Depression

Ha ha! I hooked you with that title. You thought this piece was going to be an elegy for the stock market slide and what it has done to everyone who had faith in it for the last five years, or a definition of what�s happening in the economy. Or perhaps you thought this would be about my own mood.

Actually, I�m reading a book called Noontime Demon: An Atlas of Depression by Andrew Solomon. I usually try to read the National Book Award and Pulitzer Prize-winning books every year, because it�s the only way I pay homage to my education as a literature major. Andrew Solomon happens to have written this year�s National Book Award winner. In addition, he writes for The New Yorker, a magazine I�ve subscribed to for the past forty years, also in homage to my past. (Grew up in Manhattan � couldn�t you tell?) I was curious what he could have to say about depression, a subject usually left to high school students, poets, and shrinks.

Here�s what he has to say in a nutshell: �we have made but small advances in our understanding of depression at the same time that we have made enormous advances in our treatment of depression. Whether treatment can continue to outstrip insight is hard to say, since that kind of development depends to some extent on luck; and it will take a long time for knowledge to catch up with what we can already do.�

That�s comforting. Everyone who is depressed is a live animal experiment. Especially Andrew Solomon.

Andrew Solomon has done the most courageous thing imaginable: he has taken seriously the Zen proverb �the way out is through� and has studied not only his own depression, but the entire subject and mechanism in the most thorough, readable fashion imaginable. He begins by dissecting his own depressions, and expands out, like a stone that causes ripples in a pool, to the broadest possible focus.

I�ve not finished the book yet, but there are many tidbits worth sharing:

--Although everyone knows SSRIs (Prozac, Zoloft) work, no one knows exactly how. Serotonin levels are a complicated issue, because simply raising or lowering them doesn�t necessarily plunge a person into depression. It�s a much more complicated issue than that, one involving neurotransmitters. One of the worst things about SSRIs is that different people respond to them differently, and often severely depressed people have to try four drugs before finding one that works.

--Everyone knows St. John�s Wort works, too, but since it can�t be patented, there are no controlled studies.

--Talk therapy works as well as medication, but HMOs don�t want to pay for it. Ultimately, pills are cheaper. All therapists are not alike, either. Solomon describes with rich irony his search for a therapist, from the ones who told him to �snap out of it� to the one who covered all her furniture in Saran Wrap and who seemed crazier than he was.

--Dogs with low serotonin levels can become aggressive randomly. All primates can suffer from depression and mask it with anger, just as humans do.

--Each time a person (and probably a dog) goes into a major depression and comes out, he/she is a little more likely to repeat the experience. Depressions �lift,� but people who are really severely depressed are never cured.

--Although in general women are twice as likely to be depressed as men (or to report the fact), Jewish men and women have relatively equal rates of depression.

--Men who beat their wives are often found to be depressed.

--Most SSRIs interfere with REM sleep. Too much REM sleep, or going in and out of it for short periods, is thought to be a factor in depression.

--All SSRIs interfere with sexual function. Most common side effects are loss of libido, impotence, and delayed orgasm. People routinely go off them for this reason, fall back into their depressions, and are harder to cure the next time. Doctors are now prescribing Viagra regularly with SSRIs.

--In Senegal West Africa, there is a ritual treatment for depression called �ndeup,� which involves making a sacrifice to placate the spirits by covering one�s self with the mixed blood of a cock and a ram, dancing to drums, being rubbed in millet by old women, and chanting �leave me be; give me peace; let me do the work of my life and I will never forget you.�

Solomon actually went to West Africa, took part in this ritual, and found it to be quite useful. He thought this was because it involved intimacy, exercise, prayer, and the uplifting of the senses.

The Noontime Demon: An Atlas of Depression is worth reading -�not just for Solomon�s description of trying to carry the live ram in the trunk of a taxi on the way to the ceremony (the cost was lower if you supplied your own ram),and for his version of the ram�s odors,--but for his willingness to try anything.

Namaste,
Francine