Spectator Health

It’s time we accepted that depression is a terminal illness

15 August 2014

2:29 PM

15 August 2014

2:29 PM

For Robin Williams, depression was a terminal illness. He also, his wife has revealed, suffered from Parkinson’s disease. These two problems are far more connected than most people know: for many sufferers the first signs of Parkinson’s, often ten years or more before the more readily recognized abnormal movements are seen, are those of a depressive illness. Why? Because the abnormal brain chemistry of the two illnesses is essentially the same.

But it is a grave mistake to assume that Williams must have killed himself because he couldn’t face the onset of Parkinson’s. He killed himself because he suffered from depression. Suicide is the final symptom of a mental illness. The prescribed instruction of ‘don’t kill yourself’ is as useful as telling someone with a cold not to cough. It is also an illness that is startlingly undetected, hidden and untreated, as the new President of The Royal College of Psychiatrists explained this week in an interview for the Guardian.


Depression is terminal. Depression kills. It is time we understand that and do more about it.

Dr Julius Bourke is a clinical lecturer and honorary consultant psychiatrist at St Bartholomew’s Hospital.

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  • Rebecca P


  • Ryan

    The problem here is that “depression” can refer to a bad day as much as it can refer to a terminal illness. We must learn to make this distinction. Individuals who think depression is definitely not a terminal illness simply don’t know what it’s like to experience that kind of depression. Individuals who think depression is sometimes a terminal illness have struggled with it their entire lives and know this is correct.

    Some depression does not respond to treatment. Some depression does not respond to lifestyle changes, environmental or circumstantial changes, and so forth. Some depression just keeps getting worse no matter what happens around it. This depression is terminal. Individuals who experience this kind of depression know this is correct. Individuals who disagree do so out of ignorance only.

  • lailahaillallah

    It kind of IS for some people, sadly. However, the suicide rate is low compared to the number of people with the disease. I think we are fortunate to have very good drugs now, and, in most parts of the country, reasonable access to Talking Therapies now.

    One problem is the over use of the term “depression” by people who are exhibiting a justifiable reaction to negative life events. Some of them probably do get depressed, but many are just sad or DISTRESSED. (Sorry- can’t do italics!) I don’t believe we can (nor should??) treat “Sadness”.

    Depression can and does remit on its own, but also can be remorseless. It is linked strongly to PD, and we know that it is also linked to drug use, though we don’t know why. We surely all know of people who have blown dope for years and never had an ill effect?

    When I look back on my life, I can see that for much of my adulthood I was depressed, but only got on medication c 7 years ago. I feel soooo much better for it and can only regret all the wasted years when I didn’t enjoy life as much as other people. Chronically tired, chronically anxious, insomniac, snappy with other people (mainly family) inability to have fun like others did. OK, not as bad as being in chronic pain with a bad back, or dying of TB and HIV in Africa, but no fun.

  • brotherbaldrick

    And the elephant in the room is his alimony payments which were bankrupting him, he said himself that he had to sell his ranch just to pay the alimony, and he was taking work that he hated – just to pay the alimony, I guess he got to the point where he said: you know what, I’m tired of being a slave…

  • Gwangi

    Or maybe Robin Williams made a rational choice. He was facing severe illness and, we hear, bankruptcy because of the vast cost of his divorces. Twas marriage which killed him possibly? Or maybe not. I don’t know but neither do you. Only Robin knows. why…so let’s stop assuming we know why he did it, eh? Far too many people doing that to appropriate this event for their own political and career ambitions – just like with David Kelly. Deeply distasteful, dodgy and offensive.

  • Freedom

    Interesting that, among other omissions in this highly selective argument, Dr Bourke failed to mention that Mr Williams was a long-time drug addict and had suffered relapses. I don’t doubt that Mr Williams was genuinely depressed, nor do I doubt that his drug abuse had everything to do with it.

    • Youbian

      There also seems to be evidence that cocaine abuse causes Parkinson’s

      • Freedom

        Well, if eating refined carbohydrates can cause type-2 diabetes and hypertension and I. B. S. and heart disease, I don’t see why cocaine couldn’t cause conditions, as well.

  • saffrin

    What a load of old bolix.
    Depressed because he had parkinsons disease more like.
    As for depression being a terminal illness, that’s bolix too.
    Change of lifestyle and scenery would do better than getting hooked on prescription drugs.

    • GraveDave

      Go take a pill. W anke r.

      • saffrin

        You sound depressed Dave?

    • lailahaillallah

      I hope you never get depressed mate.

  • David Curtis

    Mike Barnes is quite right. “Terminal” means an illness which will inevitably be fatal and from which recovery is impossible. Yes, depression can certainly be a fatal illness but it certainly isn’t a terminal one. In fact, I think it’s very unhelpful to describe it in this way because when people are severely depressed they can believe there is no hope of recovery – that pessimism is part of the illness. So the last thing a psychiatrist should be doing is agreeing with them. Most cases of depression recover given time and/or treatment. When somebody is severely depressed they should be reassured that no matter how bad things seem now the likelihood is that they will recover, even if they can see no prospect of it themselves.

    • Pootles

      I agree with you and Mike Barnes. It might be useful if Dr. Bourke replied to your posts.

    • GraveDave

      Most cases of depression recover given time and/or treatment.

      No they don’t.

      • jboswell

        Yes they do actually. It is just that, as a society, we don’t recognize people who recover from a bout of depression as having had the same “illness” as those who fail to get better. By singling out only those sad cases where people do not recover, and retrospectively calling their condition an incurable illness (and a terminal one at that), you are reversing the proper order of diagnosis.

    • Chris

      I have been suffering for depression for well more than a decade. I have hung on to this what I call false hope of “give it time it will pass”. Are there days when I feel “ok”? Certainly, but mostly days of feeling I can’t do this, no one really cares. The dark painful despair that I fought with antidepressants and therapy have done nothing to lessen this ache no one can fix. To know that this is a physical illness like that of a terminal physical disease makes me feel less of a failure and more of a patient. I actually have more hope than “you are weak and you just need to let it go”. My Papaw pasted away from parkinson’s and had no signs of depression leading up to his diagnosis. Does it pair with a physical disease? I don’t know. What I do know is I don’t have signs of parkinson’s, but I feel a dark despair that for more than a decade I can not shake. The thought that it could be a form of a physical disease, I feel less blame to myself than just “if you think happy thoughts your life will be great”. I feel more like a failure when someone says “I was depressed and I gave it time and now I’m fine”. What if someone had cancer and people said to them the same thing? “Give it time and it will go away. If you think positively it will go away.” ? Instead of “let’s treat this aggressively with everything we’ve got.” We haven’t lost touch with all reality, we just hurt so bad inside there’s no pain pill to numb it. It hurts to be awake and there’s no pill for that, no chemo, no nothing. Imagine your worst heartbreak everyday after day! I’ve had 2 children and kiddey stones and nothing is the equivalent to a constant heartbreak. To feeling alone, like no one really cares. I can wake up every morning and say to myself “I have 2 great kids, I’m healthy and I have a house”, but my heart is still saying “who really cares if your dead or alive. They’d be better off without you.” Knowing what I know now would give me hope instead of “its in my head get over it”. I’m sure the same results would happen in physically terminal patients if they were given the same treatment. We all just want to feel normal somehow and not like we were weak and that’s why your sick.

  • Mike Barnes

    Now I’m no Doctor, but I always thought terminal illness meant something along the lines of “you will die from this regardless of what treatment we give you!”

    What makes depression a terminal illness? You haven’t explained it. It doesn’t always result in the death of a patient. The vast majority of sufferers choose not to commit suicide, and there’s lots of treatment that does indeed help. In fact some people recover without any medical intervention at all.

    Why twist the normal definitions of terminal illness, it does no favours to the people suffering from it and it’s insulting to those with actual terminal illnesses.

    “Depression is terminal.”

    Apart from all the people who recover.

    “Depression kills.”

    It’s never killed anybody. They make a choice, and then a rope or a gun or train kills them.

    • lailahaillallah

      “It’s never killed anybody. Depression is not a choice, but reacting to it with suicide is.”

      Gosh! How wrong you are. Remember the old Verdict of “took their life whilst the balance of their mind was disturbed”? When depressed you don’t think straight. And you can no more chose than you can “chose not to be gay”.

      DOI- Depressive for years but well on treatment.