Depression

By Craig Stoltz
Washington Post Staff Writer
Tuesday, January 1, 2002

U.S. cases: 10 million to 19 million

Clinical depression – usually characterized by extreme or lingering sadness that interferes with daily function and is different from normal feelings of sadness brought on by life events – is considered the leading cause of disability in America. It's twice as common in women as in men.

During 2001, two long-standing forces continued to steer patients toward drug treatment: the marketing of a new generation of antidepressant medications such as Prozac, Zoloft and Paxil; and health insurers' policies that favor drug treatment over psychotherapy.

The National Institute for Mental Health concludes that combination therapy, involving both drugs and talk therapy, is more effective for most patients. The agency singles out time-limited cognitive-behavioral and interpersonal therapies as particularly well-suited to depression.

In August, the daily-dose version of market leader fluoxetine (Prozac) became available as a generic and more than 80 percent of users have switched to the lower-priced option. Prices of competing drugs are expected to be forced downward in 2002. While the current generation of antidepressant drugs acts on a single brain chemical, serotonin, drugs in development will target other so-called neurotransmitters as well.

As science continues to explore the brain, researchers are learning more about – and discovering the limits of – neurotransmitters. They are exploring theories linking depression to cellular function, electrical pathways and bigger structures of the brain.

A 2001 study funded by the makers of Zoloft concluded that the popular herb St. Johns wort was ineffective against major depression. The study was widely considered irrelevant to the efficacy of the herb for mild depression, for which it is most commonly used. Other reports in 2001 did show that St. Johns wort interferes with the body's ability to absorb some prescription drugs, underscoring the emerging consensus that most herbs should be used in consultation with a medical professional.