7 Things You Can Do Immediately To Ease Depression

1. Get out now and walk fifteen minutes. It will get your feet moving and help you feel you are at least able to do something.

2. Go immediately and be with someone who loves you. It will give you the feeling that you are wanted.

3. Religious? Say a prayer. Ask God to help you get through this.

4. Think of a situation, a place where you were very happy. Visualize yourself in that situation once more.

5. Power of suggestion can do wonders. Say to yourself, "I think I can get better. I have to take it step by step. I will work my way out of this."

6. Go out and buy a plant, or some flowers. Having something living in your house makes you feel more alive.

7. If possible, get outside in the sunshine. If it's not possible, turn on some bright lights. Sunshine and bright light are known to make people happier.

Copyright 2004 Sharon Schurman

5 Tips to Reduce Depression

While war and poor economic conditions begin to affect people all over the world, more and more people suffer with depression. The more we focus on news events and the business climate, the more we are depressed. Whatever the reason you feel is the cause of your depression, the following five simple tips guarantee you reduce it significantly.

1. Do not read newspapers.

Newspapers publish negative stories most of the time. Even in peaceful periods, newspapers will find the worst in humanity and place negative stories on display in order to promote sales and subscribers. Stories focused on War, rebellion, death, destruction, doom and despair abound in the newspapers.

You will not miss any news. Friends, family, and your local air raid siren will keep you informed if your attention is needed. Only pay attention to the things you can control in your life.

Stop reading the newspaper and reduce the negative input to your brain.

2. Turn off your television.

Watching and listening about the horrible economy and the losses associated with War will add to depression. In fact, you guarantee the feeling of helplessness. Helplessness allows depression to nurture. If you really need to watch or listen to these kinds of news stories, promise yourself you will bury yourself in the documentaries that are sure to follow in the next 5 or 10 years. A way you can eliminate most of the negative input to your brain is by setting it aside for a date somewhere in the future. I guarantee in the future, you will not find it very interesting.

When visitors come to your home, make sure you turn off your television and keep it off. News television broadcasters are fighting for your guests' attention as they promote despair, war, death, and destruction with many headline news interruptions. Those little banners that run across the bottom of the screen achieve your attention and they take hold of your consciousness. Television will diminish your positive spirit.

3. Say good things about others

My Mother always says, "if you can't say anything nice about others, don't say anything at all." However, when you find yourself in a conversation and a relative says, "Remember Uncle Phil?" " He was an alcoholic" Respond with " yes, Uncle Phil was an alcoholic and he was the most charitable person, I have ever met."

Connect your friend's negative statement about Phil with a positive one. Set yourself up to find the positive in anyone's statement and you will keep negative thoughts and depression from overtaking your life.

Og Mandino, a great motivator once said, "treat everyone you meet as if they were going to be dead by midnight." "Your life will never be the same again."

4. Get physical exercise

Adults forget about exercise when suffering from depression. Make sure you are exercising daily and sending more oxygen to your brain cells. The result of exercise will improve your health as well as your attitude.

5. Breathe deep and relax.

Practice the following breathing exercise to relax your body and mind.

Breathe deeply and relax. For 2 or 3 minutes each hour, take a short mental vacation.

You can engage in this exercise while you are standing in the checkout line at the supermarket or when listening to others while talking on a telephone. You can complete the exercise at home or at work.

Take three deep breathes and relax. As you inhale, concentrate on calm and peaceful thoughts. You may think about relaxing by a mountain, by the ocean or comfortably in your favorite room at home.

As you exhale, concentrate on pushing any tension out of your lungs.

Focus on positive images in your life. Focus on laughter, love, excitement, and hope.

Keep breathing in and out in this pattern until you feel better. If you practice the exercise often, you will notice wonderful changes in your outlook and in other aspects of your life.

Reduce your depression now! Enjoy your family, your friends, and your life.

--Wayne F. Perkins

ADHD and Depression -- More Common Than Thought

"Thanks for Noticin' Me" says Eeyore. He walks slowly. He looks sad. He doesn't accomplish much. He's just glad to be noticed. This is Eeyore, the stuffed donkey who is so often in need of his tail being pinned back on.

Eeyore is a good picture of life is like for those who are impacted by the type of ADHD that includes sadness, or depression. It is estimated that as many as 25% of all those with ADHD have to battle depression as well. This type of ADHD is called "Limbic System ADHD" by Daniel Amen, and for good reason. SPECT scans show that when the brain is at rest, there is increased activity deep in the limbic system, in parts of the brain called the thalamus and hypothalamus. There is also a decreased level of activity in the underside of the pre-frontal cortex.

When the brain is placed under a work load, as during a homework assignment, we would expect the under-active pre-frontal cortex to increase activity and get to work. But instead, nothing changes. The over-active limbic system remains over-active, and the under-active pre-frontal cortex remains under-active.

Those with this type, or style of ADHD are often very inattentive to details, and are easily distracted by unimportant things. They have a chronic sadness or low-grade depression to deal with every day. They seem to be negative, or apathetic, and have low energy levels. They just do not seem to care. They often feel worthless, or helpless, or hopeless. As you can see this type of ADHD looks very much like a combination of ADHD and Depression.

Our specific treatment strategy for Limbic System, or Eeyore style ADHD, begins with our recommended Eating Program. In addition, experts recommend DL-Phenylalyne (up to 600 mg per day for adults), 5-HTP, and B Vitamins and St. John's Wort (up to 600 mg per day for adults).

We think that best way to approach this problem is by using the nutraceutical medicines Attend, Extress, and Deprex, which are available over the counter. The Attend contains over 70 ingredients, including GABA, DL-Phenylalyne, Ginko, Pycnogenol and Grape Seed Extracts, 5-HTP, pregnenolone, DMAE, and more. The Extress contains GABA, DL-PA, 5-HTP, and St. John's Wort. Deprex contains more GABA, and just 2 capsules of DEPREX contain 320 mg of St. John's Wort and 420 mg of DL-Phenylalyne. When combined in a targeted treatment strategy like this, the individual with limbic ADHD can expect to see improved and stabilized moods, improved concentration, and improved memory.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

New Treatment for Chronic Depression

Vagus Nerve Stimulation for Chronic Treatment-Resistant Depression

About Vagus Nerve Stimulation

VNS is not brain surgery, although it is a treatment that affects the function of the brain. Vagus Nerve Stimulation uses specific stimulation of the vagus nerve to send stimulation to specific parts of the brain that are involved in mood. It is not like Electro-Convulsive Therapy (ECT), a treatment that involves stimulation of the entire brain and induces convulsions in patients. In fact, patients may not even feel the stimulation from VNS since the vagus nerve does not have the type of nerves that carry pain signals. Nor does VNS interfere with drugs, and patients having Vagus Nerve Stimulation can continue taking their other drugs without worrying about side effects or interactions between drugs.

On June 15th, the FDA's Neurological Advisory Panel recommended APPROVAL of the vagus nerve stimulator as a treatment for chronic depression.

What is the Vagus Nerve ?

Vagus means "wandering" in Latin, and is the perfect description for the vagus nerve, the longest nerve in the body. It averages almost two feet in length and "wanders" throughout the upper body. The vagus nerve starts in the brain, goes down the neck and into the body where if affects the vocal cords, the acid content of the stomach, the heart, the lungs, and other organs. In the brain it projects to areas believed to be responsible for seizures, mood, appetite, memory and anxiety (note 3). However, the vagus nerve cord does not have many pain nerves, so stimulation of the vagus nerve is not painful, although some patients may feel some sensation when electrical pulses are generated.

The History of Vagus Nerve Stimulation
Vagus Nerve Stimulation has been used to treat epilepsy patients for years; the first human clinical trial was in 1988,(note 1) and the FDA approved VNS therapy for epilepsy in 1997 (note 2). So far over 22,000 people worldwide have had VNS therapy (note 3), and it has proven to be a safe and effective treatment for epilepsy. These patients have reported minimal side effects, which have tended to decrease over time. The efficacy of the treatment has also been shown to increase with longer treatment time (note 1).

When Vagus Nerve Stimulation was first approved for epilepsy, some patients reported an improvement in mood. Researchers decided to design a study specifically to measure changes in a patient's mood and depression due to stimulation of the vagus nerve. In 1999, scientists began the first open label (no placebo group) study for depression with 60 patients. This first study found that there was indeed an improvement in mood for depressed patients. Based on this study, a more detailed and thorough study was designed to determine if Vagus Nerve Stimulation would be a safe, tolerable and effective treatment for chronic depression.

The recently completed one-year, double blind, placebo controlled trial had 235 patients from 21 participating hospitals in the United States, and showed clinically significant improvements due to treatment compared to baseline (note 2). The acute (short-term) phase lasted three months, during which half of the patients received stimulation (treatment group) and half did not (control group). The long-term phase of the study lasted an additional 9 months (for one year total treatment) of stimulation. The HRSD-24 (24 item clinician-rated Hamilton Rating Scale for Depression) improvements observed over the first year were highly significant. The results of this long-term, pivotal study were submitted to FDA in October 2003; the FDA's decision on the use of Vagus Nerve Stimulation for depression is not anticipated before October 2004 (note 2). Of note, Vagus Nerve Stimulation therapy was approved for use in patients with treatment resistant depression in the European Union in March 2001, and in Canada in April 2001 (note 2) .

How Does Vagus Nerve Stimulation Therapy work ?

The Pulse Generator (battery) delivers a small amount of electrical current to the vagus nerve intermittently (30 seconds on and five minutes off ) (note 3) 24 hours a day, 7 days a week for up to 10 years. The stimulation is delivered automatically, so the patient does not have to do anything. Because there is nothing to remember, compliance is assured. The stimulation is not supposed to be uncomfortable, and some patients do not even feel the stimulation. A nurse at the doctor's office can adjust the level of stimulation (amount of electricity delivered) if the patient ever feels uncomfortable. In the study currently being reviewed by the FDA, researchers noted several similarities between epileptic and depressed patients (note 4).

One of the most important similarities is that Vagus Nerve Stimulation treatment efficacy improves over time. The longer the patient receives stimulation, the better the results. In addition, both populations of patients share the following:

· Assured adherence to treatment regimen
· Safety of the procedure
· Safety of the therapy
· High continuation rates
· No drug interactions

What is the surgery like?

Vagus Nerve Stimulation is NOT brain surgery, even though it is an invasive surgical procedure that changes the function of the brain. The stimulator is a pacemaker-like device that generates electrical pulses (Pulse Generator); it is implanted under the skin in the left chest through a small incision. While this may sound like a serious or dangerous procedure, it is not. The FDA has approved the use, and confirmed the safety of this procedure, and 22,000 patients have received the implant to treat epilepsy. The Vagus Nerve Stimulation surgery involves two small incisions, one in the chest and one at the lowest part of the neck. At no time is the brain physically manipulated by the surgeon.

The surgery to implant the NCP System takes 45 minutes to two hours. Local, regional or general anesthesia (putting the patient to sleep) is used during the surgery; the doctor and anesthetist determine which type of anesthesia is best for each patient. Most Vagus Nerve Stimulation patients will have outpatient surgery, (note 3) but some patients may need to stay in the hospital overnight, and in that case they will need a family member or companion to take them home from the hospital.

What Happens After the Vagus Nerve Stimulation Surgery?

Most Vagus Nerve Stimulation patients go home the same day or the next day. You will feel some minor stiffness/soreness around the area of the implant for a few days. Your doctor may prescribe a minor pain medication such as Tylenol with codeine. A week later your surgeon will probably want to check the scars and a nurse can program/change the settings on the stimulator in the doctor's office.

Is the Vagus Nerve Stimulation Surgery final?

The Vagus Nerve Stimulator can be turned off or removed (explanted) at any time if the patient feels that it is not helping, or in the unlikely event that the patient can't tolerate the stimulation. The device can be completely turned off in less than 30 seconds in the doctor's office, all it takes is for a nurse to hold a programmable wand over the skin above the Pulse Generator. Explantation (removal) of the Vagus Nerve Stimulation device is also possible, however, less than one half of one percent of the 22,000 patients have elected to have the device removed. As for implantation, the surgery to remove the device is a very simple procedure. Only the Pulse Generator is taken out of the body; attempting to remove the electrode from around the vagus nerve could cause damage, and is not recommended.

References

1. Pharmacoresistant Epilepsy and VNS Therapy. September 24, 2003 presentation by J.W. Wheless, MD. The University of Texas Health Science Center, Houston TX, USA.

2. Form 10-Q for Cyberonics Inc, September 4, 2003.

3. Vagus Nerve Stimulation Therapy Mechanisms of Action. September 24, 2003 presentation by M.S. George, MD. Medical University of South Carolina, Charleston, SC, USA.

4. The Investigation of Vagus Nerve Stimulation Therapy in Treatment-Resistant Depression. September 24, 2003 presentation by R.L. Rudolph, MD. Cyberonics, Inc.

by Charles Donovan

Chronic Fatigue Syndrome And Depression Are Not The Same Thing!

Chronic Fatigue Syndrome is a very misunderstood illness and this is perhaps why there are so many myths about it. Perhaps the most common myth about Chronic Fatigue Syndrome is that it is effectively a mental condition, and another name for depression.

But these two conditions are very different!

And when you label a condition incorrectly it can cause no end of problems when trying to diagnose and treat it. So it's extremely important to make the distinction between Chronic Fatigue Syndrome and depression - because they are completely different illnesses.

For one, depression can be a symptom of Chronic Fatigue Syndrome, but there are many Chronic Fatigue Syndrome sufferers out there who do not suffer from depression at all.

Second, research has shown that Chronic Fatigue Syndrome sufferers have an abnormality in their 'deep sleep' brainwave patterns. In contrast, depression sufferers do not have this abnormality.

In addition, depression sufferers tend to feel tired all the time, whereas Chronic Fatigue Syndrome sufferers' exhaustion increases notably after mental or physical exertion.

There are also symptoms of Chronic Fatigue Syndrome that are not shared by depression sufferers. Nasty flu-like symptoms, headaches, reversal of sleeping patterns, painful muscles and joints, Restless Legs Syndrome, and an increase in colds and viruses all are just a few symptoms that can play a part in Chronic Fatigue Syndrome.

These are just a few of the differences between Chronic Fatigue Syndrome and depression!

Another myth about Chronic Fatigue Syndrome is that all Chronic Fatigue Syndrome sufferers need to do is to 'pull themselves together' - and they'd be cured...

... if only it were that simple!

Chronic Fatigue Syndrome is actually a bio-physical condition and was (finally) accepted as such by the UK government in 2001. But no cure has yet been found.

Unfortunately there are still many people out there (including some medical professionals) who still think that the condition is 'all in the sufferer's head'.

It is because of this misunderstanding that the Chronic Fatigue Syndrome community has fought so hard against Chronic Fatigue Syndrome being wrongly labelled as a mental illness. And it is perhaps because of this battle that depression amongst Chronic Fatigue Syndrome sufferers has often sadly been overlooked...

Yet for many, depression can be a very real symptom of Chronic Fatigue Syndrome. If you suffer from depression as a Chronic Fatigue Syndrome sufferer, then it's vital that you take it very seriously and that you try to address it as soon as possible.

If you don't deal with your depression, you are unlikely to be able to recover from any chronic illness...

...and recovering from Chronic Fatigue Syndrome is no exception.

It is possible to recover from Chronic Fatigue Syndrome. So if you do experience depression as a symptom of your Chronic Fatigue Syndrome, make it a priority to deal with it. Only that way can you get yourself on the road to recovery.

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** Reprinting of the article above is welcome! **

The article above may be freely reproduced provided that: (1) you include the following resource box; and (2) you only mail to a 100% opt-in list.

Here's the resource box to use if reprinting the article above:

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Claire Williams is editor of sleepydust.net and has suffered from Post Viral Fatigue Syndrome/ Chronic Fatigue Syndrome since 1995.

She created 'sleepydust.net' to help Chronic Fatigue Syndrome and Fibromyalgia sufferers to deal with the condition - from handling their money worries, to recovering from their illness....

http://www.sleepydust.net

Depression in Teenagers: Now What Can We Do?

No doubt you have seen the recent news headlines about a federal panel that recommended to the FDA that anti-depressant medications carry the strongest possible warning label for use in children and teenagers. This recommendation to the FDA shook the medical community, especially those who work with depressed young people. The biggest problem from the treatment community's point of view was not the recommendation for the warning label, but the way that the media protrayed the panel's recommendation.

The panel reported that 2% to 4% of children and teens who were given anti-depressants for the treatment of depression became suicidal, that is they had suicidal thoughts, or made suicidal attempts of one kind or another. None of the 4,000 children and teens studied committed suicide.

What the media did not report well is the fact that 15% of children and teens with depression who receive no treatment will commit suicide. These 15% will not just think about it, but will actually kill themselves.

So what are we to do? If the media had their way it seems that no teens with depression would receive anti-depressants. As a result the suicide rate for those who could be using the medication would rise from nearly zero percent to about fifteen percent. But at least we wouldn't have to be concerned about evil medications.

Look, I understand that there actually are young people, even adults, who have become suicidal only after beginning treatment with an anti-depressant. Some have in fact gone on to take their own lives. This is absolutely tragic. But so is the fact that untreated depression is potentially a fatal disease. Fifteen out of one hundred young people with depression take their own lives. They should be allowed to receive a treatment that will lower the suicide rate dramatically, and without any stigma attached to it by the media.

Recently we had a patient brought to our counseling center named John (not his real name). John was rebellious, angry, withdrawn, and in trouble often, and yet he was diagnosed and treated for depression.

When we think of someone who is depressed, we usually picture a sad, tearful, lonesome person. But teenagers with depression don't look like adults with depression. Current studies show that there are about as many teenagers who are depressed as there are adults that are depressed. However, depression is exhibited far differently by teenagers than by adults. Teenagers do not commonly display gloom, self-depreciation, or talk about feeling hopeless like adults do.

Teenagers with Major Depression are described in diagnostic manuals as often becoming negative and antisocial. Feelings of wanting to leave home, or of not being understoodand approved of increase. The teen often changes, and becomes more restless, grouchy, or aggressive. A reluctance to cooperate in family ventures, and withdrawal from social activities, with retreat to one's room are frequent. School difficulties are likely as concentration is affected. Sometimes there is inattention to personal appearance and increased emotionality. Often there is an increased sensitivity to rejection in love relationships as well.

Teenage boys will often become aggressive, agitated, and get into trouble at home, at school, or with the law. Teenage girls will sometimes become preoccupied with themes of death or dying, and become decreasing concerned about how they look. Suicidal thoughts are common. Some studies suggest that 500,000 teens attempt suicide each year, and 5000 are successful. Increased use of alcohol or other drugs is common, along with other forms of "self-destructive behaviors." Poor self-esteem is common with teenagers, but especially with those who are depressed.

Parents are often confused and frustrated when their teens begin to act like this. Sometimes parents become stern disciplinarians, or even put the teen down, which only serves to increase feelings of guilt and depression. Other times, parents feel helpless, and stand by waiting for adulthood to arrive. Of course neither course is the right one to take. If you know of a teen whose behaviors have changed to look like what has been described above, let the parents know that there is help available, and encourage the family to seek help from a professional. With proper diagnosis and treatment a depressed teen, or adult, can be greatly helped.

If someone close to you is suffering from depression, first please understand that depression is a very emotionally painful condition. For some people with depression it turns into a "terminal illness" due to suicide. Please take the situation seriously.

1) Get a medical evaluation. Symptoms of depression can be the result of a wide assortment of illnesses, including thyroid problems, viral infections, and other factors.

2) Deprex is an amino acid and homeopathic medicine for the treatment of depression that we have seen work well with our patients. It may be worth trying as long as the situation is "stable" and there is no suicidal thinking on the part of the depressed person.

3) Medications such as Prozac can be very helpful for more difficult cases. Consult your doctor. These medications are often prescribed by Family Practice Doctors, but in most cases ought to be monitored by Psychiatrists.

4) Increase intake of Protein somewhat. Use a protein powder supplement, just like a weight lifter.

5) Exercise daily. Just get out and walk for about 15 minutes.

6) Seek out counseling from someone who is good at treating depression. This can do a world of good for you. However, always use great wisdom and common sense when choosing a therapist. Some are good, and some are not, so choose wisely.

by Douglas Cowan, Psy.D.,

The Patients Guide to Vagus Nerve Stimulation and Depression

INTRODUCTION

Everybody has a story. My story is the one I know best and can write about. It is not a memoir of chemical dependency or self-abuse. Those subjects have been written about many times. This is a story of my winning battle against depression and the vagus nerve stimulation treatment that saved my life by bringing me Out of the Black Hole. And, this is the first book to be published about winning the battle with a medical implant procedure called VNS Therapy?.

Personally, I don't believe the stigma associated with depression has changed one bit in the past century, so I was apprehensive about sharing my story. After all, I had spent the majority of my life hiding my depression from family, friends, and business associates--and now I was writing a tell-all book.

I wrote the main part of this book as if I were having a conversation with my closest friend who was looking for guidance with his or her debilitating chronic depression. I discuss the misery I experienced, the seemingly unending search for answers, the vagus nerve implant procedure itself, and my subsequent recovery from the grip of depression. The last part, the appendices, contains technical information about depression; the VNS Therapy System?; and Cyberonics, the manufacturer of the vagus nerve stimulator.
I hope my journey and the treatment I chose helps readers with their depression treatment plans; especially when they consider whether or not to undergo vagus nerve stimulation therapy. When I decided to participate in the investigational trial there wasn't any information available to me. I just signed an eleven-page consent agreement and hoped for the best.

On June 15, 2004, the FDA's Medical Device Advisory Panel recommended approval of vagus nerve stimulation as an adjunctive long-term treatment for chronic depression. Cyberonics, the manufacturer of the VNS Therapy System?, is in the process of providing the FDA additional information required for the FDA to render a final decision consistent with the Panel's recommendation. Currently VNS Therapy for the treatment of chronic depression is available in Canada and Europe.

I also wrote Out of the Black Hole: The Patient's Guide to Vagus Nerve Stimulation and Depression for the loved ones of people who suffer from depression. When a patient reaches the severe, chronic level of this disease, often it is their family members who are making the medical decisions. At the other extreme, the family members may be in the dark about what is going on between the doctor and the patient, or they don't trust the information that they're receiving from their loved ones. One thing is for certain, the lack of knowledge about this disease and not knowing the best way to help and interact with the suffering loved one complicates everything.
.

I have been fortunate throughout my life because I have always had access to the best medical care available (for any illness), and I have a close and supportive family. I don't know how people survive severe depression if they don't have access to good doctors, the latest pharmaceutical drugs, psychologists, psychiatrists, and a strong support group. Many depressed patients have none of the above, yet they still endure. Their stories, in many ways, are more remarkable than mine.

Senator Hillary Rodham Clinton wrote a book titledIt Takes a Village. It's about how we can shape our society into the kind of village that enables children to grow into able, caring, resilient adults; physically, intellectually, emotionally, and spiritually. If my family wrote a similar book about the past ten years of my life, it would be titled It Took Heaven and Earth. So, I've also written this book for them. Let's get started.

Chronic Depression: Disease or Charcter Flaw?

A major survey on depression symptoms from the National Mental Health Association (NMHA), released in july 2001, revealed a dramatic degree of progress in public understanding. Yet even amid this promising trend, the survey sheds light on the difficulties faced by millions of people striving to manage this sometimes chronic, life-long illness.

The NMHA survey shows a major shift in public opinion in the last decade about the cause of depression. A majority (55 percent) of those polled who have never been diagnosed with depression symptoms understand depression is a disease, and not "a state of mind that a person can snap out of." In 1991, only 38 percent recognized depression as an illness.

The survey also sketches a troubling portrait of the socio-economic lives of some people with depression symptoms. Survey respondents with depression symptoms reported higher levels of unemployment and divorce than respondents who don't have the disorder.

"We set out to get a snapshot of the state of depression and its treatment," said Michael M. Faenza, president and CEO of the NMHA. "The good news is that there is greater public understanding of depression and that people living with depression are finding substantial relief by following their treatment plans. The challenging part is understanding the degree to which public perceptions impact those in treatment," said Faenza.

In this year's survey, nearly one in three Americans say they believe depression symptoms is a state of mind. "Fifty-five percent understand the truth about depression. That is good, but it is not enough," said Faenza. "You'd never hear 31 percent of the population deny that diabetes and heart disease are real. Erroneous beliefs about depression fuel stigma, bad public policies and poor personal choices by those living with the illness and may impede their recovery."

The survey also describes a strong correlation between clinical depression symptoms and diminished social and economic circumstances for families. Survey respondents with depression report greater rates of divorce and unemployment than the general public. What's more, respondents who have experienced multiple depressive episodes are even more likely to be divorced or unemployed. They also are more likely to have lower income and educational levels. The NMHA survey, conducted by Public Opinion Strategies LLC, comprised interviews with 500 adults currently being treated for depression, 300 primary care physicians, psychiatrists and psychologists and 800 members of the general public.

Gap Between Knowledge and Behavior

Survey respondents who are living with depression symptoms overwhelmingly feel that treatment, including medication, psychotherapy or both, works. (Their average self-rated symptom severity dropped from 8.5 before treatment to 3.6 within six to 12 months after starting treatment, using a severity scale of one to 10, with 10 being the most severe.)

Yet people are finding that staying with treatment is hard work. While they seem to understand the value of long-term treatment (in fact, most respondents believe that adhering to treatment is not difficult) nearly one-third (29 percent) of people on antidepressants report skipping doses during the week and nearly one-fourth (24 percent) have difficulty attending regular psychotherapy sessions. However, physicians and psychiatrists surveyed believe adherence is much lower than people in treatment profess. Almost 40 percent of doctors believe those they treat have difficulty staying with their medication regimens (a number consistent with most studies), and half (52 percent) say those they treat have difficulty staying with their psychotherapy regimens.

The survey suggests many reasons why some people don't stick with treatment. In addition to struggling with the nature and demands of the depression symptoms, they may find the requirements of long-term vigilance overwhelming. A majority of doctors (70 percent) say those they treat for depression symptoms might find adherence easier if they could take medication less often. But medication is not the only issue. Though people with depression symptoms believe diet and exercise to be beneficial to long-term wellness, they nevertheless report not adhering with these regimens either.

"The survey clearly shows that the fewer episodes of depression people reported, the more likely they were to have stayed with treatment, whatever that treatment may be," said Faenza. "Facing up to this illness and taking personal responsibility for its treatment are vital. Yet some may not acknowledge and seek treatment for depression because of negative public attitudes and misperceptions."

In fact, even as people with depression symptoms struggle with the illness itself, they also seem to be searching to determine their best course of treatment, how long they should stay in treatment, what they might expect from treatment and whether they will ultimately recover. As a result, more people are employing a combination of techniques to get and stay well.

Perceptions Diverge

Public perceptions about depression symptoms often diverge significantly from the perceptions of people in treatment and may discourage them from seeking effective therapeutic approaches. For example, the survey results showed that the general public ranks regular exercise, a healthy diet and psychotherapy higher than medication for effectiveness in warding off future episodes of depression symptoms. In contrast, doctors and people in long-term treatment rate staying on medication as the most effective way to prevent a relapse, even as they seek the right mix of psychotherapy and lifestyle choices.

Perceptions also diverge when it comes to understanding what treatment can deliver. Thirty-five percent of the general public believe that a person can be cured completely of depression symptoms, a belief held by only 12 percent of people in long-term treatment for the illness. It is likely that many in this group are struggling to achieve realistic expectations for treatment because the majority of subjects in the survey sample are in long-term treatment for multiple episodes of depression symptoms.

About half of those who experience depression symptoms will never have another episode; half will. The findings suggest that people treated for clinical depression symptoms understand the frequently episodic nature of this common illness. More than three-quarters (76 percent) believe that they will need some type of treatment for the rest of their lives, and most understand that their treatment will control, but not necessarily cure, their depression symptoms. However, even as more people come to terms with the long-term demands of depression symptoms, too many still find it difficult to make a treatment plan work for them. "The upshot is that people living with depression conduct highly individualized searches for the right mix of therapies-medical, psychological or lifestyle. The last thing they need is for stigma or public misperceptions to diminish their efforts," said Faenza.

Source : National Mental Health Association, July 11, 2001

Charles Donovan is a study patient in the investigational trial for vagus nerve stimulation and chronic depression. He testified at the FDA Panel Meeting on June 15th and is the author of the upcoming book: Out of the Black Hole: The Patient's Guide to Vagus Nerve Stimulation and Depression.