NOTION OF PROZAC-DEPENDENT NATION RELIES ON HEAVY DOSE OF MYTH

Whether Americans take too many anti-depressant medications is less
clear-cut than some might think.

Data show anti-depressants are underprescribed for patients with
severe clinical depression, said Laura Miller, psychiatrist and chief
of the Women's Services clinic at the University of Illinois at
Chicago Medical Center. Yet too many women with mild depression and
life problems are helping to make best sellers of anti-depressants
such as Prozac, Zoloft, Paxil and Luvox.

Even as researchers work to eliminate these contradictions, they find
many explanations for them.

For those who perhaps should be taking anti-depressants but aren't, a
likely reason is that people simply don't get medical attention for
their problem. "There is a stigma attached to seeing a psychiatrist,"
Miller said.

Doctors also may undertreat depression because many stick to the
belief that people can lift themselves out of it without drugs.

Complicating matters is that anti-depressants don't work for
everyone--about 30 to 40 percent of patients don't respond to them,
said Eva Redei, researcher and associate professor in the psychiatry
and behavioral sciences department at Northwestern University Medical
School. If the medication is effective--which requires two weeks to
two months to find out-- the patient should stay on the regimen for at
least 6 to 12 months to reduce the risk of the depression returning.

Even if the drugs do help with the depression, they can affect the
body in other undesired ways. Common side effects (affecting about 10
to 25 percent of patients) include nausea, diarrhea and sexual
dysfunction.

The drugs also can seem to erase feelings altogether rather than help
patients to modify behavior and emotions.

"Lots of women eventually complain about feeling flat when using
anti-depressants," Redei said.

Women represent about two-thirds of patients who are diagnosed with
depression, estimated to affect more than 17 million Americans.
Theories that more women are diagnosed because of willingness to
consult doctors have not been confirmed in recent studies. There also
are hypotheses that today's U.S. women are stretched emotionally by
work and family roles. A landmark cross-cultural research project,
however, showed similar gender ratios for depression across ethnic
groups and among 10 industrial nations.

To help determine whether anti-depressants are necessary, Miller said
women need to distinguish between depression and normal life problems.
Midlife can create a series of new challenges for women, especially
hormonal fluctuations and role changes in the family.

"Anti-depressants are not intended as a way to make more friends or
address an unhappy or unfulfilled life," Miller said. "Women should
insist on a thorough evaluation (from a psychiatrist) and maybe even
allow a spouse or loved ones to be interviewed."

Any physician seemingly too quick to write a prescription for
anti-depressants should be suspect. Miller said depressive illness has
numerous variations that are difficult to analyze in a short visit.

"For someone whose depression can be traced to stress or a traumatic
event, psychotherapy will typically be more effective than
medications," Miller said. "But if the depression is chronic, a course
of anti-depressants might prove beneficial."

A recent meta-analysis of 19 anti-depressant studies published in New
Scientist magazine showed that the placebo effect plays a greater role
in treatment results than drug companies report. Industry-sponsored
studies show anti-depressants result in 40 percent greater relief of
symptoms (decreased energy level, sleep disruption, appetite changes),
while researchers Irving Kirsch of the University of Connecticut and
Guy Sapirstein of Westwood Lodge Hospital in Needham, Mass., reported
the drugs were 25 percent better than dummy pills.

"Depression is far from solved (by today's medications)," Redei said.
"We need to develop more specific drugs and study more closely
depression in women, who are significantly more prone during their
reproductive stages of life. Finding out why can provide clues for
better drugs used more narrowly."

Checked-by: Patrick Henry