Depression: Louganis and Allen to speak at forums in New York, and San Francisco Oct. 27.

Diver Greg Louganis and actor Chad Allen spoke about their struggles with depression at a public forum in New York (at the LGBT center on October 11), and will speak again in San Francisco on October 27, to raise awareness of the problem in the gay community. Men who have sex with men may be three times as likely as others to experience depression in their lifetime. These forums are sponsored by Gay and Lesbian Medical Association, the Association of Gay and Lesbian Psychiatrists, and GlaxoSmithKline.

The San Francisco forum is Wednesday October 27, 2004, 7:00 p.m., at The San Francisco GLBT Community Center, 1800 Market St., San Francisco.

Comment: Why Depression Is More Important Than Generally Realized

I attended the New York program, which had about one hour for talks by the panelists, and by a psychiatrist from St. Vincent's Hospital Medical Center who served as moderator; the other hour was for questions and comments from the audience and responses from the panelists. I had not realized how serious and widespread debilitating depression can be for many individuals and for the community. A very impressive informal community response developed, with members of the audience helping some of the questioners learn how to get the services they needed after the formal program had ended. At least 150 people showed up for this forum, despite only a couple days' notice; others might have been unable to get in because the room was full, even after extra chairs were set up.

Antidepressant drugs were not the focus of this program, and were only briefly mentioned as a tool that some people may need temporarily. Certain kinds of short-term psychotherapy, and social support from friends and others, were more important to the participants. This program was intended for reducing stigma and silence, allowing depression to be talked about so that people can get the support and medical treatment they need.

Background Note on Risks and Benefits of Antidepressant Drugs

Coincidentally and not present at the New York public forum, the current issue of Nature Medicine published a news feature on antidepressant drugs (1). This article clearly explained a problem that has been in the news recently, that antidepressants can increase the suicide risk for children (and maybe adults). This problem, well known among psychiatrists but not always among general practitioners, is that patients with major depression often have suicidal impulses but are too depressed to act on them. But antidepressants cause different symptoms to lift at different rates. "The psychomotor retardation is the first thing to go, existential sadness is the last thing to go," so there is a critical risk period when people have the energy to act on their suicidal thoughts and feelings.

That article also noted that it is difficult to design antidepressant drugs because nobody knows what depression is or what causes it. Also, there is no animal model, as depression is seen as something that happens only to humans.

But it is now becoming well known in the medical world that depression can seriously increase progression of HIV and other diseases directly through biological mechanisms (not only indirectly, such as by interfering with medication adherence or social support). Chronic anxiety also appears to greatly increase disease progression, probably through different biochemical pathways. Medical care for these mental conditions may reduce progression (we do not have definitive data yet). AIDS Treatment News has described new scientific findings on depression and HIV progression twice in the past year. (2,3)

This matter has not had the attention it deserves, because of a philosophical bias in Western culture toward seeing the "mental" world as a ghostly reality separate from the physical body. In fact, depression and anxiety exist as biochemical changes in the body. It is no surprise that evolution could produce a level of anxiety that is unhealthy, because we needed fear to survive throughout human development. How the biochemistry of serious depression could be selected by evolution is much less clear, and a great diversity, of theories has been proposed.

The immediate concern is that mental health care is usually the first to go when funding for medical treatment is cut. Also, if we understood how depression and anxiety (the biochemical changes that are most easily recognized by their mental effects) act to speed disease progression, we might find new mechanisms for pharmaceutical intervention to slow disease development and increase overall health.

References

(1.) "Mood Swings," by A. Mandavilli. Nature Medicine. October 2004, volume 10, number 1-, pages 1210-1212.

(2.) "Chronically Depressed Women with HIV Almost Twice As Likely As Others to Die from AIDS-Related Causes; Those with Mental-Health Services Had Half the Death Rate of Those Without." by John S. James, http://www.aidsnews.org/2004:08/depressed-progreession.html.

(3.) "'Shy' Study Suggests New Treatment Mechanism," by John S. James. http://www.aidsnews.org/2003/12/Shy.html.