Reportedly the proportion of depressed women to men is the same. However the report rate for women is higher for various reasons. A primary factor in lower reporting for men is the social expectations that prohibit men from learning they even have a depressed condition. (A book I’ve read on the subject “I Don’t Want to Talk About It”, by Terrence Real.)

As a person who spent 27 years living with recurrent major depression (and not knowing it) anti-depressants are critical to my ability to sustain myself today.

These grand pundits spinning yarns about the effect of anti-depressants are obviously people who have not suffered with the burden of this invisible illness.

it’s sounds grate

Alex:
“I’m glad you found relief by taking an antidepressant, and I certainly wouldn’t advise you to stop.”

No, but you’d make it a felony to continue.

I’ve seen antidepressent drugs work in situations that nothing else would touch. And I’ve also seen SSRI users with no previous symptoms of _serious_ depression unexpectedly blow their brains out. The latter type of case invariably involved prescription of the drugs by a GP without either a psychiatric diagnosis or any treatment plan more comprehensive than “here, take these pills and you’ll probably feel better soon”.

Clarification:
I meant that it’s only a *quantitative* difference. There’s no real objective difference between “real” depression and just being in a bad mood.

Lisa,

I’m glad you found relief by taking an antidepressant, and I certainly wouldn’t advise you to stop.

However, I don’t think that it is humanly possible for someone to use introspection to discriminate between a drug’s direct, biochemical effect on the brain, versus an indirect (placebo) effect.  If this were possible, we wouldn’t need double-blind, placebo-controlled clinical studies.

(Incidentally, I never suggested toughing it out.  I suggested taking measures that I think would obviate the need for toughing it out.  Are these measures 100% successful?  Certainly not — but nothing is perfect.)

See also: "Most Patients Report Troublesome Side Effects, Modest Improvement Using Current Antidepression Treatments "

I’ve been on antidepressants for the past 4 months. What prompted the prescription was an acute anxiety attack ,,, while driving. In less than 5 minutes I found myself stumbling out of my Jeep, collapsing in the grass in front of a gas station, and turning from gray to blue. Since taking antidepressants I’ve only had a few minor episodes. Want to talk about a social good? How about antidepressants making the road just a little safer. An example falling into the rule of small numbers, I know. But it illustrates a point – if you’re going to be talking about a social good, you’d better have some experience to back up your opinion.

Matt wrote:
“There’s a significant and important qualitative difference between a debilitating psychiatric disorder like major depression or bipolar disorder, and a socially (or even personally) undesirable mood.”

Yes, but that’s all it is – a *qualitative* difference. Why should we draw a line where none exists?

Should mildly depressed people be told “Sorry, you’re not quite unhappy enough to warrant a drug. You’ll just have to tough it out”? Who gets to make this distinction? The government, I suppose?

Francis Fukuyama, in his book Our Posthuman Future, makes much the same point about the gender effects of antidepressant prescriptions — in fact, he goes one step further by saying (you’ll have to forgive the paraphrase, I can’t put my hand on my copy of the book) that SSRIs give women a neurotransmitter profile closer to a man’s, giving them some of that “alpha male feeling”, and that Ritalin prompts little boys to display behavior in school that’s more like that of little girls (attentive, cooperative); he suggests, wryly, that pharmacology is pointing us toward a unisex future.

Hi, Alex. I’ve read your comments on DB’s Medrants blog and found them interesting. I’m going to say something that isn’t exactly congruent with what you’re saying, but I recognize you as someone who plays fair in debate and wouldn’t strike back with something overly personal.

“Depressed people are unemployed or have dead-end jobs; they don’t get along with their loved ones; they don’t exercise; they live on junk-food; they’re deep in debt; they stay up late at night watching sit-com re-runs. Instead of taking measures to do something concrete and practical to improve their lives, these people look for a quick fix in the form of a little pastel capsule they take every morning.”

Um, this here doesn’t describe me. I’m happily married, I have two children I adore, before my children were born I had a remarkably successful career and now I am building my own business. For seven years I did not own a car and bicycled everywhere, and I participated in a 500 mile bicycle ride across the Rockies; I’m in excellent shape from biking and open-ocean kayaking. My diet is excellent. I don’t abuse drugs, alcohol, or smoke. I have friends and hobbies and I am a volunteer who visits the sick. I have a strong personal religious faith.

Yet, like other members of my family I suffer from periodic depressions. For over a decade I tried to “tough it out” doing the things you recommend, but I still suffered from deep periodic depressions. I didn’t like the idea of antidepressants either, but after my first child was born I read the research regarding cognitive outcomes for children of depressed mothers (not good). It was fine for me and my husband to decide to “tough it out,” but tiny children are just helpless passengers. I decided to swallow my pride and do _whatever it took_ to be the best possible parent I was capable of being.

I certainly take your point about depression being a disease in which behavior (and something you didn’t address, styles of thinking) plays a role, and I have by no means given up on all of the other things I do to both have a life that’s not depressing and to stay healthy. I find that the antidepressant I take helps me to be *able* to give my best effort towards helping myself. I agree with you that many people turn to antidepressants as a cure-all, and that that’s a bad thing. But that’s just not true of all people who take antidepressants. I think you have a good argument, and in a way, a good “sorting” program for those who need antidepressants and who doesn’t (eg, lifestyle modifications first!), but I do think some qualifiers are in order. Adding some “mosts” or “manys” to your statement would strengthen, not weaken, your argument.

Oh, one more thing:

I forgot to mention the single-most important common-sense measure to treat depression.

Substance-abuse is very common among depressed people.  If you abuse alcohol or drugs, nothing else you do will make any difference.  You must stop abusing chemicals if you want to feel better.

OK, I’ll shut up now.  Thanks.

Take More Vacations. Most Americans only have 2 weeks a year, as opposed to Europeans who have a minumum of double that(and often more) and aren’t a drugged up society. Could there be a relationship? I know it gets me down terribly is I go without a good break for too long.

And if it’s money you worry about: buy a European sized car and TV and prepare your food european style: fresh ingedients. (these also have other advantages than just saving money)

Maybe I am stereotypical here, but don’t blame me for starting it!