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Depression and women

National Women's Health Report, August, 2003

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One problem is that primary health care providers often just don't know enough about treating depression, say, Drs. Kessler and Hollon, particularly about the various medications available. In fact, many patients in the JAMA study had received anti-anxiety medications like valium and lorazepam for depression, says Dr. Kessler, even though these drugs are, at best, helpful only in the short term, and can become addictive fairly quickly.

Getting the prescription right is no easy task, admits Paula J. Clayton, MD, professor of psychiatry at the University of New Mexico in Albuquerque, even for doctors with a lot of experience treating depression. "An antidepressant generally has only a one-in-three chance of helping the person taking it recover," she says.

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So how far do you go? Dr. Clayton suggests if you've been on the maximum recommended dosage of an antidepressant for four to six weeks with no improvement, or if the medication causes intolerable side effects, your doctor should try another medication and/or review other treatment options. In some cases (if side effects are not a problem), adding another medication to what you're presently taking may provide better results.

If you are just beginning treatment with an antidepressant, your physician most likely will have you return once a month for a medication "checkup," until you and your physician feel you are stabilized, Dr. Clayton says. After that, you may have checkups about ever), three months. "Suicidal patients should be seen more frequently," she says.

As for how long you should be on the medication, that depends on your own situation. Some people with chronic or recurrent depression may remain on it for life, while others may need medication only for a few months.

Esther Nitzberg has been taking a variety of medications for 20 years. Every few months, her psychiatrist adjusts dosages, switches medications, or adds another to help with her recurrent depression.

Even if adequate treatment is prescribed, however, many patients don't follow it, says Dr. Kessler. Part of that is tied up in how people feel about depression, he says. "They feel inadequate, that they're failures," not understanding that they have a brain disease caused in part by a chemical imbalance. So getting help is often a last-ditch effort. Once they start feeling better, they quit taking their drugs or stop going to therapy, even though they're not considered "adequately" treated. "When you ask them why they quit, the most common reason is 'I want to handle it on my own,'" he says. "That's something you'd never say about a broken arm."

Often, as Terry Wise learned, you can't handle depression on your own. On Christmas Day 2000, 15 months after her husband died of Lou Gehrig's disease, Ms. Wise tried to commit suicide by swallowing 60 doses of morphine, 200 Percocets and a large glass of gin. She'd tried therapy a year before, but quit. Amazingly, she woke up from her suicide attempt two days later.

With the help of a caring therapist and the antidepressant medication bupropion (Wellbutrin), Ms. Wise ascended out of the pit of depression, and has since written a book about her experience, Waking Up: Climbing Through the Darkness, scheduled for publication in December 2003 by Pathfinder Publishing. She knows she's not cured; she knows, in fact, that because she's suffered one major depressive episode, she's at high risk for becoming depressed again in the future. But now she has the tools to deal with it.

Health Care Industry

Depression and women

National Women's Health Report, August, 2003

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