Could Dominic have been saved? A question often asked by those affected by the traumatic loss of a loved one – and a difficult one to answer. To say ‘yes’ leaves us feeling regretful of what we did not do to help our son. To say ‘no’ makes us feel helpless. But the exercise of asking the question is nevertheless useful to the narrative.
Though the wonder will remain, asking the question has propelled us to compile and disseminate information that may have helped us save Dominic. We share this research and excerpts of Dominic’s story with the hope of preventing others from ever asking the same question.
Recalling some of his statements made us realize that Dominic exhibited some of the classic tell-tale signs of depression. We believe that our continued effort to distribute a mental health curriculum to adolescents may have helped Dominic and has the potential to help other youth combat their feelings and de-stigmatize the topic.
Could Dominic Have Been Saved?
- Age 13
'I’ve stopped participating in class because my classmates roll their eyes whenever I respond to a teacher’s question. They snicker every time I ask a question. At first, this made me mad, but now it makes me sad. I’m sad all the time.' - DominicSign: Feelings of isolation from classmates, friends and peers. As depression worsens, these feelings of being ostracized and alone will include members of the immediate family. The sense of being different and excluded is oftentimes not real but imagined. Adolescents who are very sensitive and/or self-critical are more prone to thoughts of exclusion. The isolation naturally leads to a profound sadness that – if allowed to continue over a prolonged period of time – becomes the norm rather than an exception to healthy feelings of happiness and well-being.PAD’s Efforts: PAD’s presentations to students help them realize that, if they are experiencing feelings of isolation and are sad most of the time, they are not alone. Many of their peers and classmates are experiencing the same feelings. Students are encouraged to share their feelings with their parents, guardians or a trusted adult. PAD presentations and materials also provide students with concrete steps they can take to combat the feelings of sadness. They offer information on how to seek help, with whom to speak, and simple changes to correct any imbalances that may be affecting their feelings and outlook.Retrospective Thoughts: If we had received a PAD brochure, had known to discuss this topic with Dominic, or been provided information to share with a health care professional, we feel certain that Dominic would have experienced a much better outcome.
- Age 16
'The worst mistake that I ever made was dropping karate so that I could take the lead role in the school play. The only time I felt completely normal was when I was in karate class.' - DominicSign: Mood and disposition dissonance. Adolescents who are depressed often experience transitory periods of manic euphoria. These mood swings are frequently unpredictable and do not coincide with events or circumstances that could be interpreted as associative or as mood-swing triggers.PAD’s Efforts: Our research has taught us that Dominic was describing a very common phenomenon. What he – and we – didn’t understand at the time is that exercise and physical exertion of any kind is responsible for triggering the secretion of endorphins and other mediating hormones that serve to keep the body and mind in a steady state relative to mood, disposition and outlook on life. The symptoms of depression act as if they are attached to a boomerang launched from an unseen hand. They return again and again with little or no warning, and can strike at the most inopportune times. We have incorporated our research on the effect of physical activity to hormones into our presentations.Retrospective Thoughts: If we had the opportunity to attend a PAD presentation to parents, we would have learned how to help our son mediate out of control hormones, and helped him navigate his imbalance with a health care professional and psychologist.
- Age 18
'Everyone went to the University of Maryland football game – except me. My friends asked me to go along, but I just couldn't go. I spent the entire day all alone in my room. I watched the fireworks after the game through my bedroom window.' - DominicSign: Agoraphobia – shying away from crowds and social events. People suffering from depression often experience this condition as a reaction to their nonstop irrational thoughts that everyone is watching them or talking about them.PAD’s Efforts: We have discovered that agoraphobia, synonymous with social anxiety, is recognized in literature and clinical settings. Once understood and diagnosed, it is a very treatable condition, treated effectively with counseling and medication. PAD’s presentations to students, teachers, and parents discusses these treatments and how therapies are most effective if the social anxiety is diagnosed early and administered in the teen years.Retrospective Thoughts: If Dominic had learned about his condition in a classroom setting, he would have understood that treatment is available for this condition. In turn, he may have been more willing to discuss his feelings and we could have played a more integral role is our son’s care, to ensure that his social anxiety was appropriately addressed.
- Ages 18-29
'I think that I am losing my mind. I just can’t seem to think clearly. I know that people are talking about me all the time. I am sure that my teachers and classmates hate me.' - DominicSign: Difficulty distinguishing between perception of reality and real world experiences. Uncontrolled depression can lead to imagined thoughts replacing reality, a cruel distortion of facts, and these thoughts ultimately affecting how a person reacts to people and events. Responses become inappropriate and no amount of rational discussion or reasoning will alter the person’s determination that erroneous perception is absolute reality. As irrational thoughts take more and more time and mental effort, rational thought and intellect become cloudy and difficult. Concentrating for extended periods of time becomes difficult and sustaining the mental rigor to solve complex and theoretical problems is nearly impossible.PAD’s Efforts: Through our research in developing the PAD curriculum, we have learned that these kinds of thoughts are classic indicators of depression that is completely out of control. Out-of-control Cortisol levels are often the cause for the irrational thoughts a depressed individual is experiencing. In our presentations we explain that a normal range for blood Cortisol levels is 6 – 23 micrograms per deciliter. Dominic’s blood Cortisol levels might have been so high that he was possibly nearly toxic. As Dominic became an adult according to the legal definition (age 18 and over), we were no longer privy to his medical information such as his chemistry assay. In the future, PAD intends to tackle this important legal issue. Access to medical information of a patient unable to make sound medical judgments should be granted to parents and something must be done to ensure this.Retrospective Thoughts: If we had known what we know now about Cortisol, we would have taken immediate steps to address Dominic’s clinical emergency. We could have helped him sooner. Still, we did spend hours and hours assuring Dominic that people were not talking about him and that he was well liked. These feelings continued even into Dominic’s post-graduate work. He was convinced that he was disliked by his fellow Ph.D. classmates and his professors. His entire Doctorate class and his professors attended Dominic’s funeral and all of them told us how much they admired and respected Dominic’s intellect and kind heart. His professor told us what a wonderful gift Dominic had for science and that he would have done well in the field.
- Age 23
'I just can't bring myself to turn in my qualifying exam. I work and work at it night after night and I just can't seem to get it right. No matter how many times I modify my answers – they just aren't right.' - DominicSign: Prominent personality traits such as perfection may predict a propensity towards depression. Medical science has identified a set of personality traits which – while predictive but not diagnostic of the potential to develop a depression disorder – serve to provide clinicians with a model to which they may be able to match the results of more quantitative measures. Prominent among these personality traits is the need to strive for perfection. So deep-seated is this drive that it becomes almost a moral imperative.PAD’s Efforts: Using the personality traits researched by medical scientists, we list and explain the personality trait indicators in our presentations to students. We encourage them to be on the lookout for the warning signs in themselves and in their friends.Retrospective Thoughts: If PAD had been available as a resource for Dominic – and for us as his parents – we would have been aware that our son’s constant quest for perfection, and his sense of profound failure at anything less, was a warning sign. We would have been on the lookout for the other behaviors that placed him in a high-risk category for becoming clinically depressed.
- Age 25
Dominic finally recognized that he needed professional help.The first psychiatrist prescribed the drug Effexor. He was told that he would probably be on the drug for an extended period of time, if not for the rest of his life.When Dominic was not getting any better, he went to see another psychiatrist, who continued to prescribe Effexor even though the drug was only minimally effective in treating Dominic’s depression. PAD has learned that oftentimes Effexor – and other antidepressant medications – are only effective in a certain percentage of the patient population.It is important for physicians to closely monitor their patients not only for effectiveness of the medications they have prescribed but for blood levels of the drug to ensure that therapeutic levels are reached and maintained.Effexor was not an effective treatment for our son’s depression. He never attained remission from his brain disease. Did Dominic report to his psychiatrist that he was feeling better – even though he was not? Did our son tell the doctor that his prescribed treatment was working well – so as not to disappoint him? We will never know.Patient confidentiality laws prevent parents from gaining access to health information for their adult children. In order for parents to participate in their adult children’s care, health care law much accommodate a patient advocate (such as a parent) to be present during a patient’s meetings with their health care professionals.
- Age 28
Dominic agreed to partial hospitalization after years of struggling to get better with very limited positive results. Unfortunately, hospitalization may have come too late.A combination of antidepressant drugs, group and private counseling – including CBT (Cognitive Behavioral Therapy) – helped only marginally. Dominic was among the percentage of patients for whom Effexor was ineffective. His serum cortisol levels were probably so high that internal stress simply overpowered his intellect. Dominic’s vitamin levels were also not monitored. When his Vitamin D level was finally checked at age 30, it was only 7 ng/ml. The normal range is 40-80 ng/ml per the Vitamin D Council.Our son’s hormonal levels were so imbalanced that rational thought was impossible.
- Age 29
'I want to relive my teens and twenties. I want those lost years back. I want to start over.' - DominicWe could not grant his wish. No matter how hard we tried we could not convince him to keep on fighting and to keep hope alive. He had come to the end and he had no more fight left in him.“Why didn’t you save me?”This broke our hearts. He could not see – or remember – how hard we had tried to help him.
- Age 30
On his 30th birthday, October 29, 2012, Dominic asked, 'Do I have to threaten to kill myself to get some treatment?'Dominic went through six weeks of Transcranial Magnetic Stimulation (TMS). Even though he did not miss a day of his treatment, he was unfortunately part of the small percentage of patients who did not benefit from it.Following this, Dominic slowly weaned himself from Effexor and was prescribed Lithium in January 2013. Within a day or two, he felt much better. Unfortunately, Dominic’s relief was temporary. His psychiatrist told him the only option left was antipsychotic drugs to stabilize his situation. The Mayo Clinic explains that doctors may recommend a blood test called cytochrome P450 to check for specific genes that affect how the body processes antidepressants if antidepressant treatments do not seem to work. We now know that Dominic might have benefitted from this test.
On March 25th, 2013 – Our beloved son Dominic took his own life.
Early intervention is key. PAD is committed to bringing young adult depression out of the shadows and into the light of discussion and discovery.