It is the autumn of 1995: I am 14 years old. Each morning I am meant to get out of bed at 5.45 to catch the school bus, which leaves 50 minutes later. But this hasn’t happened in weeks. Instead, I have a new routine. My alarm goes off like a piercing scream; I unplug it and smash my face into my pillow. I am dizzy with fear and can only move in a slow and laboured manner, as if the air in my room has been thickened with gelatin. I listen for the sound of my father’s footsteps. He bangs on the door.

“Time to get up,” he says, cautiously.

“F**k off,” I reply, feeling alarmed that I’m saying this to my father.

He sighs and goes to get my mum. Her approach is softer.

“Darling,” she says, standing next to my bed, stroking my hair, ” you really have to get going now. I’ll make you some tea.”

“Fuck you,” I say, pushing her away, burrowing deeper under my duvet. I can hear her crying in the hall. I start the first of my own daily floods of tears.

I wail for 90 minutes; the bus rolls past. My father pushes and persuades me into his car. Upon arrival, the crying starts again. Dad parks the car and tries to cajole me into going to my lessons.

He is gentle, persuasive. Yes, I think, I can do this, I can go to school. But then I put my hand on the door handle and am overwhelmed with the conviction that if I step out of the car I will die. After an hour or so of the back and forth, Dad gives up and takes me home. Or I gather all of my strength and shuffle into my English lesson, telling my friends my face is swollen because of hay fever.

It all started with the occasional fleeting thought when I was 13 - something would go a little bit awry, and I’d find myself thinking “I should kill myself”. My favourite trousers aren’t clean? I should kill myself. I have a difficult geometry proof on my maths homework? I should kill myself. Gradually, over the course of the summer in which I had my 14th birthday, killing myself was the only thing I could think about. By the time I returned to school in the autumn I had changed from a happy, bright girl into a despondent disaster.

Whatever normal 14-year-old girl things I was trying to do - taking the dog for a walk, arguing with my siblings, fancying the boy who sat next to me in school orchestra - my thoughts were hijacked by an overwhelming sense of self-loathing and desire to die. I’d visualise slicing my wrists to ribbons or hurling myself off the roof. I spent a lot of time fantasising about shooting myself in the face.

I was appalled: always independent and assertive, I had always prided myself on my ability to take control of my life. But now I had no control over my thoughts. In occasional moments of lucidity, I knew that suicide was not a good idea. I decided that the best way to deal with it was to avoid ever getting out of bed. Bed was safe, because sleeping didn’t permit me to think. And it was soft, so I couldn’t really use it for self-harm, although I did experiment a couple of times with covering my mouth and nose with a flannel-covered pillow in a pathetic attempt at self-suffocation.

I was seriously depressed.

And clinically, at least, I’ve been seriously depressed ever since. But few people know that, because soon after I was diagnosed, I started taking SSRI anti-depressants. Because of them, I rarely have symptoms - and have sufficient control over them that only a small circle of my friends and family notice them when they’re exacerbated. I don’t like to think about what would have happened to me if I hadn’t been medicated as a child. I might not still be alive. I am certain that my quality of life would be severely compromised.

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When my symptoms began I didn’t know what depression was. I just knew that something was really wrong, and I was determined to hide it from my parents: I was convinced that it would only be a matter of time before they figured out that I was crazy and shipped me off to an institution (Sylvia Plath’s The Bell Jar had been included on my school’s summer reading list). My mother was an educational psychologist, however, and she took a progressive approach once she realised that I was not just going through a phase. First I had some talk therapy. Trying to unpick what was wrong in my life that was making me miserable was impossible because nothing, besides the fact that I was depressed, was wrong: my family was stable and loving, I was a star pupil, I had lots of friends.

Staring at the clock in silence during the course of my allotted hour, I considered whether I should make up some kind of dreadful story in order to make the way that I felt seem justified. But I didn’t. I was just really sad, I said. “Get over it,” the therapist said. Feeling that I was incapable of doing so made me feel worse. But when I didn’t get over it, my GP referred me to a psychiatrist. This, I was certain, was a sure route to my Bell Jar nightmare, so I kicked and screamed and threw my shoes as my parents dragged me out of the house. But when the psychiatrist pronounced me clinically depressed and prescribed antidepressants I cried with relief, knowing that the thing that was wrong with me could be treated.

Taking Prozac didn’t provide me with instant happiness or transform me into an artificial, cheerful version of my former self. I was still sad. But the medication did pull me out of despondency into a normal range of emotion, such that I could engage in the task of learning to cope with a chronic illness.

It amazes me how often people who learn that I’m on Prozac suggest that I should stop taking it. “You don’t seem depressed,” they say, and I suppose I don’t: I’m quite outgoing and successful and well-groomed. Other times, people make ridiculous assumptions about the kind of person I am, like the dental hygienist who read my medical notes (where I had dutifully marked down the medications that I was on, as directed) and remarked that my plaque build-up was obviously because I had depression and didn’t take good care of myself.

Over the last dozen years, I’ve taken several breaks to see if it is possible for me to cope without antidepressants. It isn’t. I always become depressed again, although I now have the self-knowledge to arrest the process by going back on to medication before it becomes so severe that things disintegrate. Why should I screw around with my emotional equilibrium just because of the current culture of shame and distrust about antidepressants, despite the fact that they mitigate my symptoms? I don’t believe that mine is a mindless dependency: I clearly have a physiological problem with my brain that causes me to go from being cheerful and funny and friendly to miserable and suicidal when I am not medicated. Several doctors have confirmed this. Theories abound: maybe it’s because I had febrile seizures when I was a toddler. Perhaps it’s linked to the time I fainted and bashed my head on the kitchen floor and ended up in intensive care with a severe concussion when I was 10. (A recent study found that American footballers who’ve had several concussions have a greatly increased chance of suffering from depression.) Maybe it’s genetic. The cause is a moot point but, now, I just focus on keeping well.

The MP David Laws has recently argued that the quadruple increase over the past decade in prescriptions of anti-depressants to children is evidence of an over-reliance on pharmaceuticals to treat childhood unhappiness. I disagree. Rather, I’d suggest that it might be evidence that society has moved, at long last, towards a more enlightened view in which childhood depression is recognised as a treatable illness, rather than something to be ashamed of. Parents are actually seeking help for their children instead of banishing them to their bedrooms and then wondering why they self-destruct. That’s fantastic.

I don’t advocate prescribing anti-depressants to children without the roots of their depression being investigated. There are many environmental and social factors that may lead to the increased incidence of childhood depression, as demonstrated in the recent Unicef report that ranked British kids at the bottom of the table when it comes to happiness. But instead of positive, progressive debate about how to improve the emotional wellbeing of children, we are embroiled in a moral panic about medication, undoubtedly because no matter how much people like me try to demonstrate that it’s real, it’s treatable, and it’s not something to be ashamed of, depression is an invisible, stigmatised illness. It is easier, and lazy, to blame pharmaceutical companies for marketing “happy pills” than to acknowledge, treat and finally prevent depression.

Rates of other chronic childhood illnesses, such as asthma and diabetes, have also had exponential increases in the last few decades. But no one suggests that parents shouldn’t allow their children to receive appropriate pharmaceutical treatment for these conditions. Just because an illness isn’t tangible doesn’t mean that the appropriate medication is an option that parents and children should always avoid.

Johanna Morrison, 50, has mental health problems and didn’t understand the downside to what she was doing, said her attorney, James Gentile.

Fire investigators said they believe Morrison is responsible for as many as 13 fires in her neighborhood dating back to April 2006 until she was arrested last October. No one was injured but some of the homes were damaged so severely that they had to be abandoned.

Morrison told Mahoning County Common Pleas Judge John Durkin during Friday’s sentencing hearing that she’s been taking the antidepressant drug Prozac while in jail and that her mental health has improved.

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She also apologized for setting fires.

“I did not know what I was doing,” she said. “I feel the remorse. I was always afraid something bad would happen. I tried to stop myself but I couldn’t.”

Morrison pleaded guilty June 21 to four counts of aggravated arson and two counts of arson. A judge had found her competent to stand trial.

Gentile said his client’s goal was to rid the neighborhood of non-law abiding persons.

“In her mind, she thought this was the only way she could make the neighborhood a better place,” he said.

An effective approach for the management of chronic pain begins with a thorough assessment and concludes with a targeted biopsychosocial treatment plan. The assessment identifies the functional disability associated with the pain and provides sufficient justification for educational interventions. In addition, the social impact of the debilitating pain disorder might lead the physician to suggest counseling opportunities for the immediate family. Naturally, the patient’s principal objective is maximum pain relief. Among the pharmacologic options available and in addition to standard analgesic remedies, antidepressants can be an important ally in the physician’s quest for safe pain management.
USE OF ANTIDEPRESSANTS IN THE MANAGEMENT OF CHRONIC PAIN
Pain and depression are closely intertwined, strongly hinting at a shared neurophysiology. As a consequence, one prevailing pharmacologic strategy identifies a central role for serotonin and norepinephrine reuptake inhibitors (SNRIs).1 Other justifications, even without a common biologic rationale, strongly support the use of antidepressants in the management of chronic pain. For example, chronic pain characteristically causes sleep problems, anxiety, and depression, all of which may improve with antidepressant treatment.2 Providing an effective, nonhabituating sleep medication that also improves mood may significantly enhance the patient’s quality of life.

Clinical evidence suggests that antidepressants exert their beneficial analgesic effect directly, apart from the physiologic mood improvement. When examining the use of antidepressants among persons who have fibromyalgia or diabetic peripheral neuropathic pain, a recent study concluded that more than 75% of the improvement in painful symptoms was due to the direct analgesic role of the medication.3 Patients may initially not appreciate the recommendation of taking an antidepressant for a pain disorder, but a moment’s education stressing the unique analgesic action of antidepressants should satisfy that concern.

Clinical investigators report effective pain relief across the spectrum of presently available antidepressants. Not surprisingly, the bulk of published studies focus on the tricyclic antidepressants (TCAs). Their efficacy in chronic pain management is well established.4,5 The efficacy of antidepressants, specifically TCAs, in the management of chronic pain is recognized in clinical practice guidelines;6,7 typical guidelines recommend the initial use of TCAs for neuropathic pain. Studies have revealed that patients with specific pain disorders, such as diabetic neuropathy and postherpetic neuralgia, seem more likely to benefit from TCAs than patients who experience the chronic discomfort associated with neck or back pain.8

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Although TCAs have a long-established record of safety, efficacy, and tolerability in the role of augmenting chronic pain management, prudent prescribing requires awareness of the major adverse effects of TCAs, which predominantly cluster around cholinergic, histamine, and adrenergic receptor activity. As a consequence, dry mouth, sedation, constipation, urinary hesitancy, and orthostatic hypotension are among the potential adverse effects. Additionally, TCAs should be used with considerable caution in the presence of certain medical conditions, such as glaucoma and benign prostatic hypertrophy. They should also be avoided in the presence of second- or third-degree heart block or a prolonged QT interval.9

Chronic pain management with TCAs can usually be achieved at much lower doses than those typically required for an antidepressant effect. Clinicians can expect results at one half of the antidepressant doses. For example, a starting dose of desipramine would be 10 mg, with 10-15 mg adjustments made weekly until improvement is noted or a dose of 50 mg is reached. Limited improvement at 50 mg might justify a tricyclic blood level test, dose increase, or referral to a specialty pain management clinic.

Other classes of antidepressants have also been studied in the management of chronic pain conditions. The secondary amines, such as desipramine or nortriptyline, also provide effective relief from chronic pain. A particular advantage of the secondary amines is better tolerability and safety, which is the result of less intense anticholinergic adverse effects and less sedation. As a consequence, these medications may be the better and safer choice for chronic pain management in elderly patients.10 Clinical evidence also supports the efficacy of the newer selective serotonin reuptake inhibitors (SSRIs) in relieving chronic pain, although the data may be, comparatively, less convincing.11,12 This may, in part, be because of the broader array of neurotransmitters that are involved in the maintenance of chronic pain, instead of simply serotonin. TCAs and secondary amines inhibit the reuptake of both serotonin and norepinephrine.

The notion that other neurotransmitters are involved in mediating pain is further supported by the emerging efficacy of SNRIs in relieving chronic pain. Venlafaxine is an SNRI used in the treatment of chronic disorders such as fibromyalgia and postmastectomy pain syndrome.13 Duloxetine is an SNRI with clinical treatment indications for both major depression and diabetic peripheral neuropathic pain. This newer antidepressant is a more potent inhibitor of serotonin and norepinephrine reuptake than are other similar medications. As with TCAs, duloxetine’s analgesic effects appear independent from its antidepressant actions. Duloxetine is the first antidepressant approved by the US Food and Drug Administration (FDA) for the management of the pain associated with diabetic peripheral neuropathy. Numerous studies positively cite duloxetine’s effectiveness in managing pain among elderly patients, its role in managing fibromyalgia, and its relief of the pain associated with diabetic peripheral neuropathy.14-16

CONCLUSION
The basis for all treatment of chronic pain conditions begins with a thorough pain assessment. The assessment should include the use of structured instruments to determine both the severity of pain and the associated functional impairments. A psychological assessment is an important routine step in the development of a chronic pain care plan. The assessment must also include a determination of the patient’s safety in terms of potential suicide risk. In conjunction with or in lieu of analgesic options, antidepressant therapy or augmentation may be suggested for patients with lingering stress, depression, insomnia, and lack of remission with standard analgesic remedies. Given the breadth of available clinical research and comparatively lower cost for TCAs, this class of antidepressants remains the preferred initial option, but the newer antidepressants (eg, venlafaxine, duloxetine) should be considered an alternative if TCAs prove ineffective.

The company was “shocked” and “very disappointed” last month when the FDA rejected one of its studies on its formulation of bupropion, a key component of a new antidepressant, Biovail chief executive officer Douglas Squires told analysts on a conference call yesterday.

At the meeting next Tuesday, Biovail will try to get the approval process for the bupropion salt back on track.

Biovail was counting on revenue from the new drug to help it counter the decline in revenue from Wellbutrin XL, which accounts for a substantial portion of its revenue. The time-release antidepressant is now facing competition from generic knockoffs in the 300-milligram dosage. Generic versions of the 150-milligram dose will come on the market in 2008.
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The Globe and Mail

In its second-quarter financial report released yesterday, Biovail said revenue from Wellbutrin XL fell by more than half to $54-million (U.S.), compared with $114-million in the same period a year earlier.

That drop contributed to a 20-per-cent decrease in overall revenue in the quarter, and a 21-per-cent decline in profit.

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When Biovail announced the problems with FDA approval of the bupropion salt on July 20, its stock declined by about 20 per cent to slip below $22 (Canadian) on the Toronto Stock Exchange. It has fallen even further since then.

Mr. Squires said yesterday that he hopes investors will regain confidence in the firm when they realize how many potentially successful products it has in development.

“As investors begin to appreciate what’s in the pipeline … I think they will begin to have confidence in what we have and in the growth of the company.”

Among those new products is the company’s first foray into drugs that treat sexual dysfunction. Biovail said yesterday it has signed a licensing agreement with a privately held drug development firm that will give it exclusive global rights for a “novel product” to treat sexual dysfunction.

While Biovail is reluctant to release many details of the new project because of competitive concerns, Mr. Squires said the move could be very important to the company. “This is a very large marketplace and a significant unmet medical need.”

Because the drug has “some significant intellectual property wrapped around the product,” it could have a longer life in the market than some of Biovail’s past products, he said.

As for the bupropion salt, “we know the product will eventually be approved,” he said, if Biovail agrees to conduct the extra study that the FDA wants. “The difficulty is that it takes time.”

While the bupropion salt is important in itself, it is also a “scaffold” product that will be used as a component of another combination of products that includes an antidepressant.

Analyst Claude Camiré of Paradigm Capital in Toronto said he thinks Biovail’s new products will eventually kick-start its stock, but perhaps not for another year.

“The pipeline is there, but revenue growth won’t kick in until the second half of 2008,” he said.

Investors may continue to flee the company in the short run, Mr. Camiré said. But he’s confident that Biovail’s balance sheet, with its strong cash flow, can sustain the company until growth resumes.

The findings, based on a review of research studies and case reports involving more than 78,000 patients, published online in May 2007 by Diabetes Care and will appear in the August print issue.

In their study, the researchers concluded that the risk of heart failure increased up to 100 percent higher in patients who took thiazolinediones (which combines Avandia and Actos) to treat type 2 diabetes.

The researchers estimate that for every 50 patients taking the medications over a period of 26 months, one person will develop heart failure and need admission to hospital.

The drugs, approved by the National Institute for Health and Clinical Excellence for use on the NHS to treat Type 2 diabetes, are not recommended for people suffering from, or at risk of, heart failure. But the new study links an increased risk even to those who have never suffered heart failure.

After the release of new study that linked Avandia to a 43% increased risk of heart attacks, the US health agency Food and Drug Administration reviewed dozens of drug studies and presented their report on Thursday.

In the report, the American health watchdog stated that the widely used diabetes drug Avandia increases the chance of serious heart problems, including a 30% to 40% higher risk of myocardial ischemia, or decreased flow of blood to the heart.

Actos, a drug manufactured by Takeda Pharmaceutical Co., carried no similar risks, according to the FDA documents that released in advance of an FDA advisory panel meeting on Monday.

Approved by the FDA on May 28, 1999, Rosiglitazone maleate, marketed as Avandia, is a drug that reduces glucose (sugar) level in the blood by increasing the level of insulin. It belongs to the antibiotic drug class called “thiazolidinediones” and is used to treat type II diabetes. Actos (pioglitazone) is another member from this class.

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Avandia’s drug class “thiazolidinediones” affects a gene called PPAR-gamma and helps the body to use insulin more effectively. GlaxoSmithKline, the manufacturer of Avandia medicines cautioned from the beginning that the drugs were not suitable for patients at risk of, or with a history of, heart failure.

It even warned that patients who combined the drugs with insulin treatments were at increased risk for this complication. But the latest analysis found that the drug equally affected those with no risk for heart failure, even in the absence of insulin.

In wake of concerns about the diabetes drugs’ risks, two advisory panels for the FDA are re-examining both drugs. FDA’s division of drug risk evaluation is due to hold a meeting on Monday to review the drug’s safety.

In the meeting, the FDA panel could recommend stronger, “black box” warnings or withdraw the drug from the market. If recommended by FDA advisory committee, the expanded warnings, which will appear in a black-ruled box displayed prominently on the prescribing information, would note that patients with heart disease or who are taking insulin should not use the drug.

Although FDA is not bound to follow its advisory panel’s recommendations, it generally follows their guidance. The health agency makes a decision on whether a product should be approved after evaluating all data and considering the recommendations of the advisory committee.

GlaxoSmithKline is the second largest pharmaceutical company after Pfizer with its headquarters in UK. It has received a perfect score of 100 percent from the Human Rights Campaign Foundation’s in 2005.

GSK also entered into a controversy in December 2006 when a committee of obstetricians published their opinion in the journal Obstetrics & Gynecology regarding the increased risk of birth defects due to intake of the antidepressant Paxil by pregnant women.

GPs have been accused of handing out medication too freely because youngsters may get used to taking medication for their depression rather than getting to the source of their problem.

According to figures from the Office of National Statistics, one in ten children has some form of mental disorder, be it depression, anorexia or others. Frequent high-stress examinations and family breakdowns are just two of the cited causes for the rise in childhood mental illness.

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“In a sense, it shows some of the pressure many youngsters are under - their lives are chaotic and there isn’t as much stability at home,” said David Laws, the Liberal Democrats’ children’s secretary.

“But instead of trying to treat the causes and create a more stable and supportive environment for young people, we think we can solve these problems by prescribing a pill.”

Although guidelines prohibit the prescription of anti-depressant Seroxat to under-18s, Prozac is still routinely prescribed.

“What? Your dog is on Prozac?”

Yes, he is.

“And,” Angie says, “when he’s having a really bad day, he gets Valium, too.”

The Food and Drug Administration approved psychotropic drugs for dogs in 1999. In the years since then, prescribing these drugs for pets has become more common. Just because it’s new to me doesn’t mean it’s new. Still, it leads to a lot of quizzical looks.

“I’m used to people reacting like that,” Angie says. She will laugh along with your jokes about “doggie rehab” and “Rover’s little helper.”

I went to visit Spencer, and he seemed like an average dog; friendly, inquisitive. He is not lying on the floor in a stupor, if that’s what you’re thinking.

A few years ago, Jason and Angie Hamm picked Spencer from among the dogs available at the Sangamon County Animal Shelter.

“Since the day we got him, he’s been the sweetest dog,” Angie says.

Everything was great until Angie became pregnant. About three months into her pregnancy, Spencer began exhibiting unusual behavior, for him. He began sleeping in odd places and “fly snapping,” which is the term for a dog snapping at nothing but air.

Doctors thought he was going blind. “We were devastated” at that diagnosis, says Angie.

The Hamms were referred to an animal neurologist in Chicago. But before their appointment, the doctor had some questions. One of those questions was, “Have there been any major changes in the house recently?”

Angie said, yes, she was pregnant. Bingo, said the doc. Your dog isn’t going blind at all. He’s reacting to the pregnancy. The doctor prescribed Valium.

But when the Hamms thought Spencer was going blind, they arranged to take him to Florida to see the ocean once before he lost his sight.

“I was being corny,” Angie says.

After the diagnosis was changed, they went ahead with the trip, as a sort of last fling for Spencer before the baby’s arrival. They found a pet-friendly condo for the dog, and he loved being the center of attention.

But back home, he reverted to odd behavior. The vet put Spencer on Prozac. It helped. Spencer was more like his old self.

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Since their baby, a girl named Avery, was born last year, Spencer has been fine most of the time. He likes the baby and is protective of her. But Spencer still has bad days and cannot afford to miss a dose of his Prozac, which he gets twice a day.

“We get it from Sam’s Club,” Angie says, “and the pharmacists there have some fun with it. They give it to us and ask, ‘Does the patient have any questions?’ We tell them no, but when he does we’ll let them know.”

The FDA first approved Prozac for dogs to deal with separation anxiety, but it can treat other problems. There is Prozac for people (Spencer’s medication) and a special Prozac for dogs. More and more vets are prescribing it.

“They’ve done research on it, and it works for dogs,” says Petersburg veterinarian Dr. James Cline.

I told him it still seems unusual to me, but he explained that it is becoming more common as real-life experiences with animals continue to show that it is effective.

Spencer’s vet, Dr. Margaret Gaut in Williamsville, says Spencer is the only animal at that practice on Prozac. She says it should be a last resort.

“As it becomes more popular,” she says, “I’m concerned that people will use it as an easy out instead of spending time with their pet and making sure there isn’t something else going on.”

She recommends first taking the animal to a vet that specializes in behavioral problems. The closest one to Springfield is in St. Louis.

I told her that sounds just like the advice parents get about their children. Don’t go to the Ritalin first thing, most pediatricians say - try other stuff first.

“That’s right,” she says. “Dogs can have the same kinds of problems that people have.”

You know, Puppy Uppers and Doggie Downers used to be nothing more than one of those fake commercials on “Saturday Night Live.”

It’s no joke anymore. It’s real.

Throughout the book, Shields unflinchingly flays the skin of her emotions, painfully revealing at a visceral level her emotional vulnerabilities, fears, and frustrations. In painting painstakingly the canvas of her sojourn in the realm of postpartum depression, Shields likewise exposes to plain view a fascinating multitude of highly personal details which enliven the book with great animating force. For the reader willing to patiently probe the book’s terrain, an abundance of richly edifying deposits will likely be unearthed.

Shields opens her discourse by focusing principally, in the book’s first chapter, on her frustrating efforts to become a mother. In determined pursuit of motherhood, Shields gamely traverses an obstacle strewn path cluttered frustratingly with: vexing fertility issues, the demanding ordeal of in vitro fertilization therapy, a pregnancy truncated by an emotionally jarring miscarriage, and further fertility treatments (resulting, again, in pregnancy).

In Chapter Two, Shields describes vividly the expansive gamut of emotions, reaching to joy, pain, thrill, anxiety, and fear, conflictingly tugging and pulling at her and her husband as she was pregnant (with her “little cashew”). The emotional malaise continued, after Rowan’s birth. As chronicled poignantly in the chapters that follow, the great joy occasioned by Rowan’s birth was followed by Shields’ bittersweet roller coaster ride, along a bipolar route of thrilling and agonizing emotions.

The growing cascade of negative emotions casting a heavy pall of gloom over the early days of her motherhood is the core subject of Chapter Three. As Shields plaintively recollects, she was crying more than her baby. And she felt very unjoyously disconnected from her baby. Actually, for her, motherhood sadly was akin to a lingering nightmare. At first, the medical explanation given to Shields for her depressed feelings was that she was going through the “baby blues”, which likely would end when hormonal imbalances tied to postpartum hormonal shifts eventually corrected. Although Shields’ doctor raised the possibility of going on medication, she explains that she associated the taking of medicine, to remedy emotional problems, with shame, weakness, and failure. Shields was concerned additionally about possibly becoming drug addicted.

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As explained in Chapter Four, however, when Rowan was about two weeks old, Shields relented, and grudgingly started taking an antidepressant. But Shields’ self image remained yoked firmly to her professional identify; and the feeling that motherhood was interfering with her professional acting career continued to vex her. Shields’ efforts to gingerly navigate a course leading to a satisfactory balance between the competing demands of parenthood and her professional career garner further attention in later chapters.

The tenuous resolve of Shields to take antidepressant medication proved to be fleeting. As fleshed out, in Chapter Five, Shields abruptly pulled the plug on her antidepressant (without first telling her doctor), when she started to feel less hopeless. Before long, a flood of tears poured down. Feeling scared and desperate, Shields heeded her doctor’s advice to go back on antidepressant medication. Acting on her doctor’s belief that she might be suffering from postpartum depression, rather than simply experiencing the baby blues, Shields strived to self educate herself about postpartum depression. As Shields dug deeply to educate herself about postpartum depression, she uncovered an important realization: to properly address her severe emotional difficulties, she needed to talk about her feelings with a professional.

And in fact, as recollected in Chapter Six, Shields commenced therapy. The therapeutic experience proved to be cathartic. In therapy, Shields and her therapist worked hard to disentangle knotty emotional strands bound sorely to such issues as: what it means to bring a child into the world, the both frightening and thrilling rite of passage flowing from motherhood, and problematic mother child connectedness.

At the beginning of concluding Chapter Nine, Shields notes that over a year had passed, since Rowan’s birth. Although Shields was feeling stronger and happier, postpartum depression had been the most frightening and devastating challenge in her life. An important lesson imparted by this engrossingly instructive book is that it may be very dangerous medically for a depressed mother to seek to overcome depression without professional help, because an initial drizzle of symptoms may portend an eventual overwhelming deluge. Shields pensively muses, in the book’s last chapter, that she waited too long to seek professional help for her depression. And, in tune with this introspective rumination, Shields, in a pithy “afterword”, sounds the clarion note that a mother should seek professional help immediately, if she suspects that she may be suffering from some form of postpartum mood disorder.

Academically entrenched critics may carp that the book, although immensely interesting, is styled in an academically informal manner. And that, substantively, Shields draws from a well of anecdotal contents, thus significantly diluting the book’s academic potency. Moreover, in important ways, Shields’ personal experience with postpartum depression may differ substantially from the particular experiences of other mothers afflicted with this condition.

Yet, Shields’ willingness to describe, in detailed fashion, the thicket of thorny challenges she encountered personally may especially enthrall women suffering from depressive disorders, and their families. Shields’ riveting account may further be of absorbing interest to those with a professional interest in postpartum depression, including: psychiatrists, psychologists, fertility specialists, obstetricians, and pediatricians.

The Food and Drug Administration said in a letter to Lilly unit Elanco Animal Health, released Monday, that statements on a company website, in a veterinary magazine advertisement, and in other promotions suggested Reconcile was more effective than studies have shown and were misleading.

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Lilly’s materials touted the percentage of dogs that improved with Reconcile compared with a placebo, but failed to mention that both groups received behaviour modification training, the FDA letter said.
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The promotions “suggest that the product is more effective than has been demonstrated,” the FDA said.

The FDA asked Lilly to stop using the claims and to outline a plan to circulate corrective messages to the audiences that received the promotions.

The study results come after a controversial 2004 recommendation on antidepressant labeling from the U.S. Food and Drug Administration (FDA). That move slapped a strong “black box” warning on the labeling of drugs called selective serotonin reuptake inhibitors (SSRIs), which include Celexa, Paxil, Prozac and Zoloft.

The warning outlined the potential for an increase in suicidal thoughts among teenagers and young adults prescribed the medications. The warning also urged closer clinical monitoring of these patients.

However, “the FDA warning was based on placebo-controlled trials,” noted lead researcher Dr. Greg Simon, a psychiatrist and researcher at Group Health, a Seattle-based nonprofit health care system. “They did not look at suicide attempts, because they were too rare. In the whole group of studies the FDA looked at, there were only two suicide attempts,” Simon said.

The current trial, published in the July issue of the American Journal of Psychiatry, does focus on suicide attempts. It finds that pharmaceutical and psychotherapy treatments aimed at fighting depression reduce those attempts.

Simon’s study looked at suicide attempts among more than 70,000 people who got an antidepressant prescription from their primary care physicians, almost 7,300 people who got prescriptions from a psychiatrist and more than 54,000 who started psychotherapy for the treatment of depression.

“The pattern of [suicide] attempts over time was the same in all three groups: highest in the month before starting treatment, next highest in the month after starting treatment, and declining thereafter,” the report said. “Results were unchanged after eliminating patients receiving overlapping treatment with medication and psychotherapy. Overall incidence of suicide attempts was higher in adolescents and young adults, but the time pattern was the same across all three treatments,” the study authors found.

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The overall incidence of suicide attempts in the first six months was highest in those taking antidepressant drugs prescribed by a psychiatrist (1,124 attempts per 100,000), lower among those starting psychotherapy (778 per 100,000) and lowest of all among those who were taking antidepressants prescribed by a general practitioner (301 per 100,000).

The bottom line: “Our study indicates there is nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves or protect them from suicidal thoughts,” Simon said.

“Instead, we think that on average, starting any kind of treatment medication, psychotherapy or both, helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it,” he said.

The new report “is one of a couple showing that prescribing antidepressant medication for people who are depressed has the potential for reducing the number of suicide attempts,” said Dr. J. John Mann, chief of the department of neuroscience at the New York Psychiatric Institute, New York City.

Mann co-authored one such report, which relied on U.S. Veterans Administration data. “We found exactly the same thing” as the Simon report, Mann said. “Antidepressant treatment resulted in lower rates of suicide attempts after people went on to treatment.”

Such studies “suggest that these medications may be more beneficial than has been thought in the past,” Mann said. “If there is a risk in these medications, it clearly is outweighed by the benefits. No treatment is the worst option of all.”

Simon also pointed out that the FDA warning reduced use of SSRI drugs for treatment of depression, but it has not appeared to increase doctors’ monitoring of young people who are taking the drugs. The standing recommendation for three follow-up visits to the therapist prescribing antidepressant drugs was observed in only 21 percent of cases, the researcher said.

“That is where we are poor in practice,” Simon said. “My concern is that the practical impact of the warning was [only in] reduced rates of treatment.”