By Amanda Eggert EBS Senior Editor
BOZEMAN – Montana has ranked among the top five states in the country for suicide rate for the past 40 years, since the statistic was first compiled.
Among the 10- to 34-year-old age group, Montana is double the national average for suicide rate. That rate is on the rise, said psychiatrist Matthew Byerly, during his introduction of Dr. John Rush on Feb. 2 at the Emerson Center for the Arts and Culture.
Regionally, 53 percent of respondents to last year’s Community Needs Assessment survey administered in Gallatin, Park and Meagher counties said mental health and suicide prevention services were lacking in their communities, according to the Human Resource Development Council.
Rush, professor emeritus at Duke National University of Singapore, addressed these troubling trends with a lecture on his commonsense, “patient-driven” approach to mood disorder treatment.
Rush uses a few straightforward guidelines designed to thwart what he calls the “evil coach” we all possess. The evil coach, Rush says, is an irrational part of our brain that causes us to misbehave in ways that aren’t good for us.
The approach Rush uses is not particularly trendy, and it’s not a quick fix either. But it appears to be an effective one, given his commitment to both reading and conducting the latest research on the subject, and the outcomes he’s helped patients achieve during his four-plus decades in the field.
First, Rush recommends people who are at risk for mood disorders like depression and bipolar disorder partner up. As humans, we tend not to be very good at judging changes in our subjective experience. Oftentimes, family and close friends will notice mood changes we won’t necessarily register. The support of friends and family can also be vitally important to sticking with a treatment program.
Second, Rush emphasizes finding a way to put objective measures around a subjective experience so patients and their doctors can reliably monitor their condition. “The depression measure gives you a kind of thermometer,” said Rush, who’s been named as one of the “World’s Most Influential Minds.” He recommends three surveys that are available online: the Patient Health Questionnaire, the Quick Inventory of Depressive Symptomatology—Self-Report, and the Sheehan Disability Scale.
Rush said approximately 17 percent of psychiatrists, and an even lower percentage of psychologists, measure outcome. He recommends that patients do so themselves if their doctor or mental health specialist does not—“then you can tell them if you’re getting to where you want to go.”
People suffering from a mood disorder must also evaluate side effects of the options they’re considering. Rush says he tries to proactively address factors that might lead to noncompliance with a treatment program.
“What are the reasons why you might not follow what I just told you might be a good idea?” Rush asks his patients before they leave his office.
Rush says it’s important that patients give treatments time to take effect, but it’s also key that they’re willing to try a number of different approaches.
“It is definitely not the case that the first treatment is the last treatment. The first treatment is the first strike on goal,” Rush said. “Sometimes several shots on goal are necessary to get people from sick to well, or even sick to better.”
When people ask Rush if he “believes” in certain approaches like medication, hypnosis, or cognitive therapy, he responds, “It’s not a religion. It’s a science kind of thing.”
What he wants to know is whether or not it works.
“I think it’s very important for all of you to know that we honestly don’t know what the right thing to do is when you walk into our office,” Rush said. He’s familiar with a broad range of treatments including electroconvulsive therapy; transcranial magnetic stimulation; antidepressant medications; and cognitive, group and couples therapy.
“I’ve been trained in all that … I’ve even done all that,” Rush said with a chuckle. “But which one do I pick for you? I don’t know. I have to have a conversation.”
Rush reemphasized patience in dealing with depression, which accounts for two-thirds of all suicides.
“It isn’t go in, tell them you’re depressed, you go in they change the carburetor and the engine runs great. It doesn’t work like that,” Rush said. “It’s multiple steps trying to figure out what’s wrong. [You] try a key in the lock, try [another] key in the lock—and then incrementally, consistently, persistently [get] better.”
A video link to Rush’s lecture, including his brief notes on specific treatments, is available at montana.edu/lettersandscience/speakers/speakers_youtube.html.