Been Down So Long...

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There seems to be a lot of depression going around these days, which shouldn't be surprising, given the stress of the holidays and the continuing psychic fallout of Sept. 11. What is surprising is how many more depressed people are getting treatment--at least compared with 10 years ago. I remember in my first year of medical school, back in the late 1980s, being taught about a new class of antidepression medications called SSRIs, or selective serotonin reuptake inhibitors, of which Prozac is now the most famous. What we didn't realize then is that the SSRIs would start a revolution in the management of America's most common--but no less serious--mental disorder.

How far that revolution has spread was driven home last week by a study published in the Journal of the American Medical Association. Between 1987 and 1997, it reported, the number of Americans being treated for depression more than tripled, from 1.8 million to 6.3 million, while those taking antidepressants doubled.

The vast majority of those antidepressants are SSRIs. Their advantage over the earlier generation of tricyclic antidepressants, we were taught, is not that they are so much more effective but that they are a lot more selective and easier to use. Unlike the tricyclics, which interfered with neurotransmitters throughout the brain, the SSRIs zero in on serotonin, the master molecule of mood--lifting depression with fewer side effects and less risk of overdose.

The downside is that a lot of people aren't getting another important treatment for depression: face-to-face therapy, or what they used to call "the talking cure." Over the same 10-year period, the J.A.M.A. article reported, the percentage of patients in therapy dropped from 71.1% to 60.2%, and the average number of annual treatment visits declined from 12.6 to fewer than nine. The fact is, pills are a lot less expensive than therapists, which may explain why managed-care outfits make it so hard for patients to get the therapy they feel they need. The danger, critics say, is that we throw pills at problems rather than grapple with the underlying causes.

Still, most psychiatrists see increased use of the new breed of antidepressants--which includes Paxil, Zoloft and Sarafem--as a positive development. Clinical depression, as Andrea Yates's case reminds us, is a dangerous illness that may drive mothers to kill their babies, fathers to commit suicide and schoolchildren to start shooting their classmates. Most depression in the U.S., says Dr. Darrel Regier of the American Psychiatric Association, still goes untreated. If you or someone you love is suffering crying spells, feeling inappropriately guilty, thinking about suicide or having trouble eating or sleeping, don't ignore the symptoms. You should know that there's help available and that it works.

Dr. Gupta is a neurosurgeon and CNN medical correspondent