Depression

Depression

The first serious bout was back in 1963, when he was attending Queen's University and, just before final exams, locked himself in his dorm room for two weeks. The next came seven years later, when he was Vancouver bureau chief for The Globe and Mail: he dismantled the bell on his office and home telephones ("So no one could reach me, but I could still dial out," he recalls), and spent his days playing tennis and walking under the Burrard Street Bridge, contemplating suicide. The last time it happened, in September, 1993, it made the veteran journalist and seeming bon vivant the talk of Toronto media circles: what happened to Joey Slinger? After 14 years of writing a four-times-weekly humor column in The Toronto Star, Canada's largest-circulation newspaper, Slinger suddenly disappeared. Rumors abounded about how he quit in a huff, about him working as a clerk in a downtown bookstore - both true, it turns out. But what few of Slinger's readers and acquaintances suspected was that, behind his evaporation from the Star's pages lay a disease with which he has struggled for much of his life. "Every now and then, I have what used to be called a nervous breakdown," says Slinger, 54. "Now, it's called depression."

That, thankfully, is not as shocking an admission as it once was. In the nearly 10 years since the release of Prozac - the first and most publicized of the so-called SSRI (for selective serotonin reuptake inhibitor) family of drugs - there has been a revolution in the treatment of depression, and in the way many people think about it. Even well into the 1970s, depression was primarily considered a character flaw or a result of poor upbringing, to be treated with Freudian on-the-couch psychoanalysis. Now, researchers are approaching a deeper understanding of how depression affects the brain, and of its potential physical and genetic underpinnings. At the same time, a revolution of a different sort has begun among sufferers, fuelled in part by the recent public admissions of celebrities - among them, U.S. media mogul Ted Turner, 60 Minutes co-host Mike Wallace, Canadian actress Margot Kidder and singer-poet Leonard Cohen - that they, too, have mood disorders. There is a new openness about the condition, and an increasing recognition of its economic costs, as employers and insurance companies grapple with a boom in disability claims and absenteeism due to depression. And today more than ever, sufferers can find support in their communities, as hundreds of self-help groups have sprung up across Canada, allowing them to talk about their illnesses and the challenges they face in an open, sympathetic atmosphere.

Finally, depression is coming out of the closet. But it still has a long way to go. The statistics on depression make the old saw about misery loving company seem like a cruel joke. More than 24 million people worldwide now take Prozac, just one of the five SSRIs. By conservative estimates, more than one million Canadians every year will suffer from any one of about a dozen depressive disorders, ranging from dysthymia (low-grade, chronic depression) to so-called bipolar affective disorder or manic depression, which causes radical mood swings between emotional highs and the depths of despair. In fact, many doctors who treat depression think there is more of it around, although some say it just seems so because the illness is being recognized and treated more often than in the past. Still, theories abound about why depression might be spreading. Some experts blame high levels of stress in industrialized societies, or suspect that environmental chemicals may be to blame. "People cite the divorce rate, the decline in religion, the role of television," says Dr. Jane Garland, director of the mood disorders clinic at the British Columbia Children's Hospital in Vancouver. "Take your pick."

The tragedy of depression is compounded by the fact that it remains widely misunderstood. True, everyone gets the blues. And the classic symptoms are well-known: loneliness, feelings of inadequacy, worthlessness, anxiety, a longing for death. But anyone who has been spared the experience of what Winston Churchill - another famous depressive - called his "black dog" cannot fully grasp the anguish depression brings. It is simply "hell on wheels, emotionally terrorizing," says one manic-depressive, who asked not to be identified. "That's why people kill themselves, and unless you've experienced it, you cannot imagine."

Slinger's last bout of severe depression began several weeks before his "disappearance." Professionally, he recalls, he had hit "a really bad spell of the dries, like bone grinding against bone. I would find myself sitting at the word processor crying, and I thought, 'This is terrible, I'm gonna electrocute myself.' " In September, 1993, he went on a canoeing trip in the Northern Ontario wilderness of Temagami - and decided to pack in his career, calling his boss from a pay phone. Luckily, then-managing editor Lou Clancy and editor John Honderich gave Slinger a year's leave-of-absence rather than accepting his resignation. In that time, he wrote a book on bird-watching, worked part time at a bookstore, and started taking Luvox, one of the SSRI drugs. "It was wonderful," he says. "To me, it's a miracle drug."

Slinger returned to writing his column in 1994, and now says he takes Luvox only when he feels a depressive episode coming on. "The key to me is that I start thinking about suicide," he explains. "It becomes, all of a sudden and bizarrely, among the things I might do today - 'I might get a haircut, I might go to a movie, I might kill myself.' " But after 30 years of on-again, off-again depression - and with an effective treatment in hand - Slinger says he has learned to accept his disorder, and to live with it. "I'm satisfied this is something that just happens to people, like diabetes."

Thousands of others, however, are not so fortunate. Many with depressive disorders struggle for years - and often for their whole lives - to find the right balance of drug therapy, counselling and community support to help make their illnesses manageable. That runs counter to the popular notion about Prozac and other antidepressants which, given all the media attention paid them over the past decade, might be mistaken as a cure for depression. "The new medications have made a spectacular difference," says William Ashdown, a depressive himself and president of the Winnipeg-based Mood Disorders Association of Canada, a public-education and self-help organization. "But there's no rhyme or reason to these diseases, and that's a tremendous challenge for some people. They're looking for a cookie-cutter illness, and there's just no such thing."

In the vast majority of cases, treatment of depression does work: doctors concur that up to 90 per cent of people with depressive disorders will respond to therapy. The irony is that depression is so rarely treated: experts estimate that only one-third of sufferers receive appropriate therapy. Misdiagnosis or lack of treatment is particularly acute among the elderly. According to researchers, only a quarter of people over 65 who have severe depression are adequately treated. The reasons are complex. Physical ailments can mask symptoms of depression - often confused, in turn, with Alzheimer's disease - and that can make it difficult to diagnose. But there are social factors, too, and an incipient belief, even in the medical community, that depression is simply a fact of life for the elderly. Another problem, says Dr. Cesar Garcia, a geriatric psychiatrist at York County Hospital in Newmarket, Ont., is that many elderly patients are uncomfortable talking about emotional problems. "There's a real stigma for that age group about psychiatry and about depression," he says.

Depression comes in many forms, but the one thing that sufferers young and old confront is the stigma, the fear or outright antipathy still directed at the mentally ill. It prevents many from seeking help in the first place. And it can make sufferers - even those receiving proper treatment - lead a double life. Wendy, a community outreach worker in western Canada in her mid-50s, has lived with bipolar disorder for much of her adulthood. Her first bout of severe depression occurred at 19, when she stopped eating and lost 35 lb., stopped sleeping and had repeated thoughts of suicide. At the time, her doctor suspected she was pregnant. "And I said to him, 'Pregnant? I haven't even looked at a boy.' " Times have changed. And now, Wendy - who has been responding well to treatment for the past 13 years - is "living a good life." In her job, she gives support to other people with depressive disorders. She is frank about her illness - but not with everyone. In fact, like most sufferers, she prefers that her real name not be published; she does not even want her home town identified. And she still keeps two résumés on file, one (which she used to get her current job) that describes her condition, and one that does not. "I've accepted my illness, and encourage others to do that, too," says Wendy. "But not everyone accepts this - it could be held against me some day."

As a social problem, depression is devastating in its economic and personal consequences. The national mood disorders association estimates that direct and indirect medical costs of depression in Canada top $5 billion a year, and depression in the workplace is proving an enormous burden to insurers and to businesses: absenteeism due to the illness costs Canadian companies an estimated $2.3 billion annually in retraining, restaffing and lost productivity. But that's only money. The more telling figure: about 3,500 Canadians take their own lives every year - and another 50,000, by conservative estimates - attempt to. Although the forces behind suicide are varied, depression is believed to be responsible for between 60 and 90 per cent of those deaths.

When Doris Sommer-Rotenberg, a 71-year-old writer, poet and jewelry designer, talks about her son Arthur, she knows she sounds like a doting mother. "But he was a remarkable young man," she explains. "He was a doctor, a wonderful athlete - he had everything. But he also had this dreadful illness." The illness was bipolar disorder, or manic-depression, diagnosed at the age of 17. When he was well, his mother recalls, he "was great fun, and had such a love of life." But in 1992, Arthur suffered a deep depression. Doris Sommer-Rotenberg says she did not understand the significance of a visit he paid to her that fall at her downtown Toronto home. "In retrospect," she says, "I think he came to say goodbye."

Five years ago this November, 36-year-old Arthur took his own life. But his mother was not content to let her son become a statistic. Last January, the University of Toronto - matching the $1 million she helped to raise through private and corporate donations - established the Arthur Sommer-Rotenberg Chair in Suicide Studies, the first of its kind in North America, and chose psychiatrist Dr. Paul Links, an authority on suicide's causes and prevention, as the first incumbent. For Sommer-Rotenberg, the chair is a way of keeping her son's spirit alive. And although suicide among people with bipolar disorder is startlingly common, with a rate of about 25 per cent, she believes that deaths like her son's could be prevented with more understanding and research. "Some doctors might say no," she says. "But I think any suicide is preventable. I have to."

Among people with depression, it is a common refrain - the sense of being alone. "Friends and family try to be supportive, but at a certain point it is hard for them to help or know what to say," says Sara, a 33-year-old freelance writer in Montreal who suffers from dysthymia. "When someone compliments me, it doesn't sink in - they might as well be talking about the weather." Often, too, advice given with the best intentions can do more harm than good. "Some people say, 'Why don't you get out of bed, snap out of it? You've got a good job and a lovely home - just get on with it,' " says Wendy in western Canada. "But if we could do that, wouldn't we?"

Just two decades ago, there were few places for people with depressive disorders to turn for support - besides family, friends or psychotherapists. But that is changing. In early 1983, five men and women in Winnipeg - including Ashdown's ex-wife - got together to discuss their illnesses at the prompting of their psychiatrist, Dr. Jim Brown. So began the Society for Depression and Manic-Depression of Manitoba, the oldest self-help group for mood-disorders sufferers in the country. From it sprang a host of other groups, in a wave that can only be described as a self-help revolution. Today, there is a national association, regional organizations in every province except New Brunswick, Prince Edward Island and Newfoundland (plans are under way to start them there, too), and as many as 800 other support groups scattered across the country, from small towns to major cities.

Collectively, the self-help groups provide information to people with depressive disorders and their families. Ashdown says the Manitoba office fields about 5,000 telephone calls, holds 150 high-school information sessions, and has some 500 self-help meetings every year. Part of the organizations' function, he adds, is to educate the public about depression, and do what they can to counter the lingering stigma. But their central role is to provide support to people who are confused, frightened or ashamed by their illnesses. "An individual goes to a doctor, gets treated, usually gets little or no explanation of what it means to him, and is then left alone to face the fact that he is now designated as a mental patient," says Ashdown, 46. "Self-help organizations fill a huge gap."

To the volunteers who work for self-help groups, they can also provide a sense of purpose. Eva, from Thornhill, is 50 now. But she has struggled with her disease since she was 17, when she was an A student, pretty, with plenty of boyfriends - and suddenly "began to feel so, so sad." At 19, she became seriously depressed, and was hospitalized for six weeks. Diagnosed with bipolar disorder 10 years later, she has experienced it all: the medication (she has taken lithium for 21 years, now combined with another mood stabilizer, Tegratol), the cost to her personal life (her first marriage ended in divorce after five years, when she was 23), and the pervasive misconceptions of people around her, even her parents. "I'm still told by my parents that I'm not depressed, I'm lazy," Eva says. "That hurts."

Despite all the obstacles, however, Eva is coping. A big part of that, she says, is her work with the Mood Disorders Association of Metro Toronto where for 10 years she has volunteered as a facilitator for twice-monthly self-help meetings, attended by sufferers and their families. The diseases vary, from dysthymia and major recurring depression to bipolar disorder, but common themes arise: problems with work, medications, doctors and spouses. "It's not people talking down to you, or who have just read something in a book," says Eva. "It's people who have been there." Educating other sufferers' families, she stresses, is important. "I felt there was not much I could do in my own situation, so I tried to do it for others," she says. "It feels good when people say, 'Thank you.' "

In many ways, Eva's is a good-news story. In person, she is warm and funny, with a sparkling intelligence. She has had a successful career and raised two children, who she says are very supportive and informed about her illness. And she has achieved a delicate balance of drugs, psychotherapy and self-help: for the seven years since her last bout of depression, her mood has been stable. In that time, she divorced her second husband, sold her house and moved into a condominium, and underwent major surgery on her hip. Now, she is planning to begin a new career as an events planner, and she has started dating again - a nerve-racking experience for any 50-year-old. But Eva is nothing if not determined. "I've had times in my life when I've felt like a little child," she says. "But I don't want to depend on anybody, on my children or on my parents. I want to depend on myself." Given the anguish she has endured, that is a courageous stand. And proof that, while the war against depression is far from over, those who struggle with the disease can still achieve something significant: a life worth living.

Help in Hard Times

Canadians suffering from depression and manic-depression operate organizations in seven provinces, offering support groups and providing education and peer counselling. Canadians outside those areas can contact the Winnipeg-based Depression and Manic- Depression Association of Canada at (204) 786-0987. The provincial bodies are:

The Mood Disorders Association of British Columbia: (604) 873-0103

The Depression and Manic-Depression Association of Alberta: (888) 757-7077

The Society for Depression and Manic-Depression in Saskatchewan: (306) 966-8261

The Society for Depression and Manic-Depression of Manitoba Inc.: (204) 786-0987

The Mood Disorders Association of Ontario: (416) 943-0434

The Mood Disorders Association of Metropolitan Toronto: (416) 486-8046

The Quebec Association of Depression and Manic-Depression: (514) 529-7552

The Depressive and Manic-Depressive Society of Nova Scotia: (902) 539-7179

Depression Drugs

Every few weeks, several teenage girls arrive at Halifax's Queen Elizabeth II Health Sciences Centre to take part in a study that may someday ease the crippling misery of depression. For two nights, the girls, a different group each time, bunk down in a sleep laboratory with tiny electrodes attached to their heads. Through the night, electronic equipment monitors their brain activity as they pass through the various stages of sleep, including the periods of rapid eye movement (REM) when dreaming occurs. Half of the roughly 80 girls who will take part in the study have no family history of depression. The others do - their mothers have had major depression and researchers know that these girls have a 30-per-cent chance of being victims, too. Dr. Stan Kutcher, a Dalhousie University psychiatrist who is involved in the study, wants to see whether a feature of sleep in depressed adults - they reach the REM stage faster than others - shows up in the kids. If it does, doctors for the first time would have a way of predicting depression and starting treatment early. Kutcher has been working with troubled youngsters most of this life. "It's a tremendous feeling to be able to help kids get better," he says. "It's a privilege to be let into their lives."

A pioneer in studying and treating adolescent depression, Kutcher is part of an army of medical researchers whose efforts are bringing new drugs, new therapies and new ways of thinking to bear in the war on the debilitating disorder. One of the biggest breakthroughs came in capsule form when Indianapolis's Eli Lilly and Co. introduced a product called Prozac almost 10 years ago. The first of a new class of drugs that can alleviate depression without the same nasty side-effects of many older antidepressants, it profoundly improved the quality of life for millions of people. Thanks to Prozac and drugs like it, says Dr. Sid Kennedy, head of the mood disorders program at Toronto's Clarke Institute of Psychiatry, "depressed people are able to live normal, productive lives in a way that wouldn't have been possible 10 years ago."

Now, drugs that are potentially even better are undergoing tests, while researchers study the intricate universe of the brain in search of clues that could someday banish depression entirely. "Things are really moving quickly," says Dr. Trevor Young, a neuroscientist at McMaster University in Hamilton. "We're really getting close to understanding the biochemical changes that occur in depressed brains."

And doctors are coming closer to the time when they may be able to start treatment, in some cases, even before depression takes hold. After the Dalhousie researchers finish their current series of tests early next year, they will keep track of their young subjects for five years to see whether their REM sleep patterns pinpoint which of them will become depressed. If they do, then doctors in the future may be able to test children from families with a history of depression, and identify potential victims. One possibility, says Kutcher, would be to begin treating those children with antidepressants even before the first bout of depression occurred - in the hope that it never will.

Underpinning the new wave of research is a quiet revolution that has transformed thinking about depression over the past two decades. As recently as in the 1960s, when Sigmund Freud's psychoanalytic philosophy was still pervasive, depression and most other forms of mental illness were regarded as the consequences of emotional turmoil in childhood. Now, scientists have clear evidence that inherited flaws in the brain's biochemistry are to blame for many mental problems, including manic-depressive illness - with its violent swings between depressive lows and manic highs - and, according to some experts, recurring severe depression. Beyond that, many experts think that damaging events in childhood - sexual or physical abuse, poisoned parental relationships and other blows to the child's psyche - may cause depression later by disrupting development of crucial chemical pathways in the brain. "Losses early in life," says Dr. Jane Garland, director of the mood and anxiety clinic at the British Columbia Children's Hospital in Vancouver, "can raise the brain's level of stress hormones that are associated with depression."

When the dark curtain of depression descends, today's victims have access to quick and effective treatment. Short-term "talk therapies" now in use can help haul a patient out of depression in as little as four months - as opposed to years on a psychoanalyst's couch. The purpose of such therapy, says Dr. Marie Corral, a psychiatrist at the British Columbia Women's Hospital in Vancouver, is "to deal with the skewed thinking that develops when a person has been depressed for a long time." The most widely used methods: interpersonal therapy, which focuses on specific people-related problems, and cognitive therapy, which tries to counter the feelings of worthlessness and hopelessness that plague depressed people. "We try to show the patient that much of this thinking may be unfounded," says Zindel Segal, a Toronto psychologist.

But along with the new approaches to dealing with depression, a treatment introduced nearly 60 years ago that has earned a grim public image - electroconvulsive therapy (ECT) - is still a mainstay. Popularly known as shock treatment, it remains "one of our most potent forms of therapy" for severely depressed patients who do not respond to other treatment, says Dr. David Goldbloom, chief of staff at Toronto's Clarke Institute. ECT is routinely used every year on thousands of depressed Canadians, including older patients who cannot tolerate some of the side-effects of drug therapies.

ECT's bad reputation owes much to the 1975 movie One Flew over the Cuckoo's Nest, in which staff members of a mental institution punish a rebellious patient, played by Jack Nicholson, with repeated ECT sessions. Patients did endure painful ordeals in the early days of ECT when larger electrical shocks were used to induce a limb-shaking seizure in unanesthetized patients. Electroconvulsive treatment is gentler now. Doctors administer a muscle relaxant and a general anesthetic before subjecting the patient's brain to the amount of current needed to light a 60-watt bulb for one second.

ECT's aftereffects can include painful headaches lasting half an hour or so, and some memory loss. ECT does its job, they add, by altering the brain's electrical and chemical activity. The therapy has some bitter opponents, who claim that it can cause lasting memory loss and impair other brain functions, such as concentration. "ECT damages people's brains - that's really the whole point of it," says Wendy Funk, a 41-year-old Cranbrook, B.C., housewife. Funk says that after receiving electroconvulsive therapy for depression in 1989 and 1990, she lost virtually all memory - she could not recall even her own name or that she was married and had two children.

Meanwhile, for the approximately 70 per cent of patients who respond to them, Prozac and the family of drugs it spawned - Paxil, Zoloft, Luvox and Serzone - are making life far more bearable. Collectively, the drugs are known as SSRIs (for selective serotonin reuptake inhibitors) because they increase the brain's supply of the chemical messenger serotonin. The SSRIs have foes: the Internet bristles with accusations that the drugs can cause panic attacks, aggressive behavior and suicidal tendencies. But most doctors have nothing but praise for the drugs. It's not that they are better than their predecessors at relieving depression - most physicians say they are not.

But SSRIs are easier to live with than some older antidepressants, which often caused dry mouth, daytime sleepiness, constipation, vision problems and other unpleasant side-effects. "The SSRIs are better tolerated," says Dr. Russell Joffe, dean of health sciences at McMaster University, "and it is much harder to overdose on them than the older drugs" - a vital consideration in treating people who may be at risk from suicide. The SSRIs can have side-effects of their own, including insomnia and a diminished interest in sex that sometimes persuade patients to stop taking them. "You just don't get sexually aroused," says Giselle, a 41-year-old Manitoba resident who requested anonymity. "There's just nothing there."

Another problem with the SSRIs is that patients usually have to take them for three weeks or more before they start to work. The reason: when an SSRI increases the flow of serotonin in the brain, the thermostat-like mechanism that normally controls the flow of the chemical shuts down - and then takes three to six weeks to adapt and allow serotonin to flow again. "If you have a severely depressed patient who may be thinking about suicide," says Dr. Pierre Blier, a professor of psychiatry at Montreal's McGill University, "telling him he may have to wait that long for relief isn't good enough."

After studying the problem exhaustively, Blier and another McGill psychiatrist, Dr. Claude deMontigny, proposed in 1993 that the SSRIs would probably take effect more rapidly if used in conjunction with another drug that could block the brain mechanism causing the delay. Such a drug, a hypertension medication called Pindolol, existed. And the following year, a Spanish physician tried the combination - and found that it worked. Since then, studies have shown that the Pindolol-SSRI combination can cut the waiting time for SSRIs to take effect to about 10 days. Working with that knowledge, several major drug companies now are trying to develop a new generation of fast-acting SSRIs.

Meanwhile, efforts to lay bare the roots of depression are being pursued by a number of Canadian research teams:

» While most antidepressants concentrate on two of the brain's chemical messengers - serotonin and noradrenaline - a research team at the University of Alberta in Edmonton headed by neurochemist Glen Baker is studying a substance called GABA. Another of the brain's neurotransmitters, GABA appears to play a role in quelling the panic attacks that often accompany depression. GABA (for gamma-aminobutyric acid) seems to work in the brain by preventing selected nerve cells from sending signals down the line. To find out more, Baker's team is studying the action of two older antidepressants that are used to treat panic, imipramine and phenelzine. They want to find out whether the drugs work by increasing GABA activity in the brain. A possible payoff: a new class of drugs that could some day stem panic by boosting the flow of GABA in the brain.

» At McMaster, Young's team is focusing on manic-depressive illness in an effort to discover which brain chemicals are involved. One approach to the puzzle involves dosing rats - which have many of the same genes as humans - with antidepressants or mood stabilizers and examining tissue samples to see which genes are activated. Eventually, Young hopes to learn more about the signalling process inside the brain that can go awry and lead to depression or mania. He also wants to identify which defective chemical pathways make that happen. "Once we know more about these things," says Young, "we may be able to correct the problems with drugs."

» In Toronto, a Clarke Institute team co-headed by psychiatrists Sid Kennedy and Franco Vaccarino is using high-tech imaging equipment to look at brain functioning before and after treatment with antidepressants. Images produced by a PET scan machine show that, in depressed people, some parts of the brain's pre-frontal region - an area associated with emotion - are less active than normal. Surprisingly, when antidepressant drugs start acting on the brain, those areas become even less active. Kennedy thinks that may be because in depression, the brain deliberately dampens down pre-frontal activity to cope with high levels of stress, and antidepressants may help the process by reducing activity even further. Kennedy hopes next to study brains in people who had remained well on antidepressants for at least a year, and thinks "we may find that by then activity in the pre-frontal areas has returned to something normal" - meaning that the brain's overstressed condition has been corrected.

The best antidepressants can banish depression - but they do not necessarily protect patients from relapses. Susan Boning, who organizes volunteer services for the Society for Depression and Manic Depression of Manitoba at its Winnipeg headquarters, had been taking Prozac for two years when she felt her mood "dipping" last March. Her condition worsened to the point where she made what she calls "a suicidal gesture" by drinking half a bottle of rum and passing out on her living-room floor. Boning, 37, has stopped taking Prozac and has turned to three other drugs, including Serzone. Boning's experience, like countless others, shows that while medical science is making rapid progress in treating depression, for many in the remorseless grip of the disease it is still not fast enough.

The Alternative Choice

Herbalist Chanchal Cabrera has been stocking St. John's Wort in her Vancouver shop since it opened five years ago, but it is only in the past 12 months, she says, that sales "have just gone through the roof." Billed as a natural antidepressant, the extract from a yellow flowering plant has become wildly popular at a time when depressed Canadians are gobbling an exotic array of herbal remedies ranging from ginseng and gingko biloba to lemon balm and valerian. At the same time, they are increasingly turning to aromatherapists, homeopaths, naturopaths and other alternative practitioners for help. "Our members," says Neasa Martin, executive director of the Mood Disorders Association of Metropolitan Toronto, "are interested in alternative therapies big time." Dr. William LaValley, a physician who practises complementary medicine in Chester, N.S., 60 km southeast of Halifax, prescribes antidepressant drugs for the severely depressed. But in mild or moderate cases he often recommends a selection of remedies including St. John's Wort, ginseng - a root extract reputed to relieve stress and bolster the immune system - vitamins (especially the B group), calcium tablets to strengthen neurological functions, and gingko, a tree leaf extract that seems to improve mood and mental ability by improving blood circulation to the brain.

The most popular single alternative to conventional treatments is probably St. John's Wort, long used in Europe to combat depression. But does it really work? The U.S. National Institutes of Health in Bethesda, Md., announced plans in October to compare the effects of St. John's Wort and those of a Prozac-like drug and a chemically inactive placebo on 336 clinically depressed patients. Rif Kamil, a staff psychiatrist at Toronto's Clarke Institute of Psychiatry, is impressed by the herb's apparent ability to ease depression - and by its relatively low cost (about $10 a month, compared with $30 and up for a brand-name antidepressant). "I've prescribed St. John's Wort for about 20 patients with mild to moderate depression," he says, "and the response rate is roughly the same as for antidepressant drugs - around 30 to 40 per cent." Martin thinks that the search for natural remedies reflects a "general suspicion of synthetic medications - and that's especially true for people who have had side-effect problems with antidepressant drugs." But alternative remedies can have their own side-effects. St. John's Wort, for example, can heighten the skin's sensitivity to sunlight and may cause nausea as its price for easing the burden of depression.

Maclean's December 1, 1997