Survived a terrorist attack that left her physically unharmed but marked her forever from an emotional point of view. To the point of making her decide to end her life with euthanasia at the age of 23. What could have pushed Court Shanti, young Belgian, to ask for the end of life? His was what is clinically defined as major depression, a disorder that mainly affects women and often characterized by suicidal instincts.
Pain
At 17 Shanti De Corteb was at the airport to start what should have been one of the most carefree experiences in life, a school trip to Rome, along with all her classmates. That day, March 22, 2016, ISIS carried out a terrorist attack at the airport and another on the subway. 32 people died plus 3 suicide bombers. She remained physically unharmed but since then she has carried an unbearable pain inside her so much that she, despite taking psychiatric drugs, she had twice attempted suicide and twice had failed.
Symptoms of post-traumatic stress
Panic attacks, depressions, post traumatic stress symptoms: “I wake up and take medicine for breakfast, then up to eleven antidepressants a day. Without it I can’t live, but with all these medicines I feel nothing, I’m a ghost”, he writes on his Facebook profile. And again: “I can’t concentrate on anything anymore, I just want to die.”
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These are the typical symptoms of post-traumatic stress: “We know that this girl was already suffering even before the attack and therefore her level of fragility was greater and her state of alert was very strong”, she explains. Claudio Mencacci, emeritus director of Psychiatry at the Fatebenefratelli-Sacco hospital in Milan and co-president of the Italian Society of Neuropsychopharmacology. A traumatic event such as the one that Shanti experienced can cause a worsening of depressive symptoms and I do not exclude that she could also suffer from the so-called ‘survivor syndrome’. This is the dramatic condition that people suffer from, they realize that they have survived compared to others and that leads to the question of why they have been spared by generating a strong sense of guilt “.
What is major depression
What Shanti suffered from was major depression, a disorder characterized by a significant drop in mood, a reduction in pleasurable interests and activities, changes in the content of thinking and impaired cognition, as well as vegetative problems, such as alterations of the sleep and appetite. Major depressive disorder occurs mainly in females, with a ratio of about 2: 1 to males and affects about 6% of the world population.
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The data in Italy
It is also estimated that one in six people will develop at least one episode of major depression in their lifetime. And in Italy? “Of the 3 and a half million depressed people – replies Mencacci – we calculate that about 20-25% have characteristics of resistance to treatments, which means that they have undergone at least two pharmacological treatments without positive results. They suffer from forms of major depression. one million and two hundred thousand people with a prevalence among women because they have a very important anxious component and a more marked characterization in some phases of life such as pregnancy and menopause. The age groups in which it occurs range from 25 to 40 -45 years but after the pandemic we are seeing an increase in depression even among adolescents among whom there is an important suicidal drive as evidenced by the cases of assisted suicide via the web “.
Symptoms
There are various forms of depression and what differentiates them is the intensity and number of symptoms with which they occur and then the duration over time. “In major depression – explains Mencacci – even 8-10 symptoms can occur at the same time and are particularly disabling in relation to any social, relational and working activity”. As explained in the Statistical Diagnostic Manual of Mental Disorders (DSM-5), the patient with major depression remains in a state of profound sadness, despair and apathy throughout the day, with constant brooding, dips in attention and negative thoughts about themselves. , on their future and the social context that surrounds it.
The alarm bells
What should trigger the alarm in people who are close to those who are depressed? “When we notice that the person completely loses the motivation and the sense of doing things”, replies the psychiatrist who adds: “The signs to be noticed are an alteration of thinking with suicidal design and psychotic manifestations. People suffering from major depression they can have delusions of guilt, ruin, catastrophism also referring to inadequacies, to sins they have not committed but which they perceive as irreparable, somatic manifestations such as the idea of having an incurable disease “.
The risk of a relapse
Is there any way out? It depends on the cases. On average, a depressive episode varies between 13 and 30 weeks, and approximately 70-90% of patients overcome the episode within the first year of onset. Sometimes, remission is complete, in others the disorder tends to become chronic. “It is a chronic, progressive and recurrent disease”, explains Mencacci. “In general, greater severity of symptoms, other psychiatric comorbidities and the presence of trauma make the recovery process more complex.” Furthermore, the likelihood of a relapse is high. It is estimated that 80% of patients with a previous major depressive disorder develop at least one second depressive episode in their lifetime.
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The highest suicide rate
Major depression is one of the psychiatric disorders with the highest suicide rate. Furthermore, the presence of depression determines effects not only on mental health, but also on physical health, with an increased risk of developing other disorders such as diabetes mellitus, heart disorders, stroke, hypertension, obesity, cancer, cognitive disorders and disease of Alzheimer’s. “There is a suicidal drive even if suicide is not attributable only to depression. In Italy suicides are less than 4 thousand a year and are more frequent among men but we are noticing an increase in self-harm especially in adolescents who cut themselves to harm yourself “, explains the psychiatrist.
The cures to get out of it
Shanti’s renunciation of life can convey a desperate and dangerous message: that there is no way out of this form of depression. “It is not like that”, Mencacci is keen to specify. “Depression is a disease that is often curable and is always curable. Depending on the severity levels, there are procedures that have a very high scientific consensus. The mild forms can benefit from psychotherapeutic and psychoeducational interventions that have an efficacy comparable to that of For moderate-severe forms, pharmacological treatment is used in combination with psychological interventions, while for severe forms, pharmacological treatments are required with the addition of somatic therapies, i.e. Transcranial Magnetic Stimulation and in cases with high suicidal risk, electroconvulsive therapy with ‘electric shock “.
The importance of lifestyles
In any case, it is good to keep in mind that the reference expert is the psychiatrist. “Today there are many opportunities for treatment but it is also important to act on lifestyles. Those who are depressed must regularly exercise and expose themselves to light to do light therapy because this is a systemic disease in which the biological component is dominant”, he suggests. Mencacci.
Those who are depressed are not lucid
Beyond the various positions on the choice of euthanasia, many wonder if a person who, like Shanti, is in such a profound depression condition has the clarity to make any decision and even more so that on life or death. “A person who has a suicidal ideation cannot be considered in the full faculty of her choices”, says Mencacci. “It is a very complex issue, people often inform me of their suicidal intentions and explain their motivations to me: they are subjects who fall into a mental loop that prevents them from considering other ways out”.
Open a dialogue also with the family
“Shanti sort of broke”, her mother said, “she never managed to rebuild herself, she didn’t feel safe anywhere, she couldn’t bear being in places with other people, she had constant panic attacks”. Maybe her parents could try to convince her that there was a way out? “Although we may find ourselves in a dramatic condition – the psychiatrist replies – arguing that at only 23 there is no other way than dying is a dangerous message for young people who are children of unpredictability given that in the last 15 years it has happened. of everything. We cannot consider Shanti’s the only possible choice. We need a close person who can reasonably guide the choices of a depressed person and that is why it is essential to be able to maintain a dialogue between doctor, patient and family to build a a network that makes the therapy shared and is truly personalized. We are never at the end, there are so many possibilities and I believe that having a legislation that is too broad and permissive as in Belgium is not the most effective solution “.