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Dragging us down: new studies suggest that you're not alone in your blues--in fact, gay people actually may be more prone to depression than heterosexuals. (Our health: depression & antidepressants aids activism and men of color gay & lesbian health books).

We're out. We're proud. We're on Prozac?

It's been nearly 30 years since the American Psychiatric Association ceased listing homosexuality as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders--saying that gay people are not mentally ill and are not more likely to have mental health problems.

Now part of that long-held position is being called into question. As a panel of researchers reported at the APA's annual meeting in San Francisco in May, the latest studies suggest that lesbian, gay, and bisexual adults appear to be more likely than heterosexual adults to experience depression and anxiety.

These studies, which are based on analyses of large national surveys, contradict years of previous research, which most often focused on subjects culled from gay pride events and through advertisements in the gay press.

The discrepancy stems, in part, from the different methodologies--both of which have their pluses and minuses, researchers say. The latest studies, analyzing the national health surveys, best represent the whole population. Still, the percentage of respondents who identify as gay or lesbian is relatively small. In one study, for example, only 74 of the 2,917 adults questioned identified as gay, lesbian, or bisexual.

In contrast, the earlier studies, which focused specifically on gay people, naturally have larger percentages of gay-identified participants. But because the subjects were recruited from gay pride events and through the gay media, they are less likely to represent the gay and lesbian population as a whole.

To be sure, not all gay people who are depressed say it's linked to their sexual orientation. In some instances depression can be biological. In other instances it can be situational--due to a breakup, an HIV diagnosis, or the unexpected pink slip. But researchers say it is also possible that these factors only compound the stress that gay people experience as members of a minority group.

"Minority stress is socially based and stems from an environment characterized by prejudice," says Ilan Meyer, an assistant professor of clinical sociomedical sciences at Columbia University. "It is experienced on top of the other stressors people have in their lives, and it can affect a person's mental health"--including their risk for depression.

The theory of minority stress could explain why recent studies have found higher rates of depression in bisexual men and women, who often feel isolated from both gay and straight populations. In addition, it underscores how being part of a supportive community can be critical for your mental health.

"Being part of an LGBT community may be protective against depression," says Esther Rothblum, a University of Vermont psychology professor. This might be one reason the studies conducted on people at pride parades--traditionally supportive events--did not find higher depression rates, she says.

Of course, even people who completely out can experience homophobia. And, according to Queer Blues: The Lesbian & Gay Guide to to overcoming Depression, up to 1.7 million gay men and lesbians suffer from depression. "I was running a support group for gay men with depression," say Braden Berkey, director of behavioral health services at Chicago's Howard Brown Boystown and worked in professions that were accepting of who they were. So in terms of minority stress, you wouldn't expect it to be there." But as the group continued to meet, he says, the conversations turned to the anger the participants had because of the restraints they felt as a result of their sexual oreintation.

Although antidepressants do help many people suffering from depression, some psychoteraphists are concerned that these new studies will cause some doctors to simply encourage their gay patients to "take a pill" rather than push for public policies targeted at reducing discrimination and minority stress.

"I think it is important for lesbians and gay men not to neglect the cultural context for how they feel," says Marny Hall, a San Francisco--based psychotherapist and coauthor of the book Queer Blues. "There is an over-emphasis on biology and on antidepressants that makes the problem become serotonin rather than homophobia."

The need to talk about homophobia will undoubtedly become even more important if researchers continue to find that gay people are at higher risk for depression. "GLBT psychologists have worked so hard to destigmatize and depathologize our orientations and gender expressions that it is hard to now turn it around and say, 'Yes, in and of itself, being lesbian or gay is not a pathological state--but the incidence of depression is higher in our populations,'" Berkey says. "But what we need to emphasize is that there is nothing inherent about being GLBT that makes you more likely to be mentally ill. It is something about being GLBT in our society."

Differences between drugs

The widespread use of drugs to treat depression has created a sometimes confusing array of options. According to Dan Karasic, MD, an associate clinical professor of psychiatry at the University of California, San Francisco, "All of the antidepressants have similar effectiveness for depressive disorders.

There isn't one clear drug for everyone to start on."

With that said, it is still important to understand the reasons for taking one class of drug over another. All have side effects, and it's best to ask your doctor about the particulars.

In general, selective serotonin reuptake inhibitors, such as Prozac, Zoloft, Celexa, Lexapro, and Paxil, have in recent years become the first line of defense against depression. SSRIs are considered safer than other drugs and work to alleviate both depression and anxiety. Prozac Weekly, in particular, stays in the body for a long time, requiring tess stringent dosing--once a week, as opposed to every day for Paxil or other dosages of Prozac. However, because SSRIs work by increasing serotonin levels in the brain, it can cause sexual side effects, causing some people to turn to different drugs.

Before SSRIs there were tricyclics, such as Elavil, Norpramin, Tofranil, Aventyl, and Surmentil. This class of medications has additional side effects and a higher risk of death from overdose. They're usually only prescribed when a patient isn't responding to SSRIs.

Individual alternatives to SSRIs and tricyclics include Effexor, Serzone, and Wellbutrin. Effexor is similar to an SSRI but also affects norepinephrine and serotonin levels in the brain. "There's a thought that since you're affecting a second [or third] neurotransmitter, it might work better," Karasic says. And while some doctors prescribe it first, he adds, many don't, because it exits the body quickly and requires a tougher dosing schedule.

Serzone has a very Iow rate of sexual dysfunction and it helps alleviate anxiety, Karasic says, but there have been a few cases of liver failure related to the drug. This causes most doctors to limit its use to those patients for whom nothing else works.

Wellbutrin affects norepinephrine levels but doesn't affect serotonin, so "it doesn't have the sexual side effects," Karasic says, "and people tend to use it for that reason." But it doesn't have antianxiety effects, he points out.

For those people looking for an herbal solution, Saint-John's-wort has shown promise in some people. But its overall effectiveness has not been very impressive, Karasic says, and it has been shown to react adversely with other medications, including protease inhibitors.--John Caldwell
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Article Details
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Author:Rochman, Sue
Publication:The Advocate (The national gay & lesbian newsmagazine)
Date:Jul 8, 2003
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