Depression
Revised
April 10, 2002
Due to just released studies showing that St. John's Wort is
no more effective for depression than sugar pills.
See link from WebMD. for an easy to understand review of the research.
You can read the National Institute of Health press release
here, and for even more detail you can read
the entire study published in the Journal of the American Medical
Association (JAMA)
here.
by Hal Brown, LICSW
Between 5% and 10% of
people in the United States will, at some point in their life, have a bout
with depression severe enough to be of clinical significance.
It is estimated that only a third of all those who are clinically depressed receive adequate treatment. It is not unusual for a therapist, or physician, to recommend a trial on an anti-depressant medication when a patient first reports the symptoms of depression. Some doctors and therapists prefer a trial of psychotherapy first. Sometimes talk therapy is all that is needed to alleviate depression. However, antidepressant drugs take three to six weeks to "work," so it is often prudent to start the medication at the same time as you start psychotherapy. The longer you put it off, the longer you'll have to wait for results.
Antidepressants such as Prozac, Zoloft, Paxil, Celexa, Serzone, Effexor and others work in a rather elegant fashion because they actually don't add anything to the brain chemistry to achieve the positive mood changes. What they do is improve the way that brain receptors (neurotransmitters) process crucial brain chemicals, most notably serotonin. The medication, when it works, essentially "readjusts" the way the brain functions back to its optimal condition. Wellbutrin works in a different way but is equally effective.
It shouldn't be too difficult to determine if you're depressed; but even your physician may have missed it. In part this is because you didn't mention it during your last physical, but also largely because he or she didn't ask the three questions all physicians are being admonished to ask by their professional organizations:
In the past year have you had two weeks during which time you felt sad, blue or depressed; or when you lost all pleasure in things you usually cared about or enjoyed?
Have you had two or more years in your life when you felt depressed or sad most days, even if you had some periods when you felt okay?
Have you felt depressed or sad much of the time in the past year? (Questions validated through the University of Arkansas for Medical Sciences.)
Although not validated through studies yet, a fourth question should be asked, particularly of men who may not recognize, or admit to the other symptoms. That is: have you been or had others tell you that you seem depressed or are more irritable than you used to be?
There are many more thorough scales for evaluating the level of depression and making a more precise diagnosis, but I like a simple list devised by Michael J. Norden, M.D. He calls it Apes Swim. I've adapted it added a second "I" and a third "S". Here it is:
-
Appetite
- recent weight gain or loss, eating too much or too little
Psychomotor
(moving your body) problems, i.e., lethargic or jittery
Energy
loss, fatigue, tired, not feeling like doing anything
Sleep:
too much or too little, unable to fall asleep, waking in middle of night
and not being able to fall back asleep;
Suicidal
ideas or thoughts, preoccupied with deaths or ways to kill yourself,
frequently thinking life isn't worth living, and
Self-medicating with alcohol. Taking alcohol, a central nervous system depressant, to combat depression, is a common but self-defeating way to handle depression.
Worthless feelings, feeling excessive or irrational guilt (guilt is worthy of it's own letter but it doesn't fit in with Apes Swim) - Relevant to cranberry growers: are you blaming yourself for a crisis not of your own making?
Irritability, on edge, blowing up easily, often making life miserable for yourself and family: and Interest in work or pleasure reduced or not there at all
Mental ability lessened, difficulty planning, concentrating or making decisions.
"I don't even take aspirin" is a common phrase voiced with pride when I bring up the subject of taking anti-depressant medication with many farmers. Without going on an unnecessary rant, I think we all recognize in ourselves or others the notion that it is a sign of weakness to take medication for what we perceive a psychological problem. Modern medicine has established that mood disorders are caused by biological imbalances in our brain chemistry, which are often due to genetic predisposition's. Some of us are destined by the nature of our genetic makeup to become depressed no matter what happens in our lives, and others are simply programmed to react with depression when difficult situations arise or after traumatic experiences. The prevalent "anti-medication attitude," especially about mental health medicines, is a big problem in convincing those in so-called "macho professions" like farming give anti-depressant medication a try.
My own family doctor tells me he's found one way around this problem with these depressed patients if they smoke and want to quit. He prescribes Zyban, which cuts down on the craving for nicotine. After a month or so, whether or not they are succeeding in cutting down on cigarettes, he has them back to evaluate how they are feeling. They often report that regardless of their success with smoking cessation, they are feeling better than they have in years. It is then that he reveals that Zyban is exactly the same drug as an effective anti-depressant called Wellbutrin. If there's one thing that proves you were clinically depressed, it is when an anti-depressant is effective and you and those around you notice a marked improvement in your mood and sometimes your behavior.
Updated 4/10/02: I previously recommended St. John's Wort as an alternative to prescription anti-depressants for depressed farmers who were unwilling to take prescription anti-depressants. Two recent studies have shown that St. John's Wort is no more effective than a sugar pill. That isn't to say it doesn't reduce depression - it says that a sugar pill will work just as well as long as you don't know you're taking a sugar pill. These studies demonstrate the power of the mind-body connection. Even studies of prescription anti-depressants show that sugar pills are somewhat effective. However, before a medication is approved by the FDA, it must be proved to be significantly more effective than sugar pills. I will no longer recommend St. John's Wort.
Tranquilizers (anti-anxiety drugs) may cause sedation and effect reaction time and coordination, and should be used with caution until you know how you react to them. Anti-depressants rarely have such side effects. It is understandable why you would be concerned about working with heavy equipment if you have just started to take a medication like Valium or Xanax. But these drugs are used for anxiety, and not for depression. Anti-depressant drugs have been used safely for decades, and there is no medical reason why you shouldn't be unable to perform at your usual level when taking them.
Dr. Ivan's Depression Central This is a comprehensive Web site with a combination of technical information and answers to general questions about depression. It also has many links and covers research into the treatment of depression.