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Have An Antidepressant Day

The dark side of being happy

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Angela Bolin was lying on her bathroom floor in a T-shirt and panties when she woke up in a pool of blood. Paramedics hovered over her. Her mother, father and sister stood there, sobbing. She didn't know what was happening, but when she looked down at her inner thighs, she saw they were covered in razor-thin slices. There were 45 cuts on one thigh, 46 on the other. The air reeked of bandages and antiseptic cream. It took a second for it to register. Bolin looked around, dazed, and spotted the used razor next to the sink. Then she remembered.

It started out a normal day in August 2002. Bolin went to class at Georgia State University, where she was majoring in marketing, taught a yoga class and visited with her sister. Things were routine, but she felt disconnected. Something had agitated her the whole day, but she couldn't pinpoint the problem. During dinner that night, her parents asked about the new medication she'd been taking for three weeks; she had started on it after watching a commercial touting its benefits. Bolin's father said he didn't believe she should be on the drug, that it caused mood swings. She got mad, finished dinner and marched upstairs. She took apart a disposable razor and started slicing. She did it methodically -- one cut to her left leg, one to the right, moving down toward her knee. She felt like she was watching a movie, felt she had no control over her actions. She kept slashing and got to number 91 before passing out.

It took about 20 stitches to mend her, but the nightmare didn't end there. Bolin attempted suicide again, by cutting herself more than 200 times in a department store bathroom. In addition to self-mutilation, it took hospitalization in two mental institutes, dropping out of college during her final year, and endless hours of research before Bolin concluded what had triggered the unwarranted behavior that almost took her life: Paxil.

More than 18 million people suffer from depression in the United States. That's approximately 6 percent of the population, so chances are you know someone who's dealt with the disease. Depression is complicated; doctors must make diagnoses that are personal yet subjective. Unlike those suffering from other ailments, victims of depression can't exactly improve their condition with the same preventive measures -- say, a better diet or more exercise -- that stave off other illnesses. Nor can patients control the life factors that contribute to extreme lows. A woman can't turn off postpartum depression; a boy can't change the fact that bipolar disorder runs in his family; a man can't reverse the death of his wife of 60 years. Yet all these people, with their vastly different experiences, are lumped under a single common term: "depressed."

The thorny disease has boggled physicians for decades, and various ways to treat the illness compound the dilemma. The diversity of treatments, ranging from psychotherapy to shock treatment, can make the healing process tricky; doctors must not only diagnose properly but must also experiment, making patients go through a trial-and-error process that sometimes does more harm than good.

"When we think about depression, we tend to think of it as one big field," says William McDonald, director of the Fuqua Center for Late-Life Depression at Emory University in Atlanta. "But everyone's got it for a little different reason, and that's why one treatment won't work for everyone."

The problem, critics of certain treatments say, is that doctors don't always disclose all options to patients. The result is that antidepressants, which are now the primary remedy for depression, have polarized the medical field; pro-Prozac types are pitted against those who are anti-antidepressants. What's more, two schools of thought have emerged among those who oppose antidepressants. On one side, critics claim that antidepressants can cause suicidal thoughts shortly after users begin taking the drug (like in Bolin's case), while others say the real suicide risk occurs only after users discontinue its use.

In the end, the antidepressant feuds remain murky. The drugs have saved some lives and taken others, and have left the country confused as to what's the best way to relieve depression and avoid drug dependence.

In the early 20th century, shock treatment prevailed as the best solution for depression, but later became stigmatized as inhumane. In the 1960s, physicians found tricyclics, a type of antidepressant, to be the remedy of choice, even though they produced acute side effects like 20-pound weight gain and blurred vision. Then, in the 1980s, researchers at Eli Lilly & Co. stumbled upon a new relief while trying to find a treatment for tuberculosis. The drug being tested unexpectedly lifted people's moods, so Eli Lilly tested it for several years, and in 1988, the US Food and Drug Administration approved it as Prozac, the first of a new class of antidepressants known as SSRIs.

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