Examining the broad reach of depression

It's an affliction that seems to resist the rejuvenating power of Spring. Whether depression can resist the advances of modern medicine is the subject of our Cover Story reported now by Susan Spencer of "48 Hours":

Here's something depressing: The Centers for Disease Control says roughly one in 10 Americans is depressed - the Land of Opportunity apparently offering a lot of opportunity for misery.

"It really started to take hold for me in my 40s, and I would have these depressive episodes," said novelist Louis Bayard. "In the middle of the Starbucks line, I would just, like, start welling up with tears. So that this was happening was very strange to me and I couldn't figure it out."

Bayard had no obvious reason to cry; in fact, he seemed to have every reason in the world to be happy:

"I was living a really good life by my standards," he told Spencer. "I was doing the work I wanted to do. I had people to love. I had a nice house. I had all the sort of markers of happiness, right? And it still wasn't sinking in."

Depression has been recognized as a medical disorder since as early as medicine started, said, Jerome Wakefield, a professor at the New York University School of Social Work.

"Basically for 2,500 years there is a tradition in which people have recognized that at times something goes wrong with people's ability to process loss, or it goes wrong where they're just generating sadness in an unstoppable fashion that immobilizes them," said Wakefield.

Dr. Richard Friedman describes some of the problems that can arise: "People have trouble falling asleep, or staying asleep. They have a change in their appetite. Their energy level's low. They start to have a lot of negative thoughts about themselves.

"It's like wearing a dark pair of glasses," says Richard Friedman, a psychiatrist at New York's Weill-Cornell Medical College - and more and more people are seeing the world through those glasses.

"The rates of depression have been going up over the last several decades, in most industrialized nations," Dr. Friedman told Spencer.

Depression rates in the U.S. have roughly tripled over two decades, according to several studies. In America that represents 27 million people.

Several studies claim rates of depression are three times today what they were just two decades ago. But as usual in this complicated field, not everyone agrees. Professor Wakefield says there is no real spike is in depression - just a spike in diagnosing it.

"What's happened is that the definition of depressive disorder has gotten so generalized, covers so many forms of sadness, that these figures have exploded and encompassed many people who are having normal reactions to loss," he said.

Wakefield says just turn on the TV, and you'll see commercials bent on convincing people that they're depressed.

"We have direct-to-consumer advertising, where pharmaceutical manufacturers can tell the public, 'If you experience sadness, you're unhappy with your child and your spouse, you're not yourself for a period of time, you should see a physician, you may have X disorder,'" he said. "Now, I'm not saying that these don't have sometimes a good result, of certain people who need help going in for help. But it also reshapes our cultural view of what is normal range emotion that individuals can handle, and what needs to get medication or needs to get professional help."

"So it's no longer acceptable to be sad?" asked Spencer.

"Well, I think we are getting to that point," said Wakefield.

And people are taking action (or at least they're taking medication).

To put it in perspective, more Americans take antidepressants than go to the movies each week - an estimated 30 million. That's about double what it was just fifteen years ago.

You'd think we'd all be deliriously happy! But we are not . . . and University of Pennsylvania psychologist Robert DeRubeis may have hit upon why.

He co-authored a study in the Journal of the American Medical Association examining how well antidepressants work for mild to moderate patients.

"The advantage offered by the medicine over the benefit that came just from the placebo was very small," said DeRubeis, "worked on average very little better than sugar pills."

Louis Bayard was in that mild to moderate group. He was prescribed an antidepressant called Lexapro.

"I was concerned that it was going to turn me into this smiling zombie of bliss, you know, with a cloud of Disney birds around my head," Bayard said. "I thought it would alter me in some fundamental way."

But in fact, something very different happened: Nothing at all, or so it seemed.

Bayard said people would ask him, "How's it working?" and he would reply, "Fine, I guess. I don't know."

"There was no 'Eureka!' moment where the sun burst open into the room," he laughed.

According to Dr. Friedman, the answer to the question of whether antidepressants work depends on whom they are given: "If you give them to people who have sadness but not depression, they aren't going to do anything, because they don't have the disease for which the drugs are designed. And in general, if you give them to more severely-depressed people, they're highly effective."

But he says, unfortunately, THOSE people - the severe cases - too often don't get help, while the mildly-depressed (and the just plain sad) may end up on an antidepressant. One possible problem: 65 percent of all such prescriptions are written not by psychiatrists but by primary care doctors.

Bayard went to his primary care physicians, who was away on vacation, and so another doctor (who did not know him) prescribed his medication. "They didn't know me at all - and it was actually the most efficient medical transaction I think I've ever had," he laughed. "I walked in and within 20 seconds I had a prescription for Lexapro. And I think even a prescription for three refills after that. So I was ready to roll."

That was four years ago. Bayard says he feels much better today, but has no idea if Lexapro has anthing to do with it. "I ask myself why because I don't necessarily think the pill works. And I think it's the same reason an agnostic would go to church: Just in case. I'm going to cover my bases."

Louis Bayard is not alone in his uncertainty. Depression is almost as big a mystery today as it was at the dawn of medicine.

Wakefield says even today we still do not know why people get depressed. "We are putting drugs into people's bodies that may be helpful, and that's necessary sometimes in medicine. But if you ask, can we say for sure what the mechanism is that caused the depression, and by which these drugs are helping, and what the long-term effects if you stay on it for endless years - we just don't know. That's the reality."