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October 31, 2006

What You Don't Know About Depression

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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.

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.

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.

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.

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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