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SEEKING THE LIGHT PUBLIC AWARENESS OF DEPRESSION HAS REACHED A HIGH LEVEL, BUT MANY STILL LACK PROPER TREATMENT.

Byline: Evan Henerson Staff Writer

WHEN HE SET OUT to write what he calls the first comic novel on the subject of depression, Agoura Hills author/screenwriter John Blumenthal ran into a fundamental dilemma. Depression as a topic wasn't especially funny, a fact Blumenthal knew all too well.

If the travails of Martin Dorfman, the struggling screenwriter at the center of Blumenthal's ``What's Wrong With Dorfman'' seem especially real, it's probably because they're based on the author's own battle with depression - gallows humor and all. Dorfman doesn't know what ails him and the stumped medical industry submits him to every single indignity known to man before arriving at the diagnosis of depression.

``I'm a comedy writer, so, to me, everything's funny at the end of the day,'' says Blumenthal who co-wrote the films ``Blue Streak'' and ``Short Time.'' ``This was the only way I could think to treat it. It was therapeutic in a way, but I don't think I could have written this in the middle of depression. It's difficult to do anything when you're depressed.''

Anybody who has gone through a bad relationship, a career setback or a majorly rotten day would likely agree: No one is at his or her best when blue. And your ineffectiveness and feelings of despair will multiply, say doctors, when the chemicals in your brain - and not external circumstances - are consistently getting you down.

As easy as it may seem to be for people to admit to being depressed or pop a Prozac, depression remains a complicated, misunderstood disease that can be controlled but not cured. Depression keeps thousands of people out of work every year and drives others to despair or suicide. The stigma may be disappearing enough for famous people to admit to being depressed, but researchers say far too many people aren't getting the treatment they need.

People who suffer from severe and chronic forms of depression can't eat, sleep, work or accomplish anything productive. They take no pleasure in activities they normally find enjoyable. On especially bad days, many depressed people say, it's all a person can do to even get out of bed.

A study published last year in the Archives of General Psychiatry reported that 83 percent of adults with a probable depressive or anxiety disorder saw a health-care provider over a one-year period, but only 30 percent received appropriate medical treatment. The same study, conducted by researchers at UCLA, also found that appropriate treatment for depression was less likely for ethnic minorities than for whites.

The study tracked people who met the criteria for serious depression or anxiety, said Dr. Alexander Young, assistant professor of psychiatry at UCLA's Neuropsychiatric Institute. These were people, Young said, who were severely depressed and would likely benefit from counseling, medication or both.

``Without that kind of treatment, people can remain severely depressed for months or years,'' says Young, who is also the associate director of the Department of Veterans Affairs Mental Illness Research, Education and Clinical Center. ``They're unable to work, the suicide rate is high. It's important to distinguish severe depression from the more normal thing where people have grief or sadness and they work through it.''

The National Institute of Mental Health groups depression into the three most common forms: major depression, a disabling combination of symptoms that occur several times over a person's lifetime; dysthymia, a less-severe, also chronic form of depression; and bipolar disorder (also known as manic depression), which is marked by extreme cyclical mood swings. The National Depressive and Manic-Depressive Association estimates that 20 million American adults experience depression every day.

As prevalent as depression may be, the stigma attached to the condition now appears to be lessening. Author William Styron opened a door when he described the ``gray drizzle of horror'' linked to manic depression in his 1990 memoir, ``Darkness Visible.''

Other well-known people who have admitted to struggling with depression include humorist Art Buchwald, newsman Mike Wallace, Dick Cavett and actress/author Carrie Fisher. Talk-show personality Rosie O'Donnell triggered a veritable cascade of responses when she revealed she, too, was on medication for depression in the September issue of her then-new magazine, Rosie. O'Donnell also talked about the condition in a ``Good Morning America'' interview with Diane Sawyer.

In addition to O'Donnell's essay, the Rosie depression issue featured an interview with Rosemary Clooney and a conversation between O'Donnell and psychologist Martha Manning - herself a depression sufferer and the author of ``Undercurrents.''

In the first few days after the issue hit subscribers' mailboxes, the magazine's staff received 650 e-mails. By month's end, the total had reached 3,000 letters and e-mails, all from people who wanted to talk about depression.

``It was the biggest single response we received on any topic,'' said Catherine Cavender, the magazine's editor in chief. ``I've never seen a magazine devote this kind of coverage to this topic. We had a big cover line, 'The Face of Depression'; we put it out there front and center. Women recognized it and they bought it.''

They're buying the medication as well, particularly the new class of selective serotonin reuptake inhibitors, such as Prozac, Paxil, Zoloft and Luvox. The SSRIs are boasting fewer side effects than the monoamine oxidase inhibitors and tricyclic anti-depressants. Newer brands are hitting the market with increasing frequency to combat related conditions such as panic disorder, anxiety or obsessive-compulsive disorder.

Young maintains there is less of a stigma attached to medication than to therapy. For a condition like depression that isn't easily diagnosed, a doctor might have an easier time writing a prescription than getting an insurance company to accept a referral for a patient who appears physically healthy.

``If you went to a primary care physician and said, 'I've looked it up, I think I have major depression and I want some Prozac,' that's easy to prescribe,'' says Young. ``If you say, 'I think I have depression and I'd like to see a counselor or psychotherapist,' the access is not as good.

``There's counseling that works and counseling that doesn't, and you as a consumer can have a hard time knowing if the person you're seeing is doing the right thing or not,'' Young continued. ``A pill of Prozac is a pill of Prozac. With a pill, you can be pretty confident it's going to work the same way every time you use it.''

And if the popular yet ever-controversial Prozac - an SSRI first introduced in 1987 - is your treatment of choice, you might have something in common with a large portion of the depressed population.

Three years ago, when she wrote about depression for Psychology Today, journalist Hara Morano counted more than 100 books with the word Prozac in the title: from Peter Kramer's ``Listening to Prozac'' to Elizabeth Wurtzel's ``Prozac Nation.''

``You tell me another drug that can do that,'' says Morano, who now edits Psychology Today's depression-themed newsletter, ``Blues Buster.'' ``The movie of 'Prozac Nation' is about to come out, and that's going to put it front and center once again. Now with all of the people who have come forward, you're getting the literature of depression. It's having repercussions for a lot of different departments of the culture.''

But as trendy as Prozac or depression may seem to be, Morano cautions against people believing that the condition should be dismissed or ridiculed by late-night comedians.

``Don't belittle the real suffering of a lot of people just because it's become a 'fashionable diagnosis,' '' says Morano. ``There may be people who may be paying a little too much attention to every nuance and every blip of their mental existence, but most people aren't diagnosed. There's an awful lot of suffering. A lot of people kill themselves needlessly.''

``I can't say it's trendy. It's really quite horrible,'' agrees Blumenthal. ``You don't want to get out of bed, much less go to a party.''

A guide to psych meds

In its guide to medications for the treatment of mental health problems, the National Institute of Mental Health discusses anti-psychotic medications, anti-manic medications, anti-anxiety medications and antidepressants. All groups of medications are considered treatments, not cures, and the type of medication or dosage will vary greatly from person to person.

Anti-psychotic medications

To treat: A person who is out of touch with reality.

Some commonly prescribed medications: Haldol, Thorazine, Clozaril.

Possible side effects: Drowsiness, rapid heartbeat, weight gain, dizziness when changing position.

Anti-manic medications

To treat: A person with cyclical mood changes, extreme highs and lows characteristic of manic depression (bipolar disorder).

Some commonly prescribed medications: Lithium, Tegretol, Depakote.

Possible side effects: Drowsiness, weakness, nausea, fatigue, increased urination. Lithium is not recommended for people with existing thyroid, kidney or heart disorders, epilepsy or brain damage.

Anti-depressant medications

To treat: A person who continually suffers feelings of sadness, lack of interest, worthlessness and despair.

Tricyclic anti-depressants: Generally used to treat major depression.

Commonly prescribed medications: Elavil, Vivactil.

Possible side effects: Blurred vision, dry mouth, constipation, weight gain, fatigue, weakness, changes in sexual desire.

Monoamine oxidase inhibitors: Generally used to treat ``atypical'' depression, in which the symptoms include oversleeping, anxiety, panic attacks and phobias.

Commonly prescribed medications: Marplan, Nardil, Parnate.

Possible side effects: Dizziness when changing position, rapid heartbeat. MAOIs also react with certain foods and alcoholic beverages.

Selective seratonin reuptake inhibitors: Generally used to treat major depression and dysthymia.

Commonly prescribed medications: Prozac, Paxil, Zoloft, Luvox.

Possible side effects: Gastrointestinal problems, headaches, insomnia, anxiety and agitation.

Anti-anxiety medications

To treat: A person who suffers generalized anxiety, panic, phobia, obsessive-compulsive disorder or post-traumatic stress disorder.

Commonly prescribed medications: Xanax, Valium, Centrax, BuSpar, Librium.

Possible side effects: Drowsiness, loss of coordination, fatigue.

Source: National Institute of Medical Health

Are you depressed

Common symptoms of depression:

Prolonged sadness or unexplained crying spells

Significant changes in appetite and sleep patterns

Irritability, anger, worry, agitation, anxiety

Pessimism, indifference

Loss of energy, persistent lethargy

Feelings of guilt, worthlessness

Inability to concentrate, indecisiveness

Inability to take pleasure in former interests, social withdrawal

Unexplained aches and pains

Recurring thoughts of death or suicide

Source: National Depressive and Manic-Depressive Association.

CAPTION(S):

4 photos, 2 boxes

Photo:

(1 -- cover -- color) am i blue?

Although its stigma is fading, depression remains an elusive, confounding disease

Jorge Irribarren/Staff Artist

(2 -- 4) no caption (pills)

Box:

(1) A guide to psych meds (see text)

(2) Are you depressed? (see text)
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Publication:Daily News (Los Angeles, CA)
Date:Mar 4, 2002
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