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More Than Blue

Finding the Right Treatment

"The sooner a woman gets help, the better her prognosis, whether her treatment is based upon psychotherapy, medication, or both," says Lee Cohen, M.D., director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital, in Boston. "Too often, women come to us with severe depression because of a delay in seeking help."

Even among those who do make it to his office, Dr. Cohen sees resistance รณ sometimes not from the patient but from her husband or another family member. "It's important in these cases that loved ones realize depression is a true illness, like anemia or hypertension. Would they refuse or delay treatment for one of those conditions?"

Thanks to a variety of antidepressant medications, doctors now speak confidently about the treatability of the illness. Though the picture is far from complete, it appears that many depressed people have either a deficiency or a surplus of certain neurotransmitters in the brain. Most modern antidepressants, such as Prozac and Zoloft, work by altering such imbalances in brain chemistry; they're not "happy pills" that impose a false sense of well-being. As for whether it's safe to take antidepressants while nursing, the issue can't be resolved with controlled studies; it isn't considered ethical to include pregnant or nursing mothers in such research. But accumulated data (based on doctors' observations in their own practices) suggest that modern antidepressant medications have no ill effects on a fetus or a breastfed infant. An increasing number of physicians, therefore, allow women to remain on or start medication if their depression is serious enough to pose a significant risk to them and their babies. Doctors have yet to determine whether these drugs affect a child's later years. Research has shown that for mild to moderate depression, psychotherapy is sometimes helpful, with or without medication.

The growing consensus is that depression is treatable and that treatment is successful 85 to 95 percent of the time. Because of insurance restrictions, however, diagnosis has fallen largely into the hands of primary care physicians, who now dispense most prescriptions for antidepressants; many patients are leery of mentioning mood problems to a doctor they assume treats only their body.

Women who see only an ob-gyn on a regular basis may be even more reluctant to bring up psychological problems. But Frank W. Ling, M.D., chairman of the department of obstetrics and gynecology at the University of Tennessee, in Memphis, says that ob-gyns are becoming better equipped to treat depression: "A generation back, mental health issues were rarely discussed in my field, but now we're teaching residents to focus on total health."

How can you tell if your own doctor knows enough about depression to help you? First, says Ann Dunnewold, a psychologist in Dallas, be sure the reaction to your concerns is balanced. "If you go to him with a serious problem and he says, 'Oh, you're just stressed out; what you need is a night out with your husband,' he's minimizing the problem. Nor do you want someone who's just going to hand you a prescription on the spot." A quick way to figure out if your doctor is listening to you and giving correct information is to ask what diagnosis he's exploring, suggests Dr. Kelsey. "You want to hear something specific, such as 'depression' or 'dysthymia,' not an ambiguous term like 'stress' or 'nerves.'" If he doesn't think you're suffering from depression, he should be able to give reasons for his conclusion.

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