Battling depression

Thursday, August 22, 2002

When drugs don't work, people seek other means

By Linda Marsa ~ Los Angeles Times

Anti-depressants are now taken by tens of millions of Americans, and many people credit them with changing, or even saving, their lives.

But they're not for everyone.

The most-prescribed medications, SSRIs (selective serotonin reuptake inhibitors) such as Paxil, Prozac and Zoloft, have a host of potential side effects, including loss of libido, insomnia, restlessness, weight gain, headaches and anxiety. Little is known about the effects of long-term use. Furthermore, the drugs can be prohibitively expensive for people without health insurance. The lowest dosage of Paxil, for instance, costs about $70 for a 30-day supply.

For some people, the drugs simply don't work. Last year, 111 million prescriptions were written for SSRIs, a 14 percent increase from 2000, according to IMS Health, a market research firm. But a 2000 New England Journal of Medicine study found that the medications fail to help one-third of people suffering from mild to moderate depression and half of those suffering from chronic depression.

"The benefits of prescription drugs aren't as great as we all believed," says Dr. Daniel F. Kripke, a psychiatrist at the University of California, San Diego, who studies depression treatments.

Researchers still don't understand why the medications, which boost the production of the brain chemical serotonin, aren't effective for everyone. But they have begun to study alternatives. Among the most promising are psychotherapy, light therapy, supplements and good old-fashioned aerobic exercise.

Paul Cumming, a 46-year-old San Diego man, tried light therapy to ease his depression in 1998. "In less than a week, I felt like a major cloud had been lifted," he says.

Of course, people suffering from severe depression shouldn't experiment on their own with these techniques, caution experts. But used under the supervision of a trained professional, they can provide an alternative to medication. For people with milder symptoms, these antidotes might be all they need to banish the blues.

Light against darkness

For years, light therapy has been used to treat seasonal affective disorder, a type of depression that afflicts about one in 10 people who live in places with short winter days and extended darkness. Now, growing evidence indicates that being bathed at least 30 minutes a day in bright artificial light may be as effective as an anti-depressant at any time of the year.

Cumming, who tried the therapy as a last resort after nearly a year of severe depression, was surprised by the results -- as was his doctor. His depression had proved resistant to conventional medication.

He now periodically sits in front of a light box when he feels himself backsliding into depression.

Supplemental remedies

Perhaps the most popular alternative remedy for depression is St. John's wort. Although two recent studies found that it didn't work as well as a placebo in alleviating major depression, the herb has shown promise in treating mild depression.

Side effects include nausea, heartburn, insomnia and an increased sensitivity to sunlight. It also can weaken the effect of prescription medications such as the blood thinner warfarin, the heart medication digitalis, some AIDS drugs and oral contraceptives. Still, "people should consider it as an option, especially if they haven't done well on other medications," says Dr. David Mischoulon, a psychiatrist at Harvard Medical School.

Another dietary supplement, SAM-e, may also help combat depression. Produced from a yeast derivative, SAM-e was introduced to the United States in 1999. Some depression sufferers find SAM-e (short for s-adenosylmethiodine, a substance found naturally in the body that is believed to fuel dozens of biochemical reactions) more tolerable than an SSRI.

Acupuncture

Acupuncture may be an effective mood enhancer. In a 1999 study conducted by University of Arizona researchers, 34 women suffering from major depression who underwent eight weeks of acupuncture treatment reported an elevation in mood similar to that provided by antidepressants. The finding reinforced earlier studies in the former Soviet Union and China. The Arizona researchers, along with scientists at Stanford University, are conducting a larger study of 150 women.

Rx: Exercise

Numerous studies have shown regular exercise to be an excellent antidote for mild to moderate depression. And over the long haul, researchers say, it may work better than medication in controlling symptoms.

"We still don't understand the mechanisms behind this _ whether it's a change in brain chemistry or they just feel better because they mastered something challenging," says James Blumenthal, a Duke University psychologist and co-author of a 2000 study on the long-term effects of exercise.

"But we do know it works."

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