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Low Down Blues

Nearly 12,000,000 Americans suffer from it. It is an illness that can cause as much pain and be just as debilitating as a chronic heart condition. And it is life threatening; a factor in 70% of all suicides. The disease is depression. And it costs the nation more than $43 billion a year in treatment and lost productivity; more than the economic cost for heart disease.

"My sister committed suicide. My mother was in a mental hospital most of her life," a woman relates. And she goes on to describe herself as suffering too from the disease that plagued her immediate family. But today she copes well with her manic-depression, avoiding those radical up-and-down mood swings, with the aid of the drugs. In the days not long after bloodletting, the mainstay treatment for depression was electroshock therapy. Years went by and Lithium became the godsend. Now the depression drug market is a billion dollar business. t used to be that Lithium was the mainstay of drug treatment but the depression drug market has burgeoned. It's a billion dollar business that's thriving because, while depression can be controlled, there's no cure.

A twenty-one year old has multiple scars on her wrists from prior suicide attempts. "She was abused as a child," her mother says. "She has a history of bulemia and drug abuse." But she's back in college now, and doing well. She's on Lexapro.

There are several forms of therapy for depression. Mild cases can be treated with talk. Talking with family, a counselor, or a clergyman can help. Sometimes a professional psychotherapist is needed. When drugs are prescribed, just to name a few, they may be antidepressants like Prozac or Wellbutrin, Zoloft or Effexor; or antianxiety medicines like Xanax or Ativan. And despite the bad rap that Jack Nicholson gave electroconvulsive therapy (ECT) in the movie "Cuckoos Nest," ECT still has a reputation for working in severely depressed and suicidal patients, non-responsive to drugs.

Though depression can be attributed to both biological and social factors, research seems to show that chemical pathways in the brain are altered during depression, particularly the neurotransmitter chemicals, dopamine and serotonin. Drugs and ECT act by affecting those chemical pathways in the brain.

One woman, about forty, whom I shall call Nancy, came in with medics recently. "I feel like I'm going to die," she moaned. She had the same feeling several months before during an earthquake, when she lost her home. She described that then, "my chest tightened. I couldn't breath." It happened again just prior to coming in, after an argument with her son who threatened suicide. And that wasn't the end of Nancy's misfortune. Her husband was unemployed; her mother was dying. Though everything seemed to point to depression as being the cause of her symptoms, we still ran her through a battery of tests. Every depressed people have heart attacks.
Only one-third of people with depression receive any professional help. Some refuse help because they fear being stigmatized as having a "mental illness." Some say they would rather just live with the disease. Some turn to self-abusive remedies like drugs or alcohol. And some refuse to admit the root cause of their pain.

Though everyone occasionally suffers the "blues," sometimes there can be an avalanche of burdens. Tranquilizers and antidepressants can help. But Nancy wanted none of that. She was sure she was having a heart attack or dying of some other medical problem. "I don't want drugs. I'm not crazy," she said adamantly. She left he ER, angry, still depressed, and still in pain.