Women suffer depression at more than twice the rate of men

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Depression & drugs: women suffer depression at more than twice the rate of men

Depression is unpredictable. It threatens to invade the consciousness when you least expect it -- like a shadow lurking in a dark corner of a cobweb that appears in a solitary ray of light. It's a secret that I've harboured all my life, something dark, odious. For years, I felt it could only be explained by taking my life.

My "dark side" always lies close to the surface, threatening to rear its ugly head, to expose itself involuntarily -- most frequently through silence. I become immersed in a hollow cave where there are no words. This is horrifying for, as a writer, words are my life; they allow me to connect my separate inner world with what goes on outside, they keep me sane. When words fail, there is nothing. I feel displaced, incompetent, worthless. I fall and I wait to surface again -- to come up towards light.

I feel most lost when I no longer appreciate small events -- how the sunlight dances and glitters through the trees, how the wind whispers and shudders against the leaves. Depression hits and then proceeds to slowly, unrelentingly erode the spirit. It forces me to fight against something internal, invisible, imperceptible to the human eye. You and I may share certain realities -- the conversations that occur in a room -- but the darkness that occurs within, this is a private hell. Perhaps it is this feeling of aloneness that is the most devastating aspect of depression, and yet, rationally, I know this not to be the case. Depression will strike an estimated one in five Canadians at some point in their lives. Two - thirds of these will be women. Most will go undiagnosed, and consequently untreated.

For me, treatment has involved engaging in talking therapy with more than half a dozen psychiatrists seen intermittently over the last 20 years -- that is, since I was about 10. For most of this time, I found there was little progress; the hour - long sessions were mainly filled with my dreary testimonials: "Life is not worth living, there's nothing that will ever make it better. I am utterly worthless," and so on.

Psychiatrists have, for three decades, prescribed antidepressants for depressed patients, but in recent years they have come into a new vogue. It seems that every year medical journals and newspapers report findings of new "miracle" drugs that will stop depression. It started with Prozac, first approved in Canada in 1989; but that cure - all has spawned about half a dozen new antidepressants in the last five years alone (see chart, next page) -- including a newly available generic brand of Prozac marketed under the name pms - fluoxetine by the Quebec - based company, Pharmascience.

Despite the hype, it was not until a few years ago that I succumbed, with many misgivings. The alternatives seemed dim. After the death of a close friend, the suicidal thoughts became all - consuming, I was barely eating and I was finding no pleasure in life. Fortunately, I was among the approximately 70 percent for whom antidepressants worked. They helped to lift a dark veil so that I could then, through psychotherapy, confront more rationally the sources of the darkness beneath.

Once I had decided to take an antidepressant, the next challenge was to find the right one, and the right dose. Prozac is merely one of four currently prescribed SSRI's [selective serotonin reuptake inhibitors] that are all very similar, but which may cause slightly different side effects depending on the individual. Because they take about four to six weeks to take effect, finding the right one may take time. For me, Prozac worked well for about six months, and then the effects seemed to wear off. Rather than increasing the dose, I chose to go off medication and see how I was able to cope on my own.

Fortunately, years of therapy enabled me to understand the cause of my depression and to change some self - destructive patterns after going off medication. But the drugs served a vital purpose; they lifted the depressed lethargy and gave me the energy to confront my demons.

For me, drugs worked. But what's at issue for many of the doctors and therapists I spoke with, is the readiness with which depression drugs are being prescribed -- especially to women. Are they a kind and quick end to suffering or, as some critics accuse, a Band - aid solution -- chemical cure for a psychological problem? That all depends on how you define the problem.

According to Dr. Jan Fleming, associate professor of psychiatry at McMaster University and member of the Centre for Studies of Children at Risk in Hamilton, Ont., depression is a medical problem that can be influenced by environmental factors in the same way that diabetes is exacerbated by stress. Others, such as feminist psychotherapist Dr. Bonnie Burstow, are less likely to see depression as a medical or psychiatric problem than as a symptom of the human condition.

Dr. Sidney Kennedy, head of the mood disorders program at The Clarke Institute of Psychiatry and the University of Toronto says, we over - simplify when we dichotomize depression into either a biological problem or an environmental response. There is "a swirl of chemical reactions" that exists in everybody's brain, and which influence our sleep, our emotions and other aspects of our functioning, he says. According to Dr. Kennedy, deciding whether or not to prescribe medication should be based on how disabling the depression is. Most people suffer "blue" periods from time to time, but that anxiety become clinical depression when it routinely represents an inability to function -- when it impairs our ability to carry out normal daily functions (sleeping, eating, working). So - called clinical depression runs the gamut, from moderate to more severe, but in all cases the depression represents an ongoing impairment.

While research indicates that medication is more effective than talking therapy for people with moderate to severe clinical depression, many doctors encourage a combination of medication and therapy. Recent studies have suggested that those suffering from dysthymia (generally considered to be a more low - grade chronic depression) can gain what Dr. Kennedy describes as an uplifting or energizing effect from medication -- at least in the short term. But in the long term, psychotherapy may be necessary to address the problems that may have triggered the depression to start with.

Health practitioners now educate sufferers and their families about depression. When I was a child, my mother received no guidance in how to cope with me, and was consequently often frustrated for not knowing "the right thing to say." Her telling me how lucky I was and how I should look on the bright side only increased my feelings of guilt for not getting better. She didn't know what we know now, which is that telling some - one to "snap out of it" is as helpful as telling someone to snap out of diabetes. What I really needed was for somebody to acknowledge my suffering, recognize that there were problems deeply rooted in my sense of self worth and accept my intermittent need to withdraw.

I am glad I am no longer on medication; however, if the darkness returns to ravage its effects, I may again need antidepressants. Antidepressants may be prescribed by some doctors, and warned against by feminists and other skeptics, but it is the person swallowing the pill who must feel comfortable with her choice. I am sorry to use a pseudonym -- to have to anonymously tell you my secret. Perhaps one day, when I no longer feel stigmatized for suffering from this depression, or for choosing the so - called "easy way out," perhaps then I will come fully out into the light.