Depression
Why does the disorder afflict so many people?
By Richard L. Worsnop

In the United States alone, it is estimated that severe depression affects more than 15 million people. Depression is so widespread that it is sometimes called “the common cold of mental illness.” It is also the most treatable of mental disorders, with up to 80 percent of patients showing marked improvement after therapy. Nonetheless, only about 30 percent of depression sufferers seek professional. . . .

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Should the Food and Drug Administration require a warning in the labeling of the antidepressant drug Prozac about a risk of suicidal impulses?

Food And Drug 1991. Fluoxetine [Prozac] is an effective medication in many patients with clinical depression (the only indication it is approved for by the Food and Drug Administration), including patients whose depression has been refractory to other drug therapy. Evidence of its usefulness in the treatment of other psychiatric disorders, including obsessive- compulsive and eating disorders, is still emerging, but the drug appears promising in clinical trials under carefully controlled conditions. Because of the benefits that may be attributed to [Prozac], and the lower risk of injury and death associated with overdoses of [Prozac] than tricyclic antidepressants, we do not propose the drug be banned. However, the evidence linking [Prozac] to suicidal [thinking] is alarming and strongly indicates the need for caution in the use of this medication.

Prozac Company Statement Issued May 23, 1991. The position advocated by the Public Citizen Health Research Group is unfounded and unnecessary. The approved labeling for Prozac is consistent with current medical and scientific information. No additional warnings are needed. There is no credible evidence in the medical literature that Prozac causes increased suicidal thinking or suicidal actions. This medical literature encompasses more than 2,000 published articles and more than 20 years of medical and scientific research.

As the Days Dwindle Down ... Depression Flourishes

As days grow shorter and grayer with the approach of winter, some people become irritable and lethargic and find it increasingly hard to concentrate. They may suffer from seasonal affective disorder (SAD), a form of depression that afflicts an estimated 10 million persons in the United States.#

Frederick A. Cook, the Arctic explorer, provided a vivid description of the effects of prolonged darkness on the human psyche. “The curtain of blackness which has fallen over the outer world has also descended upon the inner world of our souls,” Cook wrote in his journal on May 16, 1898. “Around the tables ... men are sitting about sad and dejected, lost in dreams of melancholy ... For brief moments some try to break the spell by jokes, told perhaps for the 50th time. Others grind out a cheerful philosophy; but all efforts to infuse bright hopes fail.”

The fact that SAD peaks in the Northern Hemisphere around Christmas and New Year's Day led many people to assume the disorder was merely a form of holiday blues. But that theory collapsed with the discovery that SAD strikes most of its victims below the Equator in June and July -- the Southern Hemisphere's midwinter.

Light therapy is the most commonly recommended treatment for SAD. It entails several hours a day of exposure to artificial illumination 10 to 15 times brighter than the light in a typical room at night. Researchers have found that extra light in the morning does more to enhance mood than light administered later in the day.##

Individuals who suffer from SAD or two other behavioral disorders -- carbohydrate-craving obesity (CCO) and premenstrual syndrome (PMS) -- tend to engage in bouts of overeating and excessive weight gain. The binges usually occur at predictable times: late afternoon or evening in the case of CCO; just prior to menstruation in PMS; and in the fall and winter for SAD.

Some researchers believe the craving for carbohydrates that is characteristic of all three disorders stems from cyclical disruptions of a feedback mechanism in the central nervous system. At such times, the theory goes, the brain fails to respond when carbohydrates are eaten. Consequently, the craving for them persists longer than it ordinarily would.

The only sure cure for SAD is said to be the arrival of spring. But some people even dread the prospect of warmer weather, knowing that it will trigger a bout of summer seasonal affective disorder (SSAD). Though much less prevalent than SAD, SSAD shares many of the same symptoms. To obtain relief, SSAD sufferers are advised to avoid high temperatures and spend their summer vacations in cool northern latitudes. # Susan Gilbert, “Harnessing the Power of Light,” The New York Times Magazine, April 26, 1992, p. 17. ## Richard J. Wurtman and Judith J. Wurtman, “Carbohydrates and Depression,” Scientific American, January 1989, p. 72.