Your Health ;
; Millions suffer from this illness.
; One in 10 Americans takes antidepressants.
; What to look for, what to do.
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“It is the aloneness within us made
manifest,” Andrew Solomon wrote
in his book The Noonday Demon: An
Atlas of Depression, “and it destroys
not only connection to others but
also the ability to be peacefully
alone with oneself.”
Depression is the most common of all mental
illnesses, afflicting an estimated 7 percent of
the population. More than one in 10 Ameri-
cans have prescriptions for antidepressants,
now among the most widely used of all medi-
cations. But some doctors are questioning the
efficacy of these drugs in treating depression.
And even with new advances in understand-
ing depression, many cases still go undiagnosed
and untreated, experts say—especially among
older people.
The depression debate
Many researchers now believe that depression
is caused by chemical imbalances in the brain.
A predisposition to depression is known to run
in families, and there’s also evidence that trau-
mas, certain illnesses and childhood abuse can
lead to depression later in life.
For all that is known about depression,
however, there’s still plenty of debate about
how best to diagnose and treat it.
The most recent furor was sparked by a
report published in January in the Jour-
nal of the American Medical Association.
A team led by psychologist Jay Fournier
of the University of Pennsylvania, evaluat-
ing data from several studies, concluded that
antidepressants, despite their popularity, are
no more effective than sugar pills for most
people with mild or moderate depression.
For severe forms of the disease, the pills
do help, the scientists acknowledged. Still,
they’re far from a cure-all.
Irving Kirsch, professor emeritus at the
University of Connecticut and a professor
of psychology at the University of Hull in
England, who is widely regarded as one of
the world’s leading experts on psychiatric
drugs and the placebo effect, says this latest
study reinforces earlier findings: “Our stud-
ies show that placebos are about 80 percent
effective, which is exactly how effective an-
tidepressants are in the short term.”
But, he adds, the “placebo effect is very pow-
By Peter Jaret
erful when you’re treating depression. Place-
bos offer hope. And one of the chief features of
depression is a sense of hopelessness, the belief
that you’re not going to get better.” Anything
that instills a sense of hope, he says, “will at
least temporarily help treat depression.”
For researchers, the placebo effect makes
evaluating the effectiveness of mood-altering
drugs even more complicated. There is no ob-
jective test for depression, as there is for high
cholesterol or elevated blood pressure. The
only way to gauge if antidepressants are work-
ing is to ask people how they’re feeling.
Still, plenty of experts—including many
psychiatrists—insist that the widely used
medications do work. “We know from years
of clinical experience that these medications
help people who are moderately or severely
depressed,” says Gary Small, M.D., professor
of psychiatry at the David Geffen School of
Medicine at UCLA and director of the UCLA
Center on Aging.
One reason their effectiveness may not be
captured in studies, he explains, is that a med-
ication that works for one patient may not
work for another. “We often find that we have
