It would be great if a brisk walk in the autumn sunshine or listening to a motivational tape on self-esteem freed a depressed person from persistent doldrums. But it's not always that simple.
More than 17 million Americans suffer from depression, according to the American Academy of Family Physicians. Some are more severely afflicted than others, but all are blanketed by bleakness that doesn't lift the next morning.
The toll this takes is enormous, on sufferers, their families and the wider world. For example, a recent study funded by the National Institute of Mental Health found that bipolar disorder (sometimes known as manic-depressive disorder) costs twice as much in lost productivity as major depressive disorder.
Although six times as many people suffer from major depression, bipolar sufferers experience more severe depressive episodes, which translates into lost work days and poor functioning on the job.
For many, relief is found in medication. The percentage of Americans taking antidepressant drugs increased from 5.6% in 1997 to 8.5% in 2002, according to the most recent government data from the Federal Agency for Healthcare Research and Quality. Drug use increased in both sexes and among all age groups.
Why the uptick? It's a combination of better diagnosis, patient willingness to consider drugs as part of a treatment program and more effective drug therapy.
Consider some of the antidepressant drugs on the market: tricyclic antidepressants, most commonly used during the 1960s-1980s. These work on brain chemicals norepinephrine and serotonin.
During the same era, another class of drugs called monoamine oxidase inhibitors (MAOIs) came into being and were frequently effective in those for whom tricyclics failed to work. MAOIs were also found to work on panic disorder and bipolar depression.
Fast-forward to the 1990's, era of SSRIs (selective serotonin reuptake inhibitors) like Prozac and Paxil. These caught on because they worked better and had fewer side effects. The late 1990's brought in more drugs like Effexor and Serzone, which work on both norepinephrine and serotonin.
Finally, the newest medications like Remeron (mirtazepine) and Wellbutrin (bupropion) offer even fewer side-effects than SSRIs. And the drug ketamine, first synthesized in 1962, has been shown to provide almost immediate relief from depression for some patients. (Most antidepressants take weeks to work.)
Depression: A Host of Problems
People tend to think of depression as a bad mood that lingers. Truth is, it's a whole host of problems which can lead to symptoms as diverse as inertia or mania. Few other ailments affect such a wide range of subjects and can't be conquered by money, good looks or brains. Depression is an equal-employment disease.
For evidence of just how desperate sufferers (and science) are to conquer this malady, take a look at current clinical trials offered by the National Institute of Mental Health. These are only some of the trials seeking participants:
• Treating depression in mothers of children with ADHD
• Depression in people with Parkinson's Disease
• Postpartum Depression
• Depressed Adolescents
• Identifying specific genes that may cause a predisposition to depression in some families
• Depression-related insomnia
• Preventing major depressive disorder in older adults admitted to rehabilitation facilities for hip fracture or cardiopulmonary conditions.
• Treating depression in mothers of seriously ill children
• Treating post-traumatic stress disorder in children exposed to domestic violence
• Using Sertraline for preventing post-stroke depression
• Depression and Musculoskeletal Pain
• Depressed Low-Income Mothers and Infants
• Depression in Alzheimer's Disease
While some patients may have a familial or genetic tendency towards depression, it comes upon others as an unwelcome side-effect of illness, loss or aging.
For many, recovery from their primary illness is compromised by depression, which can lead to failure to take medication or follow up on recommended physical therapy, social isolation, and other roadblocks.
If a provider feels that antidepressant therapy could be effective, what's the downside?
Still More Benefits
Sometimes a medicine has benefits not obvious at first usage. Antidepressants were, obviously, intended to relieve depression. But medical professionals have found that they have positive effects on unrelated problems.
Here are some recent positive "side effects" of antidepressant use:
• Helping smokers quit cigarettes. The American Lung Association names the drug Wellbutrin as an aid in giving up smoking.
• PMS relief. A study at Virginia Commonwealth University showed that women who took low doses of the antidepressant sertraline had less crankiness, irritability, bloating and depression.
• Possible increase in bone density. Osteoporosis, or a weakening of bone strength, is a serious problem for many older women and some men. A recent study of Prozac-eating mice at the Forsyth Institute in Boston showed that treated mice had about 60% more spongy bone than did control animals.
• Obesity, a growing problem in the U.S (where 60% of the population is estimated to be overweight or obese) has been linked with increasing rates of major depression, bipolar disorder, panic attacks and other disorders, according to a NIMH-funded study. Studies are now underway to see if antidepressant use will aid environmental or biological factors that lead to both obesity and accompanying mood disorders.
• Ketamine, the "fast-acting" antidepressant now being studied, is being investigated for use in pain therapy and for alcohol and heroin addiction.
