Five Ways to Help Beat Depression Without Antidepressants

[Guest guest]

Five Ways to Help Beat Depression Without Antidepressants

_http://articles.mercola.com/sites/articles/archive/2010/03/09/antidepressan

ts-are-no-better-than-placebo.aspx_

(http://articles.mercola.com/sites/articles/archive/2010/03/09/antidepressants-a\

re-no-better-than-placebo.aspx)

 

 

Twenty-plus years of research on antidepressants, from the old tricyclics

to the newer selective serotonin reuptake inhibitors (SSRIs) show that

their benefit is hardly more than what patients get when they take a placebo.

 

 

More and more scientists who study depression and the drugs that treat it

are concluding that antidepressants are basically expensive Tic Tacs.

 

 

Research has found that patients do improve, often substantially, on

SSRIs, tricyclics, and even MAO inhibitors. This improvement is the basis for

the ubiquitous claim that antidepressants work.

 

 

But when researchers compare the improvement in patients taking the drugs

with the improvement in those taking dummy pills, they find that the

difference is minuscule.

 

 

Nonetheless, the number of Americans taking antidepressants doubled in a

decade, from 13.3 million in 1996 to 27 million in 2005.

 

 

This is a very important point, folks. In many cases, your beliefs are as

or more effective than pills when it comes to achieving health.

 

 

The second article linked below frowns on the notion of homeopathy,

because some people think it may work as a placebo. But the article shouldn't

be

so dismissive. The placebo effect is very powerful. Thousands of

clinical studies have found that the placebo effect can aid in healing or even

cure disease.

 

 

What it comes down to is the crucial mind-body connection. Those who have

hope and belief in the solutions they try will likely find them working.

That's why it is so key to keep your health freedom, and pay attention to

the huge corporations that continually discredit alternative methods.

 

 

Typically, more natural healing techniques won't harm you, and many of the

drugs will. In time, energy medicine will be better understood, and

perhaps this placebo element will be utilized in such a way that no pill will

ever be necessary -- your mind will be stimulated to heal on its own.

Similarly, those who pray or meditate for healing should not be ridiculed

either.

 

 

Simply labeling something as a placebo and not pursuing it any further

misses a key point. The so-called " placebo effect " may very well point the

way to the future or medicine.

 

 

Sources:

 

_Newsweek January 29, 2010_ (http://www.newsweek.com/id/232781)

 

_New Scientist February 1, 2010_

(http://www.newscientist.com/article/mg20527455.800-homeopathy-overdosing-on-not\

hing.html)

 

_The Journal of the American Medical Association (JAMA) January 6, 2010;

303(1):47-53_

(http://jama.ama-assn.org/cgi/content/abstract/303/1/47?maxtoshow= & HITS=10 & hits=\

10 & RESULTFORMAT= & fulltext=2010+depression & searchid=1 & FIRSTIN

DEX=0 & resourcetype=HWCIT)

 

 

 

Dr. Mercola's Comments:

 

 

Every year, 230 million prescriptions for antidepressants are filled,

making them one of the most prescribed drugs in the United States. The

psychiatric industry itself is a $330 billion industry -- not bad for an

enterprise

that offers little in the way of cures.

 

 

Despite all of these prescriptions, more than one in 20 Americans are

depressed, according to the most recent statistics from the Centers for Disease

Control and Prevention (CDC). Of those depressed Americans, 80 percent

say they have some level of functional impairment, and 27 percent say their

condition makes it extremely difficult to do everyday tasks like work,

activities of daily living, and getting along with others.

So why are so many people still feeling so low, even though the use of

antidepressants -- medicine’s answer for depression -- has doubled in just

one

decade, from 13.3 million in 1996 to 27 million in 2005?

Because they don’t work.

Unfortunately, antidepressant drugs are no more effective than sugar

pills. Some studies have even found that _sugar pills may produce better

results_

(http://articles.mercola.com/sites/articles/archive/2003/01/22/sugar-pills-part-\

two.aspx) than antidepressants!

Personally, I believe the reason for this astounding finding is that both

pills work via the placebo effect, but the sugar pills produce far fewer

detrimental side effects…

Many people forget that antidepressants come with a slew of side effects,

some of which are deadly. Approximately 750,000 people attempt suicide each

year in the US, and about 30,000 of those complete it.[ii] Taking a drug

that is unlikely to relieve your symptoms and may actually increase your

risk of killing yourself certainly does not seem like a rational, healthy

choice.

In addition, since most of the treatment focus is on drugs, many of the

safe and natural treatment options that DO work are being completely ignored.

No wonder so many people are suffering.

Detecting Depression in Yourself or a Loved One

Unfortunately, about two-thirds of people with depression go undiagnosed.

Untreated depression is the number one cause of suicide, which is a sad

testament to the clinical astuteness of most physicians.

The _diagnostic clues provided in this past article_

(http://articles.mercola.com/sites/articles/archive/2002/12/11/depression-part-t\

en.aspx) are

telling indicators that you or someone you love might be suffering from this

illness, so please _review them now_

(http://articles.mercola.com/sites/articles/archive/2002/12/11/depression-part-t\

en.aspx) .

Depression is much more than just feeling blue once in a while.

One set of diagnostic criteria used to assess depression is known as

" SIGECAPS,†which stands for sleep, interest, guilt, energy, concentration,

appetite, psychomotor and suicide.

If four or more of these items are a concern, it strongly suggests major

depression.

However, it is important to watch for symptoms besides mood changes,

considering relevant information from friends and family as well.

If you have been feeling down for two weeks or more and have lost interest

in activities you once enjoyed, I’d encourage you to consider the

treatment options for healing depression suggested later in this article, and

not

take potentially dangerous drugs as your first option.

Notes on Suicide: When to Worry

Most suicide attempts are expressions of extreme distress, not harmless

bids for attention. A person who appears suicidal needs immediate

professional help.

If you think someone is suicidal, do not leave him or her alone.

Try to get the person to seek immediate help from his or her doctor or the

nearest hospital emergency room, or call 911. Eliminate access to firearms

or other potential suicide aids, including unsupervised access to

medications.

Besides straightforward or “sideways†comments about not wanting to live

any longer, some of the red flags that a person has a high risk for

self-harm include[iii]:

-- Acquiring a weapon

-- Hoarding medication

-- No plan for the future

-- Putting affairs in order

-- Making or changing a will

-- Giving away personal belongings

-- Mending grievances

-- Checking on insurance policies

-- Withdrawing from people

Your suicide risk is higher if you have recently experienced any of the

following extremely stressful life situations (this is certainly not a

comprehensive list):

-- Loss of a significant relationship or death of a loved one

-- Diagnosis of a terminal illness

-- Loss of financial security or livelihood

-- Loss of home or employment

-- Abuse, rape or other serious emotional trauma

People sometimes become more suicidal as they begin the climb up out of

depression, which is one means by which antidepressant drugs can increase

suicide risk.

One of the reasons for this is, as your lethargy lifts, you can more

easily find the energy to carry out a suicide plan. Another possible reason is

that you might feel more in control and therefore at peace with your

situation once you’ve made a decision to end your own life.

This is important to keep in mind because people may appear as if they are

feeling better, when in fact, they are more at risk.

Remember that these are only general guidelines, and often your own

intuition is the best indicator that someone you love is really in trouble.

If you are feeling desperate or have any thoughts of suicide, call the

National Suicide Prevention Lifeline, a toll-free number 1-800-273-TALK

(8255), or call 911, or simply go to your nearest Hospital Emergency

Department.

You can’t make long-term plans for lifestyle changes when you are in a

crisis!

First let someone help you through the crisis -- then you can deal with

your depression later, when you’re feeling more resourceful.

Why Antidepressant Drugs Don’t Work

Every time a new study about the efficacy of antidepressants hits the

journals, we see antidepressants plunge further into the abyss.

One study that is hot off the press in the January 2010 issue of JAMA[iv]

concludes that there is little evidence that SSRIs (a popular group of

antidepressants that includes Prozac, Paxil, Zoloft and others) have any

benefit to people with mild to moderate depression, and that _they work no

better

than a placebo_

(http://blogs.mercola.com/sites/vitalvotes/archive/2010/01/07/new-study-finds-an\

tidepressants-no-better-than-placebo.aspx) .

That means that SSRIs are 33 percent effective, just like a sugar pill.

Another study presented at the _Neuroscience conference in 2009_

(http://articles.mercola.com/sites/articles/archive/2009/11/10/Why-Antidepressan\

ts-Don

t-Work.aspx) tells a similar story.

Researchers from the Northwestern University Feinberg School of Medicine

shared two major findings:

1. Antidepressant drugs were not developed for depression. Researchers

used certain drugs to manipulate the behavior of stressed animals, and then

concluded (erroneously) that the drugs would be “good antidepressants.†But

chronic stress does not cause the same molecular changes that depression

does, making the hypothesis incorrect.

So, antidepressants were actually designed to treat stress, rather than

depression -- which is one reason they are so ineffective.

2. An imbalance of neurotransmitters in your brain may not trigger

depressive symptoms as has long been thought. Instead, the biochemical events

that

lead to depression appear to start in the development and functioning of

neurons. This means antidepressants focus on the effect of depression and

completely miss the cause… yet another reason why they are so ineffective for

most people.

Unfortunately, the lead researcher is hoping the research will “open up

new routes to develop new antidepressants,†when in reality a drug solution

is not the answer.

Similarly, in 2008, a meta-analysis published in PLoS Medicine[v]

concluded that the difference between antidepressants and placebo pills is very

small -- and that both are ineffective for most depressed patients. Only the

most severely depressed showed any response to antidepressants at all, and

that response was quite minimal.

The article states:

“Given these results, the researchers conclude that there is little reason

to prescribe new-generation antidepressant medications to any but the most

severely depressed patients unless alternative treatments have been

ineffective.â€

These are not new revelations.

Back in 2002, a meta-analysis of published clinical trials indicated that

75 percent of the response to antidepressants could be _duplicated by

placebo_

(http://articles.mercola.com/sites/articles/archive/2002/07/31/antidepressants-p\

art-four.aspx) .

Many antidepressants may actually make your “mental illness†worse,

because when your body doesn’t feel good, your mood crashes along with it.

The List of Horrible Side Effects Grows

Depression -- or described another way, “unrepaired emotional

short-circuiting†-- can cause far more profound negative health consequences

than all

the denatured food and toxins you expose yourself to daily.

Psychiatric drugs kill 42,000 people every year. And the death count

continues to rise.

Antidepressants are the largest category of psychiatric drugs. It wouldn’t

be so bad if antidepressants were harmless sugar pills, occasionally

showing benefit simply because you believe they will work.

But in addition to being ineffective, they are far from harmless and are

now associated with many serious health problems:

-- _Diabetes_

(http://articles.mercola.com/sites/articles/archive/2006/06/29/dangerous-antidep\

ressants-elevate-type-2-diabetes-risk.aspx) : Your risk

for type 2 diabetes is two to three times higher if you take

antidepressants, according to one study.

-- Problems with your _immune system_

(http://articles.mercola.com/sites/articles/archive/2006/02/18/how-antidepressan\

ts-affect-your-immune-system.aspx

) : SSRIs cause serotonin to remain in your nerve junctions longer,

interfering with immune cell signaling and T cell growth.

-- _Suicidal thoughts and feelings_

(http://articles.mercola.com/sites/articles/archive/2005/03/12/antidepressants-s\

uicide-part-two.aspx) and

_violent behavior _

(http://articles.mercola.com/sites/articles/archive/2008/01/03/antidepressants-a\

nd-violence.aspx) : Your risk for suicide may be twice as

high if you take SSRIs; seven out of twelve school shootings were by

children who were either on antidepressants or withdrawing from them.

-- _Stillbirths_

(http://articles.mercola.com/sites/articles/archive/2006/04/29/antidepressants-i\

ncrease-stillbirth-risks.aspx) : A Canadian study of

almost 5,000 mothers found that women on SSRIs were twice as likely to have

a stillbirth, and almost twice as likely to have a premature or low birth

weight baby; another study showed a 40 percent increased risk for birth

defects such as cleft palate.

-- _Brittle bones_

(http://blogs.mercola.com/sites/vitalvotes/archive/2008/07/18/do-antidepressants\

-make-bones-brittle.aspx) : One study showed women

on antidepressants have a 30 percent higher risk of spinal fracture and a

20 percent high risk for all other fractures.

-- _Stroke_

(http://blogs.mercola.com/sites/vitalvotes/archive/2009/12/16/antidepressants-li\

nked-to-increased-stroke-risk.aspx) : Your risk for

stroke may be 45 percent higher if you are on antidepressants, possibly related

to how the drugs affect blood clotting

-- _Death_

(http://blogs.mercola.com/sites/vitalvotes/archive/2009/12/16/antidepressants-li\

nked-to-increased-stroke-risk.aspx) : Overall death rates

have been found to be 32 percent higher in women on antidepressants.

Diabetes or stroke will kill you, but suicide is much quicker. The link

between suicide and antidepressants is so strong that these drugs have been

mandated to have _suicide warnings_

(http://articles.mercola.com/sites/articles/archive/2006/05/30/paxil-warning-let\

ter-sent-to-your-doctor.aspx) .

Let’s consider one of the newer psychotropic medications that is now being

given to people for depression: Abilify (also called aripiprazole).

Abilify is licensed for the treatment of bipolar disorder, schizophrenia,

autism, and major depression (when taken with antidepressants). It is used

to augment the effects of the antidepressants -- because, of course, they

work so poorly!

But did you know that Abilify has _75 different side effects associated

with it!_

(http://bipolar-disorder.emedtv.com/abilify/abilify-side-effects-p3.html) ?

How absurd is it to take a drug that works about as well as a sugar pill

but exposes you to this minefield of ills?

Andy Behrman, a former spokesman for Abilify and Bristol Myers Squibb,

which manufactures Abilify, stopped taking the drug in order to avoid the

final side effects -- coma and death. _He made a short video warning you about

the drug_

(http://blogs.mercola.com/sites/vitalvotes/archive/2010/01/05/One-of-Wackiest-Id\

eas-From-Conventional-Medicine.aspx) .

If a former spokesman for the company is sticking his neck out to warn

you, how warm and fuzzy does that make you feel about what the pharmaceutical

companies are telling you?

Even More Reasons to Avoid Antidepressants

Professor of Medicine Lennard J. Davis wrote an excellent article about

SSRIs for the January 2010 issue of Psychology Today[vi]. He points out that

physicians routinely prescribe not one, but two or three SSRIs and other

psychopharmacological drugs in combination -- with really no studies to back

them up.

Physicians who engage in what is known as “polypharmacy†are hoping that

if one didn’t work, maybe two or three will.

Davis writes:

“Doctors are in essence performing uncontrolled experiments on their

patients, hoping that in some scattershot way they might hit on a solution. But

of course drugs have dangerous interactions and most physicians are

shooting in the dark with all the dangers that attend such bad marksmanship.â€

In fact, the entire serotonin hypothesis for depression should be given a

serious review.

You have heard for years that depression is caused by a chemical imbalance

of your neurotransmitters, mainly serotonin, dopamine and norepinephrine,

but there’s a serious lack of research to prove it.

This theory has become so indoctrinated into our culture and media that

most people just accept it as fact, simply because they’ve heard it so often.

Even mental health practitioners!

But there is no way to measure your serotonin or your dopamine without

cutting open your head. Scientists can’t even decide on what a “normalâ€

serotonin level is, much less an abnormal one.

Why do some depressed folks have high serotonin levels, while many happy

folks have low ones?

Your brain is far too complex for this overly simplistic explanation to

work.

More and more “psychiatric diseases†are appearing in the literature all

the time, and many could be considered “lifestyle disorders:â€

-- Do you shop too much? You might have Compulsive Shopping Disorder.

-- Do you have a difficult time with multiplication? You could be

suffering from Dyscalculia.

-- Do you tend to overdo the lattes and then can’t sleep at night? You

might have Caffeine-Induced Sleep Disorder. But take care not to go off that

coffee too quickly, lest you end up with Caffeine Withdrawal Disorder.

-- Can’t get along with your brother or sister? It might be Sibling

Rivalry Disorder.

-- Spending too much time surfing the Web? It might be Internet Addiction

Disorder.

-- Spending too much time at the gym? You’d better see someone for your

Bigorexia or Muscle Dysmorphia.

-- And my favorite -- are your terrified by the number 13? You could have

Triskaidekaphobia!

You get the idea.

Point is, each of these new “diseases†gets added to the next edition of

the official Diagnostic and Statistical Manual of Mental Disorders (DSM) if

enough people show up with those traits. And increasingly, the criteria

for inclusion involves whether or not the disorder responds to a category of

drugs.

If it does, the phenomenon is dubbed a disease.

Of the 297 mental disorders described in the DSM, none can be objectively

measured by empirical tests. In other words, they’re subjective. Mental

illness symptoms within this manual are arbitrarily assigned by a subjective

voting system by a psychiatric panel.[vii]

So, they’re making diseases to fit the drugs -- not the other way around!

It’s almost impossible to see a psychiatrist today without being diagnosed

with a mental disorder because so many behavior variations are described

as pathology. And you have a 99 percent chance of emerging from your

psychiatrist’s office with a prescription in your hand.

Why so much reliance on popping a pill for every mental or emotional ill?

Because writing a prescription is much faster and takes far less effort

than sitting down with you and talking for a while to help you figure out why

you are distressed. The shared goal of the drug companies and the overall

medical system is to ultimately have drugs coursing through the

bloodstreams of every living soul.

If Antidepressants Don’t Work, Then What Does?

There are five important strategies to consider if you are facing

depression. These strategies have nothing but positive effects and are

generally

very inexpensive to implement.

1. Do a Bit of Emotional Housekeeping

It is helpful to view depression as a sign that your body and your life

are out of balance, rather than as a disease. What you need to do is regain

your balance.

One of the key ways to do this involves addressing negative emotions that

may be trapped beneath your level of awareness. My favorite method of

emotional cleansing is Meridian Tapping Technique (MTT), a form of

psychological

acupressure.

If you have severe depression, it would be best to consult with a mental

health professional who is also an MTT practitioner. But for most of you

with depression symptoms, this is a technique you can learn to do effectively

on your own. In fact, it’s so easy that children are learning it.

There are other effective stress-management methods you could try as well,

such as meditation, journaling, breathing exercises, yoga, or simply

sharing your feelings with a close friend.

Experiment with a number of approaches, and then pick the methods you find

most helpful.

2. Get Regular Exercise

Regular exercise is one of the “secret weapons†to overcoming depression.

It works by helping to normalize your insulin levels while boosting the “

feel good†hormones in your brain.

As _Dr. James S. Gordon, MD_

(http://articles.mercola.com/sites/articles/archive/2008/07/31/unstuck-your-guid\

e-to-the-seven-stage-

journey-out-of-depression.aspx) , a world-renowned expert in using mind-body

medicine to heal

depression, said:

“What we’re finding in the research on physical exercise is that exercise

is at least as good as antidepressants for helping people who are depressed

… physical exercise changes the level of serotonin in your brain. And it

increases your endorphin levels, your “feel good hormones.â€

And also -- and these are amazing studies -- exercise can increase the

number of cells in your brain, in the region of the brain called the

hippocampus. These studies were first done on animals, and they’re very

important

because sometimes in depression, there are fewer of those cells in the

hippocampus.

But you can actually change your brain with exercise. So it’s got to be

part of everybody’s treatment, everybody’s plan.â€

If you want to establish an exercise routine, please _review my exercise

page_ (http://www.mercola.com/nutritionplan/exercise.htm) for some specific

recommendations about how to incorporate exercise into your life.

3. Improve Your Nutrition

Another factor that cannot be overlooked is your diet.

Foods have an immense impact on your body and your brain, and eating whole

foods as described in my _nutrition plan_

(http://www.mercola.com/nutritionplan/index.htm) will best support your

mental and physical health.

_Avoiding sugar_

(http://articles.mercola.com/sites/articles/archive/2009/12/22/How-Eating-Sugar-\

Can-Cause-Mental-Illness.aspx) and grains will

help normalize your insulin and leptin levels, which is another important

aspect of depression. Sugar causes chronic inflammation, which disrupts your

body’s normal immune function and can wreak havoc on your brain.

Sugar also suppresses a key growth hormone called BDNF (brain derived

neurotrophic factor), which promotes healthy brain neurons and plays a vital

role in memory. BDNF levels are critically low in people with depression,

which animal models suggest may actually be causative.

4. Supplement Your Diet with Omega-3 Fatty Acids

I strongly recommend taking a _high-quality, animal-based omega-3 fat_

(http://articles.mercola.com/sites/articles/archive/2008/10/14/how-eating-this-t

ype-of-fat-offers-new-hope-for-depression.aspx) , like krill oil. This may

be the _single most important nutrient for optimal brain function, thereby

helping to prevent depression.

_

(http://blogs.mercola.com/sites/vitalvotes/archive/2009/06/16/can-omega3-fats-pr\

event-depression.aspx)

DHA is one of the Omega-3 fatty acids in fish and krill oil, and your

brain is highly dependent on it. Low DHA levels have been linked to depression,

memory loss, Schizophrenia, and Alzheimer’s disease.

5. Let the Sun Shine Down on You

Have you ever noticed how great it can feel to spend time outdoors on a

sunny day? Well, it turns out that getting safe sun exposure, which allows

your body to produce vitamin D, is great for your mood.

One study even found that people with the lowest levels of vitamin D were

_11 times more prone to depression_

(http://articles.mercola.com/sites/articles/archive/2006/12/30/the-depressing-tr\

uth-about-vitamin-d-deficiency.aspx)

than those who received adequate vitamin D.

You can _optimize your vitamin D_

(http://articles.mercola.com/sites/articles/archive/2008/12/16/my-one-hour-vitam\

in-d-lecture-to-clear-up-all-your-con

fusion-on-this-vital-nutrient.aspx) either by sunlight exposure or by

using a safe tanning bed, or by taking a high-quality vitamin D3 supplement.

Think Twice Before Filling That Script

Think twice, be skeptical, and question a perfunctory depression-type

diagnosis you might receive after a short discussion with a rushed

practitioner.

It is easy to become seduced into thinking a pill might relieve your pain,

especially when it comes with the endorsement of your physician. Feeling

depressed is never pleasant, and you naturally want to escape it as quickly

as possible.

But drugs should always be your last choice, and antidepressants are no

exception.

There is a better way! You wouldn’t want to expose yourself to the

enormous risks these drugs present, especially for so little gain.

Hang in there, and if you implement the healthy strategies above, I bet you

’ll soon find yourself feeling better.

----------

----

Pratt LA and Brody DJ. _Depression in the United States household

population 205-2006_

(http://www.docstoc.com/docs/1926814/Depression-Statistics-in-US-Households)

,†(September 2008) NCHS Data Brief No. 7

[ii] _Caruso K. Suicide.org _ (http://www.suicide.org/suicide-faqs.html)

[iii] Read K. (March 5, 2008) _Red flags: Warning signs of suicide_

(http://bipolar.about.com/cs/suicide/a/9805_redflags3.htm) â€

[iv] Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD,

Shelton RC, and Fawcett J. “_Antidepressant drug effects and depression

severity_

(http://jama.ama-assn.org/cgi/content/abstract/303/1/47?maxtoshow= & HITS=10 & hits=\

10 & RESULTFORMAT= & fulltext=2010+depression & searchid=1 & FIRSTINDEX=0 & resou

rcetype=HWCIT) ,†JAMA 2010; 303(1):47-53

[v] Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al.

2008 _Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data

Submitted to the Food and Drug Administration_

(http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045) .

PLoS Med 5(2): e45.

doi:10.1371/journal.pmed.0050045

[vi] Davis L. (January 7, 2010) _Five reasons not to take SSRIs_

(http://www.psychologytoday.com/blog/obsessively-yours/201001/five-reasons-not-t\

ake-ss

ris) ,†Psychology Today

[vii] “_Marketing of Madness_

(http://www.foodmatters.tv/_webapp/The%20Marketing%20of%20Madness) ,†DVD,

available through Foodmatters website

Related Links:

_Why Antidepressants Don't Work_

(http://articles.mercola.com/sites/articles/archive/2009/11/10/Why-Antidepressan\

ts-Dont-Work.aspx)

_10 Antidepressant Alternatives Proven to Work_

(http://articles.mercola.com/sites/articles/archive/2009/01/29/10-antidepressant\

-alternatives-proven-to

-work.aspx)

_How Eating This Type of Fat Offers New Hope for Depression..._

(http://articles.mercola.com/sites/articles/archive/2008/10/14/how-eating-this-t\

ype-of-

fat-offers-new-hope-for-depression.aspx)