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October 31, 2006

What You Don't Know About Depression

Antidepressants are among the most prescribed drugs in America. So why isn't everyone happy?

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MYTH #1

YOU'LL GET AN ACCURATE DIAGNOSIS.

Almost half the people in the U.S. with clinical depression don't get diagnosed properly, says Wayne Katon, nosed M.D., of the University of Washington Medical School in Seattle. In part, that's because many clinicians use a test developed in the 1950s called the Hamilton Depression Rating Scale ("Ham-D"), which was designed to measure antidepressant effectiveness, not to diagnose depression, says Andrew G. Ryder, Ph.D., of Concordia University in Montreal. The test overlooks some symptoms that indicate depression (such as sleeping too much) and highlights others that aren't always relevant (such as weight loss). When trying to diagnose or rule out depression, nothing is more important than detailed conversations with your doctor.

MYTH #2

MEN AND WOMEN HAVE THE SAME RISK FOR DEPRESSION.

In fact, women are twice as likely as men to experience major depression. Scientists think hormones, an increased tendency to ruminate, and a possible heightened response to stress could all contribute to making women more vulnerable.

MYTH #3

ETHNICITY HAS NO BEARING ON DEPRESSION.

Differences in the way people from various cultures express depression can result in a missed diagnosis or the wrong medication being prescribed. For instance, "'having nerves' in most Caucasian-American cultures means you're anxious or stressed out; in Latino culture, it can mean you're depressed," says Carolyn Kaufman, Psy.D., of Columbus State Community College in Columbus, OH. So a Latina woman could walk away from her doctor with a prescription for an anti-anxiety medication when what she really needs is an antidepressant. The shocker: Doctors from the same ethnic backgrounds as their patients aren't always better at figuring out what's what. What to do? Make sure your physician can repeat back to you, in different words, what it is that she thinks you're feeling.

MYTH #4

ETHNICITY SHOULDN'T AFFECT YOUR PRESCRIPTION.

Most drugs are tested on white men. But about 40 percent of African- Americans and Asian-Americans actually metabolize drugs more slowly than Caucasians do, as a result of a genetic difference in liver enzymes, according to research conducted by L. DiAnne Bradford, Ph.D., of More house School of Medicine in Atlanta. The impact: They wind up with more of the drug in their bodies, which increases side effects (insomnia, diminished libido, and scores of others) without increasing benefits.

MYTH #5

DEPRESSION IS GENETIC.

Scientists think that both your genes and your environment affect your mood. No one has found a gene that's directly responsible for depression, but you can inherit one type of gene that can make you more vulnerable to depression after stressful events. So, while you may be able to blame your family for many things, it's not all their fault if you're depressed.

MYTH #6

ANTIDEPRESSANTS MAKE YOU FAT.

Most antidepressants do carry about a 30-percent chance that you'll gain weight, says Thomas L. Schwartz, M.D., of State University of New York Upstate Medical University. But one-- Wellbutrin XL (buproprion)--may cause you to shed a few pounds. Other antidepressants raise serotonin, the chemical that regulates appetite, and may make you feel famished. Even if you eat less, the serotonin might make you store more fat and sugar. But buproprion raises levels of norepinephrine and dopamine, not serotonin, thus avoiding appetite issues.

MYTH #7

DEPRESSION IS ALL IN YOUR HEAD.

Physical illness can trigger depression. One pathway may have to do with cytokines, a natural part of the body's immune response to illness. In fact, when some patients are treated with a certain type of cytokine, they become depressed or even suicidal. In addition, "a mood disorder can potentially affect the body's ability to fight an illness," says David Spiegel, M.D., of Stanford University School of Medicine. Stress can lead to arterial spasms and heart attacks, even if your arteries are clear. Depression is also associated with a poorer prognosis for diseases including stroke, epilepsy, and diabetes. Bottom line: Get treatment for both your physical illness and your depression.

MYTH #8

PILLS ARE THE ANSWER IF YOU HAVE A DOWN DAY HERE ANDTHERE.

Placebos have been found to work as well as antidepressants in people with minor depression--meaning you can get through the day but have a low mood for a couple of weeks and don't enjoy certain activities the way you used to. And yet drug-makers have been expanding the definitions of mood disorders so much that even healthy people who have the occasional bad day (and who doesn't?) think they should reach for a pill, according to Ray Moynihan and Alan Cassels, authors of Selling Sickness. Don't buy the hype: Some times, counseling or meditation is just what you need to feel like yourself again.

. . . AND TWO WE'RE MONITORINGANTIDEPRESSANTS RAISE THE RISK OF SUICIDE.

An analysis by Glaxo-SmithKline found that adults with major depressive disorder who took its drug Paxil had a higher risk of suicide than similar people who were in a placebo group. But that was only one study of one drug. Furthermore, the increased risk may not be directly from the pills: Oddly enough, psychiatrists think the boost that occurs when people are first treated for depression--with therapy or medication--might give some people the energy to carry out suicidal thoughts they had before the treatment.

ANTIDEPRESSANTS ARE DANGEROUS WHEN YOU'RE PREGNANT.

Most antidepressants have not been adequately tested in pregnant women, and some may not have undergone animal studies. But recent case reports suggest that babies born to mothers on antidepressants may be prone to jitters, irritability, feeding problems, and seizures. A report in the New Eng land Journal of Medicine recently found that a small percentage of babies exposed to SSRIs were born with persistent pulmonary hypertension of the newborn (PPHN)--a condition in which too little oxygen reaches the blood. And the FDA warns against using Paxil during the first trimester. If depression is left untreated, however, babies may be born earlier and lower in birth weight because women are less apt to take care of their bodies when they're depressed, says Nada Stotland, M.D., of Rush Medical College in Chicago. They're also more likely to have postpartum depression and not bond well with their newborns.

Additional sources: Kenneth S. Kendler, M.D., of Virginia Commonwealth University in Richmond; Kurt Kroenke, M.D., of Indiana University School of Medicine in Indianapolis; William B. Lawson, M.D., Ph.D., of Howard University College of Medicine in Washington, D.C.; Bruce S. McEwen, Ph.D., of The Rockefeller University in New York; Eric Nestler, M.D., Ph.D., of the University of Texas Southwestern Medical Center at Dallas; Nick C. Patel, Ph.D., of the University of Cincinnati; Richard Shelton, M.D., of Vanderbilt University Medical Center in Nashville; Michael D. Yapko, Ph.D., author of Breaking the Patterns of Depression


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