career in pro football or simply from many years of playing football at any level. Last year, C.T.E. was found in the brain of Owen Thomas, a University of Pennsylvania football captain who killed himself in April. "
As far as solutions to preventing and treating concussions, fish oil has shown great promise.
"Study and use Omega 3/DHA supplements: Dr. Bailes said his research with rodents indicated that these supplements, commonly called fish oils, show promise in the treatment and possibly prevention of concussions."
Also, the survivor of the Sago Mine Disaster was treated with extremely high dose fish oil intravenously for his brain issues and it was very effective.
The only thing I wonder about is that high EPA fish oil has been shown to be most effective with depression and ADHD. Interestingly, the miner appears to have received a 2-1 EPA/DHA ratio. As a result, I think researchers need to do a study comparing the different fish oil formulas to see which one works the best with concussions.
Also, coconut oil, which I previously mentioned as being helpful for weight loss may be useful for dementia/alzheimers . See this link to an article by Dr. Mary Newport who accidentally found that it helped considerably with her husband, Steve.
She was unsuccessful in getting him into a specific drug trial. So in researching the ingredients, she discovered that one was similar to what was found in coconut oil. Figuring there was nothing to lose, she decided to try it with her husband and obtained spectacular results even though he didn't make a complete recovery.
No matter what, I think we all agree this type of tragedy needs to end. Hopefully, we will hear a success story in the future instead.
damn good read.. very informative.
AA: I think psychiatrists like depression as a cause of memory loss because it happens often, and it gets better. Many other reasons for memory loss are irreversible, so for us, it's the language of hope.
I don't believe it's good for people's brains to get chronically knocked around. I would not be at all surprised if this football player's brain showed changes associated with repeated trauma (or the CTE syndrome).
So it's a complicated issue:
We've read he's worried about cognitive decline, and we believe his death was from suicide (I feel I have to keep some degree of skepticism from anything I read in popular media, so my hedging language).
Both depression and suicide are common. If his depression had been treated, would he still have committed suicide?
And if his depression was caused by CTE, would it respond to treatments the way other depressions do? I think that was my main question and why I think it will be helpful for football players to have their depressions treated and write about it: if their memory problems remain, then maybe they do have CTE, but wouldn't it be nice if treatment helped the depression and slowed the progress of the dementia and allowed for more quality time alive?
If the idea is that suicide is an understandable reaction to the onset of memory problems, and not a sign of depression, then my ideas have no credence.
Memory/depression/brain pathology are already known to have a relationship in Parkinson's Disease. Here there is a known mechanism for the illness, and the co-occurance of depression is very high ~70%, much more than one generally sees with reactions to say cancer. When the depression is treated, it gets better, but often, so do the symptoms of Parkinson's (obviously they don't get ALL better, but there is often notable improvement) including the memory problems.
It's complicated stuff. Clearly brain pathology influences mood and impulsivity.
Rap: Thank you!
Even where I live (Australia) the issue of brain injury from impact sports is starting to get traction. Our own versions of football, and we have 2, are starting to investigate the likelihood that players are slowly damaging themselves whilst playing.
But the big issue of course is what to do about it. Football is so popular, and there is so much money involved, that actually doing something significant about it is unlikely.
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