Depression hurts mind and body

As Shakespeare wrote, "When troubles come, they come not single spies but in battalions."

He could have been writing about Canada's recent problems with SARS, mad cow disease and West Nile virus. So I can't imagine a better topic than depression when so many of us are thinking "Why, God, have you done this to our country?"

Noted humourist Art Buchwald suffered from depression. About this trauma, he wrote, "Everything was black. The trees were black, the road was black. You can't believe how the colours change until you have it. It's scary."

Late-night talk show host Dick Cavett also fought depression. And Mike Wallace of 60 Minutes has often talked publicly about his episodes of despair.

They're all in good company. Abraham Lincoln wrote, "I am the most miserable man living. Whether I shall ever be better I cannot tell. To remain as I am is impossible. I must die or get better."

And Winston Churchill despairingly remarked to his doctor, "I don't like to stand by the side of a ship and look down into the water. A second's action would end everything. Is much known about worry, Charles?"

It's estimated that one in every 10 North Americans encounters depression. So one would think it would be easy to spot.

But it's often an elusive diagnosis. It's rare that patients blurt out, "I'm depressed." Or that "I'm going to jump over Niagara Falls to end my life."

Dr. J. Raymond De Paulo, a professor of psychiatry at Johns Hopkins University, predicts that by 2020, depression will be the second most debilitating disease worldwide, after heart disease, and a leading cause of death.

Depression isn't the despondency you experience when your partner runs off with the local preacher.

Or the grief that accompanies the death of a loved one. Uncomplicated gloom is a normal reaction in such instances that is eased with the passage of time.

Rather, depression is a psychosomatic disorder of the entire body. A depressed person experiences more than just a troubled mind. A number of body systems are placed under strain.

Simple unhappiness or that "down-in-the-dumps" feeling becomes depression when people lose interest in events around them or things they used to enjoy.

They have little or no desire for food or sex. They dwell gloomily on the past and complain of insomnia, fatigue, intestinal complaints and chronic pain. And they're often unable to make even the smallest decision.

The causes of depression are legion. Rates are higher for those with a family history of mental illness or depression. Some people are simply born unhappy. They would find it hard to smile even after winning the $20 million dollar jackpot.

Illness is a major cause of depression. Who wouldn't be depressed by the onset of cancer, multiple sclerosis or Lou Gehrig's disease? Or it can be a manifestation of guilt when a patient says, "I should have seen my mother before she died." Or due to a combination of drugs.

How depression is treated depends on the gravity of the illness. Many cases are best treated by a caring family physician and one who is aware of the patient's overall medical problems, and what family resources can be mustered to assist in recovery. After all, not everyone with a headache needs a brain surgeon. The most effective approach is support and understanding. Often merely the admission of guilt to an empathetic listener is enough to reverse depression.

But those beyond the range of communication need antidepressant drugs. The so-called "happy drugs" such as Prozac could have helped Lincoln, Churchill, Cavett and others. It might even have stopped Vincent van Gogh from cutting off his ear.

When isolation strikes a family member or friend, depression should be suspected. Cavett would stay under the sheets until afternoon. Just getting out of bed and taking the laundry downstairs was a huge effort. And it lasted six weeks before he sought treatment.

Each year 4,000 Canadians and 30,000 Americans commit suicide. So act quickly when you suspect depression. And in these depressing times please, please, God, at least protect our country from earthquakes.

Heart-attack depression can kill Death rate remains high for 6 months

People who suffer from clinical depression after heart attacks are much more likely to die within six months than those who aren't depressed, researchers at the Montreal Heart Institute have found.

A study of 222 heart attack patients, to be published in today's Journal of the American Medical Association, shows that depression shouldn't be accepted as a normal state of mind after a heart attack, Dr. Nancy Frasure-Smith said yesterday.

An editorial in the Journal says the institute findings "should signal, we believe, a turning point" in the study of emotion's effect on heart disease.

Instead of looking for more evidence that depression hurts patients, it's time to study whether treating the depression can help them, the editors write.

Of the 222 heart-attack patients Dr. Frasure-Smith and her colleagues studied, 16 per cent suffered from major depression, according to a questionnaire developed by the U.S. National Institute of Mental Health.

That's roughly in line with earlier studies of the rate of depression among heart patients, she said.

Follow-up phone calls six months later showed that the depressed patients were three to four times more likely to die than patients who didn't show symptoms of depression in the questionnaire.

The researchers considered the possibility that depression and high mortality rates might both be the unrelated result of especially severe heart attacks, Dr. Mario Talajic said. "But once you tease out this and other factors, depression remains an independent risk factor."

In fact, depression appears roughly as life-threatening as a history of previous heart attacks, Dr. Talajic said.

The study opens up more questions than it answers: whether depression causes chemical changes that hurt the heart, or causes changes in behavior like a reluctance to give up smoking, for instance. Doctors also know little about the reactions between anti- depressants and medicines administered after a heart attack.

And similar studies have not been done on the effect of depression after major surgery or among cancer patients.

Following up on these questions is "an enormous task," Dr. Francois Lesperance, the third member of the research team, said.

Men's work feeds depression, hurts families

The pundits of psychiatry tend to hold forth about how bad men feel. They say that depression in men goes largely undiagnosed, that depression causes rejection by female partners. And remind us once again that men, especially young men, are three times as likely to commit suicide as women.

Men feel bad about themselves, their relationships, their children, about working too hard or not having any work. In short they feel like women.

It is just that women are more likely to seek help.

I meet many downhearted men in my line of work. I am only surprised that some men are not more depressed. The feel-bad factor exudes from all sorts of men in public life.

Whole areas of debate about men are being conducted without them actually being there. Arguments about fatherhood, divorce, child care, nursery education continue to dominate the news.

On the left, it is women who continue to make the running, whether the subject under discussion is parenting or fatherhood. On the right, there is an absence of voices.

But where are the men who will say that they, too, were responsible for failed marriages? Where are the young men who feel that their parents' divorce did not destroy them forever?

We read, too, that there is a ``time bomb in the nursery;'' and ``Career women warned: don't send children to school too young.''

We read about toddlers still in diapers being sent off to daycare so that their feckless mothers can amuse themselves with little jobs.

Little jobs such as working in newspapers, perhaps.

Imagine a headline that said ``Career men warned: working may damage your children's health.'' Perhaps in some media fantasy men are so cowed by monstrous feminists that they cannot speak up about fathering or what it is like coming home after a hard day and taking over the child care.

Perhaps they cannot discuss in public the rewards of spending time with their children, perhaps they dare not mention how nice it is to get away from the kids sometimes.

In real life, however, some men can and do talk about these things. Emotional literacy is not the province solely of women.

If masculinity in crisis is a topic to be debated by women, it is still an experience to be lived through by men.

One of the old masculine values is courage. It takes courage to change, it takes courage to admit that there is no going back, it takes courage not to suffer in silence.

Some surveys show that half of the men interviewed are unhappy about the hours they work, feeling that this has a detrimental effect on their family life, yet few are prepared to do anything about it. Most successful men feel that their children are adversely affected by their working lives.

The struggle that women who work have is a struggle that men share in, but instead of joining forces they continue to feel isolated in their misery. What comes over most strongly from reports about depression is the sheer loneliness of many men's lives.

The image of the macho loner who needs nothing and no one - exalted in films such as Heat, where Robert de Niro claims that the basis of his success is being able to leave anyone or any situation within 30 seconds - is at odds with the sadness that this brings for many ordinary men who have left and lost all the important connections in their lives.

As long as men see themselves as giving up power by even admitting that all is not right with the world, they will continue to submerge themselves in that stagnant reservoir of immutable male behavior.

Beware the undertow, my friends . . . they may kid themselves they are riding the waves but it looks a lot like drowning to me.

Now that some women have some of the things we used to envy men for, we are asking whether they were ever worth envying in the first place. When more men can do the same, they may even come to terms with the idea that this is not such a depressing way to live after all.

Depression Hurts

Study: Depression increases death risk for heart patients - Canadian Press Montreal - PEOPLE WHO suffer from clinical depression after heart attacks are much likelier to die within six months than those who aren't depressed, researchers at the Montreal Heart Institute have found.

A study of 222 heart attack patients, to be published in the Journal of the American Medical Association, shows that depression shouldn't be accepted as a normal state of mind after a heart attack, Dr.

Nancy Frasure-Smith said recently.

An editorial in the Journal says the institute findings "should signal, we believe, a turning point" in the study of emotion's effect on heart disease. Instead of looking for more evidence that depression hurts patients, it's time to study whether treating the depression can help them, the editors write.

Of the 222 heart-attack patients Frasure-Smith and her colleagues studied, 16 per cent suffered from major depression, according to a questionnaire developed by the U.S. National Institute of Mental Health. That's roughly in line with earlier studies of the rate of depression among heart patients, she said.

Follow-up phone calls six months later showed that the depressed patients were three to four times more likely to die than patients who didn't show symptoms of depression in the questionnaire.

The researchers considered the possibility that depression and high mortality rates might both be the unrelated result of especially severe heart attacks, Dr. Mario Talajic said.

"But once you tease out this and other factors, depression remains an independent risk factor," he said.

In fact, depression appears roughly as life-threatening as a history of previous heart attacks, Talajic said.

The study opens up more questions than it answers: whether depression causes chemical changes that hurt the heart, or causes changes in behavior like a reluctance to give up smoking, for instance. Doctors also know little about the reactions between anti- depressants and the medicines normally administered after a heart attack.

And similar studies have not been done on the effect of depression after major surgery or among cancer patients.

Following up on these questions is "an enormous task," Dr.

Francois Lesperance, the third member of the research team, said.

"We're in over our heads." For patients, the best advice to draw from the study is that depression isn't a normal state of mind after a heart attack, Frasure-Smith said.

If patients notice the symptoms associated with major depression - such as debilitating sadness combined with weight changes, sleep disturbance, agitation, and problems concentrating - "what they need to do is describe those symptoms to their physicians," she said.

Depression Hurts Young Workers

Younger workers in Canada are the most likely to suffer from depression, anxiety and anger, and the situation is growing worse, according to a report by WarrenShepell Research Group.

The report reveals links between worker age and the frequency of depression and anxiety, and warns employers it will cost them more to ignore the problems than to deal with them.

"Over the last three years [from 2001 to 2003], we've seen a tremendous

jump in anxiety rates among 20- to 29-year-old employees, and depression rates among employees under 20 years old are higher than in any other age group," said Rod Phillips, president and CEO of the consulting and research firm.

"Younger employees ... are the ones reporting the highest rates of depression and anxiety symptoms, and it looks like it is going from bad to worse."

These workers, who already account for one-third of the workforce, will be desperately needed by employers with the impending retirement of the baby boom generation, it noted. If these trends in anxiety and depression continue, employers will quickly feel the impact in lower performance in problem-solving, decision- making, team effectiveness, and building and maintaining relationships.

The study provided two reasons why younger workers are more likely to suffer from depression, anxiety and anger: People tend to become more stable as they mature and older workers tend to experience fewer social, occupational and financial upheavals.

An increase in anxiety from 2001 to 2003 is understandable, it said, given increases in work hours and intensity in Canada, the growing conflict between the demands of the workplace and the home, such as caring for children and the elderly, and recent world events, including war, terrorism and corporate improprieties.

Not only are employees who suffer from emotional problems less productive -- with difficulties in problem-solving, decision-making and meeting goals -- they can also be disruptive to the workplace, it said.

The report estimated a Canadian firm with 500 employees loses $120,000 each year in wages and salaries alone as a result of depression in the workplace, and that financial losses would be substantially greater if other indirect costs, such reduced productivity, were included.

"Depression accounts for a higher absenteeism rate than back pain, cardiovascular disease, hypertension, diabetes and other mental conditions," it said. A wealth of studies have concluded that productivity gains from the treating of depression in the workplace far exceed the direct costs of doing so, it said.

Those employers who understand and take steps to address the problem will be winners in the battle to recruit and retain workers, concluded the study, which surveyed more than 123,000 employees in over 2,500 Canadian firms.

Employers can help by providing employees with workplace autonomy and clear feedback, encouraging employee input into decision- making, and training managers to recognize and address the symptoms of emotional problems.

It noted, for example, that research suggests personal control is one of the most critical factors in workplace mental health and suggested employers maximize employee autonomy.

The establishment of employee assistant programs can also be effective, it said.

Illness Now a State of Mind as Rules Loosened

The Food and Drug Administration relaxed its rules this summer governing TV ads for prescription drugs. We can now watch a blissful woman windsurfing over amber waves of grain and learn that the product, Allegra, is an anti-allergy drug. But drugs aren't like the newest pair of Air Jordans; there are risks to marketing medications that don't exist in the selling of shoes. The FDA is s aware of at least some of those risks. Pharmaceutical companies can't tell consumers to "Just Take It." Their ads mustprovide the kind of information usually found on package leaflets, such as possible side effects, contraindications and interactions with other drugs.

But when advertisers aim their products at patients rather than physicians, they are changing the dynamic of the way drugs are prescribed. They are suggesting that consumers diagnose themselves - and present that diagnosis to their doctor.

Of course, doctors can - and should - say no to anyone who doesn't need a particular medication. But let's not fool ourselves: If doctors are under pressure from their patients to prescribe a particular medication, they must become strong gatekeepers to prevent misuse.

Recent print ads only increase that pressure. In magazines and newspapers, we are seeing more and more advertisements for prescription drugs, and sales of some drugs that have been advertised directly to consumers are rising.

Consider the message in Eli Lilly's ads for Prozac that recently appeared in Newsweek and Time. On the left-hand page of a recent ad, against a black background and just beneath a picture of a cloud and raindrops are the words "Depression hurts." On the right-hand page, against a sky-blue background, under a bright yellow and orange sun, are the words "Prozac can help."

The first words of the small print below the cloud are, "Depression isn't just feeling down. It's a real illness with real causes." So far, so good. But the ad continues: "Depression can be triggered by stressful events, like divorce or a death in the family." Now the reader learns that being depressed isn't just feeling down; if you've just gotten divorced or lost somebody in your family and you're feeling sad, maybe you have a "real illness."

The ad suggests some symptoms that might be worth looking for. "When you're clinically depressed . . . you may have trouble sleeping. Feel unusually sad or irritable. Find it hard to concentrate. Lose your appetite. Lack energy." Since most of us experience at least some of those symptoms some of the time, how can we tell if we're experiencing them intensely enough to warrant taking Prozac? According to the ad, it's when those symptoms "last for more than a couple of weeks and if normal, everyday life feels like too much to handle."

But isn't it more likely that something is wrong if, a couple of weeks after a stressful event like divorce or death in the family, you aren't experiencing a few of those symptoms?

The ad recommends discussing symptoms (and treatment) with a physician: "Only your doctor can decide if Prozac is right for you - or for someone you love." But it ends with, "Chances are someone you know is feeling sunny again because of (Prozac)." Feeling sunny? Is that the way people who aren't clinically depressed should feel?

Aggressive consumer-oriented ad campaigns like this one raise some particularly thorny issues. According to the Pennsylvania- based consulting firm, Scott-Levin, which focuses on the pharmaceutical industry, 92 per cent of patient requests made for Prozac in 1997 have been granted.

That being said, there are some benefits to advertising psychotropic drugs directly to consumers. Psychiatrists largely acknowledge that clinical depression is under-diagnosed, and many agree that drugs like Prozac can help treat it.

And the idea that medication can be used to remedy normal feelings is not new. When Peter Kramer's best-selling book Listening to Prozac came out in 1994, he argued that Prozac could be used not just to treat illness, but to diminish everyday experiences of sadness, and to enhance feelings of wellness.

In response, Eli Lilly ran an informational ad in professional journals arguing that it "is intended - as are all Lilly medications - for use only where a clear medical need exists." The ad asserted it would be "trivializing a serious illness" to suggest that some people might use the drug who were merely unhappy. But don't the new ads risk doing just that?

Many people benefit from drugs such as Prozac. But for the rest of us, it might do more good to change the habits and social conditions that make us feel bad than to change the chemistry of our bodies. We forget that much of our sadness and worry is the result of the lives that we have created for ourselves.

Depression Hurts Job Productivity

Depression among workers poses problems in most North American offices and factories, according to human resource managers who responded to a questionnaire.

Among those human resource managers for 406 U.S. companies, more than half -- 56 per cent -- said employees suffering from depression have had a negative impact on productivity at their companies in the past three years.

Nearly four in 10 said depression among workers is a moderate or large problem for their companies.

The survey, faxed to 2,300 companies, was conducted in July by the Society for Human Resource Management and the National Foundation for Brain Research.

Symptoms that can indicate depression that human resource managers said they most often recognized among workers include tiredness or lethargy, poor concentration, a decline in productivity, overall sadness and an increase in unexplained absences.

Counselling recommended

Not all of the managers took action when they recognized a problem, however. Six out of 10 said they had taken steps such as suggesting the employee seek counselling.

"We're doing a pretty good job at getting the word out that depression is an identifiable illness that affects productivity. However, we still have a ways to go in tying that together with good treatment," said Daniel J. Conti, who runs an employee assistance program for Bank One Corp.

Two-thirds of the companies responding to the survey have similar employee assistance programs that could arrange counselling for employees and 98 per cent have health-insurance plans that cover treatment for mental illness. But managers and co-workers may not know how to approach someone who needs help, or confidentiality concerns may deter a worker from seeking assistance.

That's unfortunate, since co-workers and managers are in a good position to see early signs of depression and offer help, said Dr. Michael Thase, a psychiatry professor at the University of Pittsburgh School of Medicine.

"The best opportunity is when a productive and competent employee suddenly becomes less productive or competent," said Thase. "In this day and in this work environment, it's likely to be a depression.