Depression & Suicide: A Match Made in Hell

Did a High Dose of A Benzodiazepine Put Chris Cornell in a Psychiatric or Psychotic Episode Likely Amnesiac?

Plus Excepts from The Rolling Stone Interview as “Superunknown” Turns Twenty:  Clear Evidence of a Musical Genius’ Tortured Soul


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In 2014 Soundgarden, and their frontman, Chris Cornell sat for an extensive interview with Rolling Stone Magazine as it was the 20 year anniversary of the band’s hugely successful album, ‘Superunknown,’

He discussed a wide array of topics including topics including Depression, Isolation, Suicide. and the death of his friend Andrew Wood as well as the death of Kurt Cobain. Here are but a few excerpts that give insight into the musician’s psyche and the darkness he struggled with.

Chris Cornell Acoustic Cover of Prince’s “Nothing Compares 2 U”

Coincidentally, the first ever “Guidelines for the Recognition and Management of Mixed Depression” were published in the April edition of Cambridge University Press’s CNS Spectrum, a peer-reviewed academic journal “covering all aspects of the clinical neurosciences, neurotherapeutics, and neuropsychopharmacology.” Cambridge University Press is one of the largest and most prestigious academic publishers in the world publishing 360 peer-reviewed academic journals and more than 30,000 ebooks for the global market” (Cambridge University Press, 2017).

These guidelines were authored by a panel of 18 experts in the above mentioned fields of Psychiatry, Neurology and Neuropsychiatry, from top medical schools across the United States, Canada, as well as the UK, Sydney, Italy, Spain and Japan. To say that these guidelines are overdue is beyond an understatement as 70% of the prescribed anti-depressants are dispensed by General Practitioners and others practicing areas of medicine other than Psychiatry.

I’ll elaborate more on this topic and the role Benzodiazapines may have played in Chris Cornell’s death, after the following excerpts from the Rolling Stone Interview with Chris Cornell from 2014 which follows immediately:

Chris Cornell: The Rolling Stone Interview
Background
In 2014, Soundgarden issued a 20th anniversary edition of their landmark ‘Superunknown’ album. To mark the occasion, frontman Chris Cornell sat for two extensive, revealing interviews with Rolling Stone to reflect on how the record was made, his mixed feelings on grunge and where his head was at when the band was at its biggest.

Interview:
Rolling Stone:   What was your headspace at the time of ‘Superunknown?‘
Chris Cornell:   A lot of the lyrics are dark. I don’t know if I would say I was in a particularly dark or moody headspace more than other times. I feel the lyrics have to be born from the music. Or if I had a lyrical idea, separate from Soundgarden music, I knew if it would work with the band because it tended to reflect what the music was and what the feeling of the music was – which was usually somewhat dark and somber or moody, or over-the-top, visceral, aggressive angry.

RS:   So it wasn’t an especially dark time?
CC:   No, not that I remember. No more than usual. I think that I always struggled with depression and isolation, so those could come out. I think that the mood of Seattle to me, and the way that I always interpreted that mood was something that was always a little bit introspective and dark. And I wouldn’t say “depressing,” but introspective in a way that could be moodier and darker.

RS:   This reissue includes several versions of “Fell on Black Days,” which is pretty dark. What inspired it?
CC:   Well, I had this idea, and I had it for a long time. I’d noticed already in my life where there would be periods where I would feel suddenly, “Things aren’t going so well, and I don’t feel that great about my life.” Not based on any particular thing. I’d sort of noticed that people have this tendency to look up one day and realize that things have changed. There wasn’t a catastrophe. There wasn’t a relationship split up. Nobody got in a car wreck. Nobody’s parents died or anything. The outlook had changed, while everything appears circumstantially the same. That was the song I wanted to write about.

No matter how happy you are, you can wake up one day without any specific thing occurring to bring you into a darker place, and you’ll just be in a darker place anyway. To me, that was always a terrifying thought, because that’s something that – as far as I know – we don’t necessarily have control over. So that was the song I wanted to write. It just took a while.

RS:   The song you workshopped the most was “Like Suicide.” In the liner notes, you say it kind of became a metaphor for how you were feeling at the time about late Mother Love Bone frontman Andy Wood.
CC:   Yeah, the lyrics were actually this simple moment that happened to me. I don’t know that I ever directly related it to Andy, though there are a lot of songs that people probably don’t know where there were references to him or how I was feeling about what happened with him. I just think that that was something that happened to me that was a traumatic thing and that I had a difficult time resolving it. I still never really have. I still live with it, and that’s one of the moments where maybe in some ways it could have shown up, but I’m not really sure specifically where.

RS:   You said the lyrics were literal?
CC:   Yeah, the narrative is not a metaphor. It’s a big moment that happened while I was recording the song. I had all the music and was recording a demo arrangement in my basement. And when I came upstairs, I heard a thud against the window, and it was a female robin that had fallen into the window and broke her neck, and was just laying there. I didn’t know what to do. So I ended up smashing her with a brick, putting her out of her misery. I didn’t want to sit there and watch her suffer. Then when I went back down to finish recording, I decided that would be the lyrics to the song. As much as it sounds like I’m singing about a person and the metaphor is sort of the bird in flight and then [it] dies … it was literal [laughs].

RS:   About a month after ‘Superunknown’ came out, Kurt Cobain died. How did it color that time for you?
CC:   I wasn’t one of his close friends……It was something in a way similar to losing Andy, or losing friends that died after that. It’s not so much the person and the relationship with them, but the creative inspiration that person has and I would get from that person. My perception of the world of music at large artistically shrank, because suddenly this brilliant guy was gone. I’m not even talking about what he meant culturally; I’m talking about his creativity. It was super inspiring from the very first demo I ever heard. It broadened my mental picture of what the world was creatively, and suddenly a big chunk of it fell off.

RS:   And that’s how you felt about Andy?
CC:   Yeah. The tragedy was much more than the fact that I would never see him again – it was that I would never hear him again. There’s this projection I had with Andy, Kurt, Jeff Buckley and other friends of mine that died of looking into the future at all these amazing things they’re going to do. I’ll never be able to predict what that is. All this music that will come out that will challenge me and inspire me – that sort of romantic, dramatic version of the perspective. When that goes away, for me in particular, it was a really hard thing. And it continues to be a hard thing.

RS:   There’s a large part of Soundgarden history, to me, that’s wrapped up in that conflict of losing these incredible creative lenses of what I imagine is this incredible, infinite world of the power of creativity. These were people, and people you could share experiences with while you’re learning what your power of that creativity is.

CC:   So part of my memory of every record, and certainly Superunknown, there’s an eeriness in there, a kind of unresolvable sadness or indescribable longing that I’ve never really tried to isolate and define and fully understand. But it’s always there. It’s like a haunted thing.

Then there were these miraculous moments existing around a similar time, one of which is Eddie [Vedder] showing up and starting a new band with your friends that just lost this amazing person and having that creative output and outpouring be so phenomenal. The degree to which it changed the face of rock music in the world is this pretty incredible thing. There were these huge, amazing ups, but also these difficult conflicts I’ve never been able to resolve.


Chris Cornell’s wife Vicky issued a statement speculating whether his suicide was the result of too much anxiety medication which I’ll explain and illustrate why this is a plausible reason.

Mixed Depression (cont):
As stated above, and it bears stating it again, that 70% of all anti-depressants prescribed are not by Psychiatrists. That’s a frightening number as more than a third of adults diagnosed with MDE (Major Depression / Major Depressive Episodes – and related disorders have depression with mixed features. In other words, other significant symptomology presents itself episodically, which can include such issues as mania, psychosis and often suicidality, which can be manifested in suicidal ideation, suicidal intent, plan, and/or gestures as well as engaging in high-risk and self-harmful behavior .

For kids with depression the number is far greater, with the majority of youths diagnosed with Major Depression experiencing mixed episodes. It’s what the panel refers to as the rule, not the exception.

The guidelines state clearly what many of us in the mental healthcare field know, that the “classic point of view” of patients with MDE (Major Depressive Episodes) with mixed features and the treatment of such individuals has long been outdated.  That point of view is based on initially treating patients presenting with any depressive episodes with anti-depressants, regardless if other symptoms are present. Hence the 70% of anti-depressants prescribed are done so by clinicians other than Psychiatrists.  For many who do not specialize in mental health, the first line of treatment has been shown to be dispensing antidepressants which can make the patient much worse, kicking them into mania rendering them vulnerable for self-harm, high-risk behavior or worse.

While I agree that antipsychotics have their problems, these days there are a much wider and greater range of both antipsychotics, atypical and otherwise as well as a much wider range of mood-stabilizers, which taken together has a strong track record in treating patients with Bipolar Disorder (and related disorders), especially as it relates to harm reduction.  The problem is that psychotropic medications are trial and error.  It’s not like antibiotics or medications for the treatment of illness in other areas of the body outside of the brain.

The guidelines also encourage clinicians to think about the possibility of mixed features in ALL patients with depression.  “You will not know if a depressed patient has (hypo) manic symptoms or a positive family history of bipolar disorder unless you ask. Ask every patient. Every time,” the panel advises.

“If you only look for depression, simultaneous symptoms of mania will be missed. And even with low levels of mania symptoms, you shouldn’t give an antidepressant, at least not first-line,” said Dr. Stephen Stahl, lead author.

These guidelines represent “expert consensus” on recognizing and treating mixed depression and is also a “call to action – that is, let’s do the best we can with the data that are available,” Stahl added.

Audioslave Live in NYC on top of the Ed Sullivan Theatre – Letterman Show

Benzodiazepines & Self-Harm:
Chris Cornell, A High Dose of Lorazepam & A Possible Psychotic Episode?
Back to the loss of Chris Cornell. It’s no surprise that Mood Disorders have a high rate of co-morbid substance abuse disorders as well. Cornell, who had long been sober alarmed his wife the night he died, as he was slurring his speech while on the phone with her back at the hotel after performing. In her statement, Vicki Cornell elaborated that Chris’ bodyguard, is responsible for controlling and giving Chris his dosage of his prescription of the Benzodiazepine, Ativan (the brand name for Lorazepam), a controlled substance in the same family as Valium, Xanax, Klonopin, and many others.

Lorazepam has been considered by some Psychiatrists to pose less potential for abuse than other Benzodiazepines, especially for those who have a history of alcohol and/or substance abuse. In fact, Ativan is dispensed in emergency rooms, intravenously to treat acute alcohol withdrawal, preventing the potential neurological symptoms related to acute alcohol withdrawal which can be deadly.

That said, responsible Psychiatrists may treat anxiety with a Benzodiazepine, while many opt for a non-narcotic alternative, or permitting the controlled substance as part of a short-term course of treatment with the intention of titrating the dosage down before the patient begins to build up a tolerance which can lead to a pattern of abuse. Although Ativan has a much longer half life than other Benzodiazepines, such as Xanax, it still comes with very serious potential side effects.

Metaphorically, for a recovering alcoholic this classification of medication can open up some doorways and paths in the brain not active since the individual had achieved a period of sustained recovery / abstinence from alcohol. Benzodiazepines can cause the worsening of depression and have a paradoxical effect, causing excitement, and not necessarily the good kind, but aggression and severe lapses in memory and judgment. Individuals with a prior alcohol problem are specifically mentioned as a group that is at risk for experiencing these paradoxical negative side effects.

Lorazepam has been found to have a longer term effect on memory than other similar medications. Paradoxical effects are more likely to occur with higher doses, in patients with pre-existing psychiatric illness. Such memory impairment often exists at least 6 months after the use of the medication is discontinued.

Part of this paradox is that stimuli may trigger such reactions, despite the fact that the drug may have been prescribed to help the patient cope with such stressors and frustration in the first place. Paradoxical effects appear to be dose-related, meaning they are more likely to occur in a patient who ingested a higher dose than what is typically prescribed. Chris reportedly told his wife when asked about his slurred speech that he “may have taken an extra Ativan or two.”

Sadly, Benzodiazepines sometimes unmask suicidal ideation in depressed patients, possibly through disinhibition or fear reduction. The concern is that benzodiazepines may inadvertently become facilitators of suicidal behavior. Dosing guidelines indicate that lorazepam should not be prescribed in high doses and not as the sole treatment of anxiety or depression, but only with an appropriate antidepressant and/or other non-narcotic psychotropic medication(s).

Suicide in a Likely Amnesiac State?
So, from everything I had gathered about Chris Cornell before his shocking and far too early death, was that he struggled with alcohol and substance abuse years ago but had been sober many years and was a very devoted family man. Most recently, he flew home for the day, to celebrate Mother’s Day, spending time with his wife and two daughters whom he is quoted many times as being truly and utterly devoted to. My heart breaks for his family. A vocalist with a 4 octave range, he was known to be prouder for his status as a father. The world lost a great artist and worse, his wife and daughters lost their husband, father, and best friend.

"Tinker Bell And The Great Fairy Rescue" - Special Screening & Picnic

Chris Cornell with his two daughters several years ago.

For such a talented musician, voacalist and frontman of some of the most successful, powerful, and beloved bands, as well as a successful soloist, Chris Cornell was a humble man about his talents.  In the below video he could have easily outshined Linkin Park’s Chester Bennington, but instead harmonized during Chester’s vocals assuring that he didn’t steal the spotlight with his amazing four octave ranging voice.

Linkin Park & Chris Cornell – “Crawling” Live

His music will live on and I’m grateful to have seen him perform live both with Soundgarden and as a solo performer. After learning of his death I watched YouTube videos of some of his performances. One in particular stood out. He was performing at the Beacon Theatre in NYC in 2015, playing guitar and singing backup vocals for one of his daughters as they covered Bob Marley’s ‘Redemption Song.’ He clearly and intuitively made sure to take a back seat to his daughter’s vocals. What was clear to me as I watched this performance, was that I probably never saw him look happier. I hope he is in a better place free of the turmoil and distress that plagued him throughout his life beginning with a well documented and painfully difficult childhood.

Chris & Toni Cornell Cover Bob Marley’s “Redemption Song” – The Beacon Theatre
10/19/2015

As I listened to his music almost non-stop over the past two days, his lyrics relating to sucidality chilled me, from the Soundgarden song, “Like Suicide” to the lyrics of the band’s “Blow Up The Outside World” (See Below Video – Soundgarden Live in London’s Hyde Park – 07/13/2012). The lyrics for that song, which taken in the context of Chris’ death, are particularly upsetting as I can’t help but wonder how much he suffered quietly, yet another senseless victim of the silent assassin of untreated or inappropriately treated and rarely discussed wrath of mental illness.

Soundgarden – “Blow Up The Outside World” – Live in London’s Hyde Park 07/13/2013

If you know someone you are concerned might want to hurt themselves or someone else as a result of emotional or mental disturbance, you must say something. Contact a professional. Call the Suicide Lifeline and you’ll be connected to a mental health professional. It’s ok to call when there is not an emergency. If this is not an emergency situation, feel free to contact me anytime. I’m always pleased to help those in need either directly or by connecting them with the proper level of treatment.

Below is information as to how you can get help for yourself or someone else who you are concerned might be a danger to themselves or someone else. Take a minute and save this information as precious minutes save lives.

With grief and hope,

SCRATCH PAD - ASST. QUICK NOTES - 20160610_090454 - 16

If the matter is an emergency, do not contact me – precious minutes save lives!
Instead, please call 911 or go to your nearest Emergency Room!
NATIONAL SUICIDE PREVENTION LIFELINE INFORMATION:

National Suicide Prevention Lifeline: 1 (800) 273-TALK (8255)
(Even and especially if you or the person you are concerned about is not care not considering hurting yourself as you’ll get in touch with a counselor regardless when you call).

Callers are connected to a skilled, trained counselor in their area.
These professionals are available 24/7, and Spanish Speaking Professionals are available as well.
A wealth of information on suicide prevention and related topics from domestic abuse, bullying, dealing with distress from events of mass violence, and much more can be found at their website: www.suicidepreventionlifeline.org

There is no shame in having a problem, especially if you do something about it. Calls to the the lifeline are FREE and CONFIDENTIAL.

Again, for more information, either call the above number or visit them online at:
www.suicidepreventionlifeline.org
Don’t worry if by calling the Lifeline, that you might be over-reacting.  In fact the following message from their site indicates that you SHOULD call, without hesitation, if you or someone you know are in crisis:

“If you feel you are in a crisis, whether or not you are thinking about killing yourself, please call the Lifeline. People have called us for help with substance abuse, economic worries, relationship and family problems, sexual orientation, illness, getting over abuse, depression, mental and physical illness, and even loneliness.”
National Suicide Prevention Lifeline – Retrieved from: www.suicidepreventionlifeline.org


References

Edwards RA, Medlicott RW (1980). “Advantages and disadvantages of benzodiazepine prescription.” New Zealand Medical Journal, 92(671): 357–359.

Goldney RD (1977). “Paradoxical reaction to a new minor tranquilizer.” Medical Journal of Australia, 1(5): 139–140.

Grow, Kory. Chris Cornell Looks Back on 20 Years of Soundgarden’s ‘Superunknown’. RollingStone.com/Music. Retreived from: http://www.rollingstone.com/music/news/chris-cornell-looks-back-on-20-years-of-soundgardens-superunknown-20140527

Riker RR, Fraser GL (2005). Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy, 25(5 Pt 2): 8S–18S.

Scharf MB, Kales A, Bixler EO, Jacoby JA, Schweitzer PK (1982). Lorazepam-efficacy, side-effects, and rebound phenomena. Clinical Pharmacology and Therapeutics, 31(2): 175–179.

Stahl, S., Morrissette, D., Faedda, G., Fava, M., Goldberg, J., Keck, P., . . . McIntyre, R. (2017). Guidelines for the recognition and management of mixed depression. CNS Spectrums, 22(2), 203-219. doi:10.1017/S1092852917000165

The Real Dash: SingleFATHER; TechGeek, MovieFreak, Music/TV/Reading/Writing Junkie, Psychotherapist, RUNNER, Meditator. Mad useful/less info. If that's not enough....see my links.....

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Posted in #Addiction, #depression, #Drugs, #Mental Health, #Music, #Parenting, #Psychology, #Psychotherapy, #Relationships, #SubstanceAbuse, #Suicide

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