On Monday, the world lost über-comedian Robin Williams, who police say committed suicide in his northern California home.
Williams, 63, catapulted to fame with the 1980s television series, Mork & Mindy, in which he played the role of Mork, an alien from the planet Ork. From there he starred in films and continued his meteoric rise to fame by way of his razor-sharp wit, uncanny ability to mimic others, and his rapid-fire, stream-of-conciousness comedy routines.
But hidden behind the laughter, Williams' heart ached.
He struggled with drug and alcohol addictions, bipolar disorder that sent him soaring in its manic phase and then plunging into severe depression, and health problems, having undergone heart surgery in 2009, according to his publicist.
Williams also lost his mentor, comic Jonathan Winters, who died last year.
The confluence of factors addiction, depression, loss and heart surgery may have led to his death.
Feeling low? You're not alone.
The numbers of those committing suicide has been on the rise, said Nancy Hersch, director of Blue Mountain Health System's Behavioral Health Units.
"Since 1990, there's been a 30 percent increase in middle-aged people committing suicide. People are dealing with all types of issues, the economic situation that brought the loss of jobs and homes, for example. Someone doesn't become suicidal overnight. It starts with depression. You become despondent and don't see any other way out," she said.
Some people have a genetic predisposition to depression.
"Left untreated, it can lead to suicide. If someone has made a suicide attempt, they will likely make another," Hirsch said.
Also, "substance abuse and depression are enmeshed," she said.
She cited Williams as an example.
"It's hard to tell which started first, the depression or the substance abuse. It's a circle, and people (struggling) with substance abuse are much more likely to attempt suicide and succeed," she said.
Williams' addiction "is a terrible place to be," Hirsch said.
One's chances of being depressed are influenced by many factors, including gender, geography, family history, ethnicity, educational level, employment, marital status, addictions and physical health.
Women tend to struggle with depression more often than men for a variety of reasons, including hormones and psychosocial influences, according to the CDC. Living in the south Mississippi, Alabama, Tennessee, Louisiana, Arkansas also increases one's risk.
The CDC suggests that high rates of obesity, heart disease, stroke, sleep disorders, genetic predisposition, and the lack of education and health insurance are likely contributing factors to the elevated risk of depression and suicide.
Help is out there
Suicide claims the lives of over 1,300 Pennsylvanians each year; an average of 3.5 lives each day, Deb Shoemaker says on her website, Pennsylvania Recovery and Resiliency. The site offers links to numerous resources for those wishing to know more about prevention and current behavioral health issues. They include information about prevention for youth, adults and older adults.
Schuylkill County has a Suicide Prevention Task Force. Coordinator Debbie Heim said the county had 32 suicides last year.
The Task Force was "originally formed in 1996 in response to state statistics, which indicated we had one of the highest suicide rates in the state," Heim said.
"In 2004 the task force underwent structural changes and opened membership to community members and agencies. Today it consists of a large group of dedicated individuals working together to raise awareness and educate the public that suicide is the most preventable death."
She said the task force has prevention programs in place, including QPR, which stands for Question, Persuade, Refer. The program teaches people how to spot warning signs and how to proceed.
The organization also offers Hope After a Loved One's Suicide, or HALOS. a support group that meets twice a month in Pottsville.
All counties have mental health organizations that provide counseling and emergency help.
"The resources are getting better, but they are not there," Blue Mountain's Hersch said. "We need a network of research and resources. But mental health is at the bottom of the list."
She said depression is often caused by a chemical imbalance in the brain.
"How many people validate it as a true disease? With heart problems, the symptom is often high blood pressure. With the pancreas, you have diabetes. But with the brain, it's harder to validate the disease."
Hersch said families and loved ones of a depressed person need to understand the person cannot just snap out of it.
"It truly is something that needs to be treated. People need to recognize the signs and symptoms of depression. Being down occasionally is one thing, but persistent depression, that lasts more than two weeks, needs to be treated," she said.
"If someone says 'I don't feel like living anymore,' take it seriously," Hersch said.
"There is help out there."
Where to call for help
If you're feeling like there's no way out but to end it all, stop. Pick up the phone and call any of these numbers, or 911.
National Suicide Prevention Hotline: 800-273-8255
Lehigh County: 800-452-4189 or 610-782-3127
Northampton County: 610-252-9060 or 610-997-5840 TTY
Carbon and Monroe counties: 570-992-0879
Schuylkill County: 877-993-4357