Patients who receive medication after being diagnosed with major depression should have three or more doctor's visits in the first 12 weeks, according to guidelines developed by the National Committee for Quality Assurance (NCQA), a private, not-for-profit organization dedicated to assessing and reporting on managed care plans. That happens, however, just 20 percent of the time. It's easy to lay the blame on the primary care doctor or HMO, but just as often, the patient fails to show up for appointments, coming in only when the prescription can no longer be refilled.

Most experts agree that treatment of a mood disorder should also include increased exercise, which, along with cognitive behavioral therapy, has been proven in some studies to be at least as effective as antidepressant treatment—and it comes without side effects. "Turn off the computer or the TV and get a decent night's rest," suggests Prey, who is convinced that much depression arises from too little sleep, resulting in a malfunction of the body's circadian clock. Many doctors recommend meditation to reduce anxiety and, as some research suggests, to boost mood. Studies have also shown that eating more omega-3 fatty acids can make a difference. Finally, consider that what seems like depression may be due to an imbalance of thyroid, reproductive, or adrenal hormones, says Richard Shames, MD, the author of a recent book about endocrine imbalance called Feeling Fat, Fuzzy, or Frazzled?

It took almost a decade for me to get to the bottom of the problems that originally sent me to the endocrinologist. Eventually, I learned that my thyroid level had been tripping me up. (Reexamination of my records showed that I'd been at the very low end of normal at that first assessment, and, at least to my new doctor, my thyroid-related symptoms had been as clear as day.) I began taking a small amount of synthetic thyroid hormone. Within weeks I was sleeping well, my weight stabilized, my skin stopped itching, my hair began to grow back, and I usually had enough energy to make it through my busiest days.

Whether antidepressants are right for you, only you and your physician can decide. What's clear to me, however, is that the choice to get on them is not something to be entered into lightly. Nor, I should stress, is the decision to go off them—it's crucial not to quit suddenly.

With my physical symptoms under control, a number of people—after many years of greeting me with distressed expressions on their faces—have started to tell me that I look really well. I think they're right. Still, there are days when the stress level builds, everybody needs everything ASAP or faster, the tension in my shoulders grows, and I am convinced that I am falling into a bottomless pit from which I will never be extricated. These are the kinds of feelings that typically describe depression. But I know that—at least for me—this, too, shall pass. My emotions, my motivation, and my intuition are among the personal characteristics I hold dear. There is no way I'd trade them for the promise of life on an even keel.


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