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Rosalynn Carter Upbeat About Treating Depression

Rosalynn Carter says recovering from depression starts with getting help.
By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Former first lady Rosalynn Carter knows that mental illness has long thrived in the shadows of stigma and shame. That's why as part of her ongoing commitment to improving mental health, Carter is helping illuminate the truth about depression.

"I have had friends and close associates who suffered from clinical depression and situational depression," Carter says. "For them, early recognition and diagnosis has been the biggest difficulty to overcome. But once the proper diagnosis was made, almost everyone I know who suffered from depression has been able to get highly effective treatment, or a combination of treatments, which has allowed them to recover fully and lead healthy, normal lives."

Annually, about 19 million American adults suffer from depression or depressive disorders, according to the National Institute of Mental Health. Women suffer at almost twice the rate of men. The most prevalent of these illnesses is major depressive disorder - or more commonly called clinical depression. Depression is the leading cause of disability in the United States, and the fourth leading cause of disability in the world. 

But getting depressed about day-to-day negative events is markedly different from clinical depression, which must persist for longer than two weeks.

Depression is diagnosed by a clinical exam, including a detailed patient history. Often additional supporting information is obtained from spouses or family members. While they are not used to confirm the diagnosis, medical tests are sometimes performed to rule out other medical conditions that can cause depression, such as thyroid disease.

Symptoms of clinical depression include:

  • Feelings of hopelessness, worthlessness and helplessness
  • Persistent sadness and/or anxiety
  • Decreased energy or fatigue
  • Insomnia or oversleeping
  • Apathy or loss of interest in enjoyable activities
  • Memory and/or concentration problems
  • Weight loss or weight gain, loss of appetite
  • Suicidal thoughts and/or suicide attempts

The good news is depression can be effectively treated. 

"There are a variety of treatments available, including medications and talk therapy, and combinations of the two," Carter says. "The vast majority of people can recover from an occurrence of depression."

"In some people the combination of medication and psychotherapy works better than either on its own," says Michael Gitlin, professor of psychiatry at UCLA and director of the Mood Disorders Clinic at the UCLA Neuropsychiatric Hospital. "There's no real evidence that everyone needs both however. Some people do just fine with only medication, and others do great with therapy alone. But there's a general sense in the field that the more severely depressed a person is the more likely it is that medication will be necessary for an optimum response to treatment."

FDA warning

But ongoing studies have raised concerns that the most widely prescribed antidepression medications may be exacerbating the very problem they are supposed to treat.

On Monday, the FDA issued a public health advisory cautioning physicians and patients about the possibility that 10 commonly prescribed antidepressants --  Effexor, Celexa, Lexapro, Luvox, Paxil, Prozac, Remeron, Serzone, Wellbutrin and Zoloft -- might actually make depression or suicidal thinking worse. The FDA advises that particularly close attention should be paid to teens and children receiving the medications.

The FDA also advised that warning labels accompany the medications, which are predominantly of class of medications called selective serotonin-reuptake inhibitors.  SSRIs increase the amount of serotonin available to brain cells by blocking the reuptake of serotonin.

"Wellbutrin, Effexor, Remeron and Serzone are not SSRIs but each is in its own class of medications," Gitlin explains. "I have not seen the data yet, but I'm at a loss as to why the warning refers to some of the less strong serotonergic drugs like Remeron or Serzone. And Wellbutrin has no serotonergic effect."

All the ten drugs included in the FDA warning share about the same response rate.

"There is some conflicting evidence right now that the non-SSRIs may cause people to get a higher level of response than the SSRIs," Gitlin says. "All of the SSRIs have a relatively low side effect profile - primarily some sexual side effects. Some are more sedating. Others can be activating, and all can cause a little bit of nausea."

Gitlin and other mental health experts are a little concerned about the FDA's warning.

On the one hand Gitlin understands that regulatory bodies want to err on the side of caution to make sure everyone, both physicians and patients, are adequately warned about potential risks of medications.

"On the other hand I think we have to be careful to avoid focusing on rare risks too quickly when we don't even know what the risk really is and how frequently it occurs," Gitlin says. "All of us are especially concerned that in general the best way to prevent suicide is to treat the underlying disorder that makes people suicidal. The link between suicide and depression is enormous."

Getting help

In fact, depression is the single largest cause of suicide. And while counseling is an alternative to medications, research shows that the more severe cases of depression are more likely to benefit from antidepression medication.

"Our concern is people will be so focused on this information that they decide not to get treated with an antidepressant," Gitlin states. "We don't want to end up withholding treatment from those people who need it the most."

There are other medications besides the newer classes of antidepressants. Two older classes of antidepressant are tricyclics and MAO inhibitors. Neither was included in the FDA's warning.

"These medications have been around since the 1950s and are less well tolerated but just as effective as the newer medications," Gitlin says. "As with every other disorder, there are no perfect treatments. Every treatment has some risk associated with it. We shouldn't take that fact and use it to deny appropriate treatment for people who are suffering any significant disorder like depression."

But what type of medication a person takes only happens after a person seeks treatment. And while for the first time in 25 years mental health practitioners believe recovery from mental illnesses is now a real possibility, millions continue to go untreated.

"Stigma is still a primary obstacle preventing Americans with mental illnesses from getting the excellent care they deserve," Carter says. "In general, at The Carter Center we are very concerned about addressing the barriers to care such as stigma, and we are working to end discrimination in insurance coverage for mental health." 

By erasing stigma and securing insurance parity, the hope is that people will seek treatment for mental illness when they need it -- just like they seek help for other health problems.

That help may come from a primary care doctor or other health professionals. And Carter points out that the family members and loved ones can also help depressives seek the help and treatment they need.

"Obviously, seeking help is the best first step," Carter notes. "We know so much more now about the brain and about effective treatments, including psychosocial supports, for even the most severe mental illnesses.  In fact, we now talk about people recovering from their mental illnesses. That was unthinkable at one time."

For more information on depression, click here.

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 3/28/2004  -  John Morgan & Stephen A. Shoop, M.D.
Reviewed: 3/28/2004  -  Donnica Moore, M.D.

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