February was a month plagued by celebrity suicide. Former "Growing Pains" actor 41-year-old Andrew Koenig, 40-year-old fashion designer Alexander McQueen and Michael Blosil the teenage son of singer Marie Osmond all took their lives within weeks of each other.
Yet in between the vigils and TV coverage of the deaths, were the standard (and almost incongruous) commercials for antidepressants, promising relief.
In a country where antidepressant use is booming and suicide rates have barely budged, experts say science is still just trying to find the basic answer to how antidepressants work.
Celebrities, meanwhile, often become the face of what is usually a personal struggle. Everyone from actor Jim Carrey to singer Alicia Keys feed the public their own views on how to deal with depression.
In a 2004 interview with CBS's "60 Minutes" Carrey said he had to stop taking drugs to feel better from depression. "I had to get off at a certain point because I realized that . . . everything is just okay," he said. "It feels like a low level of despair you live in where you're not getting any answers but you're living okay and you can smile at the office," he said.
Alicia Keys confessed to a two-year bout of depression. But the singer-songwriter said she can work through her depression.
"Pain ... it's just an immediate feeling that drives me to write. But now I can say that even in joy I can express myself," Keys told the Toronto Sun in 2009.
Not everyone in America finds creativity in depression.
By 2005, 10 percent of Americans over the age of 6 were taking antidepressants, according to the Agency for Healthcare and Research Quality. Meanwhile the suicide rates in the past 10 years have modestly declined for men from 24 to 20 suicides per 100,000 people. The suicide rate was unchanged for women.
"We still don't know why these medications work, when they work or why they fail when they fail," said Dr. J. Raymond DePaulo, chair of the psychiatry department at Johns Hopkins University in Baltimore.
Doctors Still Don't Understand How Antidepressants Work
Walter Koenig, Andrew Koenig's father was apparently unaware Koenig sold or gave away all of his possessions and terminated his 14-year lease on his apartment before leaving Los Angeles for Vancouver, where his body was found in a park.
"My son took his own life," Koenig's father Walter Koenig told reporters Friday.
He also has said that his son battled depression for years, but had stopped taking antidepressants about a year ago.
"The only thing I want to say is if you're one of those people who feel that you can't handle it anymore, if you can learn anything from this it's that there are people out there who really care," Walter Koenig said. "You may not think so, and ultimately it may not be enough, but there are people that really, really care."
DePaulo said it is impossible to tell whether Koenig's decision to stop taking antidepressants might have contributed to his death. Most antidepressants fall into a class of drugs called SSRIs, or selective serotonin reuptake inhibitors.
SSRI's help increase levels of serotonin in the brain. Serotonin is a neurotransmitter that is widely believed to play a key role in regulating mood. Although the first SSRI's hit the market in 1987, researchers still don't know how they work.
And since suicidal people are generally not allowed to participate in clinical trials of the drugs, it is quite difficult to judge exactly how or when antidepressants might affect a suicidal person.
"These studies don't take people with severe depression or those who are acutely suicidal. Since FDA trials involve half the group taking placebo it is unlikely we will ever conduct a definitive trial of an antidepressant in acutely suicidal people," said Dr. P. Murali Doraiswamy, professor of psychiatry at the Duke University Medical Center in Durham, N.C.
In other words, it would be unethical to give a placebo to someone who is in danger of killing themselves. So doctors have a hard time proving antidepressants hurt or help.
Studies May Not Capture How Much Antidepressants Help
In addition, DePaulo pointed out that drug trials, which rarely last more than a year and have a few thousand people at best, is a hard model to track suicide risk since it is such a rare event.
From experience and a few studies, psychiatrists say antidepressants do help suicidal people.
"We're able to save a lot of lives with medications," Dr. Andrew Leuchter, a psychiatry professor at the University of California Los Angeles.
Yet doctors do know that "Starting and stopping medication is a time when things are a little uncertain," DePaulo said. He pointed out that while some studies have shown increased suicide ideation in young people when starting medication; other studies have shown both a jump in positive feelings and negative feelings after stopping antidepressants.
In terms of pharmacology, "it takes two months to really know whether someone's going to respond or not," DePaulo said.
"It's the decision to stop that may be as important the pharmacology itself," said DePaulo.
In many cases, DePaulo said people who have given up hope in life will then also give up treatment -- including doctor's visits and antidepressants.
"Sometimes, people who are treated for depression feel hopeless and they may throw up their hands and say 'what's the use?' They may stop going to therapy, and they may stop taking medicines," he said.
Unlike Koenig, the public statements by friends and families of McQueen and Osmond's son, leave few details about a struggle with depression before suicide.
However the scant details share a common theme of those who take their life: a recent, very personal blow.
"The biggest predictors of suicide in young adults are persistent depression symptoms and life stressors such as family conflict, relationship problems rather than a side effect of the medication," said Doraiswamy.
"My family and I are devastated and in deep shock by the tragic loss of our dear Michael and ask that everyone respect our privacy during this difficult time," Osmond said in the statement following Blosil's death on Feb. 26.
Stressful Event May Trigger Suicide in Some
InTouch Weekly reports that Blosil jumped from the 15th floor apartment he shared with roommate Sean Srnik. Blosil was enrolled at the Fashion Institute of Design & Merchandising in Los Angeles.
Srnik told InTouch Weekly, "He was so jolly all of the time. He's probably the funniest, happiest guy I've ever met in my life. It's something I would never expect from somebody like him."
But in a 2009 interview on "Good Morning America." , Marie Osmond recalled painful challenges her family faced during ger divorce to Blosil's father, record producer Brian Blosil.
Often an Event, or Social Contagion Triggers Suicides
"I mean financially, children, my son and other things going on, you know, the divorce and custody and all that kind of stuff, then my dad passed away unexpectedly," she said.
McQueen, too, had a recent upheaval in his personal life before his suicide on Feb. 11. McQueen was reportedly devastated by the loss of his close friend Isabella Blow, who committed suicide in 2007.
McQueen also lost his mother Feb. 2 of this year.
Although 90 percent of people who committed suicide are thought to be suffering from either depression, schizophrenia, bipolar disorder or another mental health issue, DePaulo said there is usually something that "precipitates" the suicide in that population.
"Often suicide is attributed to an external event," said DePaulo.