Q. I have fatigue, poor concentration, sleep problems and a lack of interest in things. My doctor diagnosed severe depression and wants me to start drugs. Aren't they addictive or a cause of suicides? Can I try St. John's wort?

A. Depression is lethal — 15 percent of patients with mood disorders commit suicide. It causes disability with a three-fold increase in sick days, and often starts between ages 12 and 24.

But only a third of folks with depression receive adequate treatment, in part because we fail to recognize or admit to depression. Symptoms are sadness, feeling worthless, weight gain or loss, irritability, agitation (or, conversely, slowness) and recurrent pain.

Despite earlier studies showing benefit, two North American studies found St. John's wort to be ineffective. Overall, the herb seems to have minor benefits, though it may not work for people with long-standing depression, nor for those with severe depression, and because yours is severe, I wouldn't use it.

I'd instead start a drug like duloxetine, fluoxetine or Celexa — drugs are superior to psychotherapy alone for the severely depressed (though you should also do psychotherapy). These drugs are not addictive and help correct a neurotransmitter imbalance in the brain that may be causing depression. The U.S. Food and Drug Administration found that in older adults, drugs actually reduce suicidality. But in short-term studies involving more than 4,400 kids, teens and adults under age 25, they found an increase in suicidal thoughts or attempts in one in 70 people. But there were no actual suicides, and a later meta-analysis on April 18, 2007, of all randomized studies to date by Jeffrey Bridge and others, in the Journal of the American Medical Association, found this number to be closer to 1 in 143. They concluded that the benefits of drugs appear to be much greater than the risks from suicidal thoughts or attempts — and again, no actual suicides were seen.

In more than 70 percent of sufferers, the depression will return. The mistake is stopping drugs too soon, risking relapse and misery. Continue them four to nine months after your depression clears, take them every day, and keep taking them even if you feel better. You'll feel better by one week and continue to improve for six weeks, but in one study, 44 percent stopped their drugs within three months. Bad move — there are about 20 different antidepressants, so if one doesn't work or causes problems, try another one or add a second drug like buspar, bupropion or risperidone. Folks with mild or moderate depression can do either drug therapy or psychotherapy alone. Get regular exercise and sunshine. Be patient — with therapy, you will start enjoying life again.

Dr. Landis Lum is a familypractice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i-Manoa John A. Burns School of Medicine. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.