PRESCRIPTIONS
Prozac among best depression treatments

By Landis Lum

Q. I've had a lack of energy, poor concentration, sleep problems, and a lack of enjoyment and interest in things. My doctor diagnosed severe depression and wanted me to start Prozac. I've heard bad things about Prozac. What about trying St John's Wort instead?

A. You're not alone. About 8 percent of adults will have major depression during their lives. It's twice as common in women as in men, and most often begins between the ages of 12 and 24.

Depression is dangerous. About 15 percent of patients with mood disorders commit suicide. It also causes disability and impairs work performance — depressed individuals have a three-fold increase in the number of sick days. Unfortunately, children of women with depression have more problems in school and with behavior, and have lower levels of social competence and self-esteem.

Only one-third of all patients with depression receive adequate treatment. Part of the reason is the failure of both patients and doctors to recognize depression.

Other possible symptoms of depression besides the ones you had are sadness, feelings of worthlessness, suicidal thoughts, weight gain or loss, irritability, agitation (or, conversely, slowness), and recurrent pain (stomachaches, backaches, headaches, etc.).

Despite European studies demonstrating the effectiveness of St. John's wort, two recent North American controlled studies found it to be ineffective. It should not be used in severe depression, and its safety beyond six weeks- use is unknown and not recommended. And you can never be sure of the purity and dosage claims of many preparations.

Therapy with an antidepressant drug is the preferred treatment for moderate to severe depression. It takes two to four weeks before you'll start to feel better.

More than 70 percent of patients experience a relapse of depression during their lifetime. Most physicians (and their patients) stop antidepressants too early, without discussion as to the risk of relapse and, as a result, of disability and death.

Antidepressants should be continued for at least six months. There is growing evidence that they are safe during pregnancy.

Therefore, go ahead and try Prozac (fluoxetine). Depression is caused by a neurotransmitter imbalance in your brain, and drugs may be needed to correct this. A systematic review of multiple studies found no strong evidence that Prozac is associated with an increased risk of suicide.

There are about 20 different antidepressants, so if one doesn't work or causes problems, try another one. You should also undertake psychological counseling and begin regular exercise to enhance the effectiveness of drug therapy — and experience joy in living once again.

Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Write: Prescriptions, Island Life, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802