I was 18 years old when I was diagnosed with depression.

These words are hard for me to write. I’ve always been embarrassed by my depression, afraid of what people will think of me once they find out. Depression isn’t an easy word to say, no matter how many times you say it.

The stigma was one of the worst parts, more painful than any rainy day could possibly be. More than anything I wanted to be normal, but ask anyone with depression and they’ll tell you normalcy simply doesn’t come with the package.

Looking back, I see the symptoms brewing in my high school years, but it’s always been difficult for me to distinguish between normal teenage angst and depression.

Like many young women my age, I started noticing the initial warning signs in my first year of university. The dramatic and frightening shift from the comfort of living at home to the sheer chaos of an all-girls dormitory took its toll on my self-confidence and my mind.

I had a hard time making friends, and as a result spent a lot of my time alone. I did have my boyfriend, but by that time the unfortunate side effects of depression had started to drive us apart. We fought constantly, and he distanced himself when he couldn’t figure out what was wrong with me.

It’s hard to tell what exactly brought about my depression. Perhaps it was the stress of freshman year, but I always thought it had something to do with the loss of my grandparents. After losing two family members in less than two years, my grasp on reality started to fade and the shadows of hopelessness set up camp in the crooks and crannies of my mind.

That summer after my first year of college, things went downhill. I couldn’t stand to be around the people I loved. I was bitter and frustrated at my inability to feel happy, and like most people who suffer from depression, my family bore the brunt of it.

On the outside, I was fine. I went to work and laughed all day with my friends. I was a different person there. When I was at work, nobody knew I was depressed and unhappy. I was free. But at home, things were different. I snapped at my parents and yelled at my boyfriend for no reason at all. I cried when something spilled, or when someone dared to yell back. I hated myself, for the person I was and for the person I was quickly becoming.

I still remember the first time I realized I had depression. I was sitting on the living room couch, dreading the moment my parents came home. They always asked how my day was, and at that time my days weren’t great.

This particular day, my mom sat down on the opposite couch, looked at me for a few minutes, then asked, rather hesitantly, what was wrong.

“I think I might have depression,” I told her. She was silent for the next few minutes but it seemed like hours. My dad walked in the room, unaware of the awkward tension, and made a joke about the cat. He sensed something was happening between my mom and I, that special way men who live with women do, and disappeared upstairs.

“What did I do wrong?” my mom asked me, struggling to keep her voice steady. “I mean, as your mother. What did I do?”

This conversation came up frequently over the next two years. Despite my family history of depression and destructive self-scrutiny, my mom always insisted that somehow my depression was her fault. It got to the point where I couldn’t talk to her about what I was feeling, because she would often direct the conversation towards her own perceived shortcomings.

Two months after our initial conversation, I finally agreed to see our family doctor. My mom insisted on making the appointment, and in an effort to get my name to the top of the waiting list, she told the receptionist I needed to see the doctor for depression. Walking into that clinic was so embarrassing; I could feel the receptionists’ eyes burning into me. That’s the thing about small towns, everybody knows your business. And when your business is something as stigmatized as mental illness, you can easily feel like the town leper.

I cried in the doctor’s office, telling the sympathetic blonde doctor how I never seemed to be happy, how my life spiraled downhill since the loss of my grandmother the summer before. I told her about my constant irritability and lack of interest in the things I used to love.

She listened to me speak, nodding her head and tapping her foot on the leg of her chair. But the minute I told her about my grandmother’s history of depression, her notebook came out. She scribbled something down on her pad and looked up at me with an air of satisfaction.

“I’m going to give you a prescription for Paxil, 20 milligrams,” she said. “Take it each day for two months, then come back and we’ll see how it’s going.”

That was it. I spent more time in the waiting room that day than I did talking to the doctor. Those 10 minutes changed my life, changed my perception of happiness and changed my self control.

I filled the prescription, against my mother’s advice. Things were different after I started taking the medication. I had a hard time focusing, and at times it seemed like my depression got worse. But I kept taking the pills, reassuring myself that I was in a period of adjustment, that my body would eventually accept the medication and allow it to fix me.

I went back to my doctor two months later. My mood hadn’t changed much, but it hadn’t gotten much worse, either, so she gave me a 12 month prescription and sent me on my way.

I didn’t think much of it at the time. Sure, I thought it was strange that she was so quick to hand me pills for something I may or may not have, but I never questioned her authority. I also never questioned the lack of options I was given when diagnosed with a disorder that has no surefire cure.

I never thought about what these drugs would do to my body and my mind, nor was I given details by my doctor. Perhaps most importantly, there was never any question of how long I would be on Paxil, let alone how hard it would be to eventually quit.

* * *

I wasn’t alone in my struggle for normalcy. According to recent Health Canada research, roughly one million Canadians suffer from depression; one in 10 will develop it at some point in their lifetime. Around 20 per cent of these sufferers are teenagers and young adults. Twice as many sufferers are women.

The same year I was diagnosed with depression, Natalie,* a second-year university student, visited her doctor complaining of the same symptoms.

“I was never happy,” the 21 year-old says. “I was tired all the time. It really started to affect my life, being tired and unhappy all the time. I had extreme anxiety and stress. There would be times when I was just paralyzed and I couldn’t do anything at all.”

She says she started to notice the symptoms of depression in high school, but it tended to manifest itself in the form of anxiety attacks. She saw a counsellor for anxiety, but stopped once she moved away to university.

It wasn’t until her second year of university that the depression set in. A self-proclaimed over-achiever, Natalie says the combination of a rigorous school schedule and a predisposition to anxiety gradually led her down the road to depression.

“I finally decided to go to the doctor about it, and they said I had depression. It was almost like a math equation; you have these symptoms and they’re going to give you these pills and it’s going to make you better.”

Over the next year and a half, Natalie went from antidepressant to antidepressant, switching dosages and desperately trying to find something that worked. Throughout most of that time, she was on more than one medication, all on the advice of her doctor.

“The antidepressants lost their effectiveness and I was more depressed than I was before I went on them,” she says. “[My psychiatrist] just gave me more drugs or upped my dosage. It was almost like trick-or-treating, every time I went in for an appointment they would just give me something new.

“It was so impersonal, like I’m a number or cattle being pushed through the trough of drugs in front of me. It just made my depression worse.”

Natalie says while her doctor stressed the importance of antidepressants, she never once recommended seeing a counsellor or a therapist, and her doctor never mentioned at what point she should stop taking the medication.

“There was no mention of therapy,” Natalie says. “It felt like they were putting a Band-Aid on it and shoving me out the door.”

Part of the problem, Natalie explains, was the infrequency and brevity of appointments. Rather than attempt to address some of her psychological or emotional difficulties, her doctor preferred to prescribe pills and send her on her way.

According to Dr. Stanley Kutcher, an internationally renowned expert on adolescent mental health and a professor of psychology at Dalhousie University in Halifax, this style of medical practice is not appropriate for handling mental illness.

“We have a health care system that is unresponsive to dealing with people with mental disorders,” Kutcher says. “It makes it very hard for people with mental disorders to get the kind of care they need.”

Medical guidelines dictate that when a doctor prescribes her patient antidepressants, she should see that patient again in a week, and then again at regular intervals to ensure the medication is working and is not inducing serious side effects. But, as Kutcher says, these are merely guidelines, and doctors are not forced to follow them.

“There is good medical practice and what’s called bad medical practice. Good medical practice means you do a proper patient history, you do a physical exam and blood tests, because sometimes there are diseases that mask as depression,” he says. “If you do all that it should take an hour-long appointment, or several 20 minute to half-hour appointments.”

Kutcher says a number of doctors are cutting corners and applying the physical health model to a mental health problem. The health care system was initially built to cater to physical injuries and illnesses: things that are visible and require only 10-15 minutes in the doctor’s office. Depression, on the other hand, is much harder to diagnose, as there are no medical tests that determine whether a patient is actually suffering from it.

Because of this, many doctors end up misdiagnosing patients who are suffering temporary distress with clinical depression, and patients that require medication are not provided with the proper follow-up to ensure the medication is working.

“Most people confuse emotional distress with depression as the chemical syndrome,” Kutcher says. “Emotional distress is normal, the regular stresses and strains of everyday life, like if your boyfriend or girlfriend breaks up with you or you lose a job. These may cause us to feel depressed, but that’s distressed, not depressed. You don’t just wake up one morning and have clinical depression.”

This confusion between distress and depression may be a leading factor in the recent skyrocket in rates depression and antidepressants, as it is impossible to distinguish between the two in 15 minute doctor appointments.

“It may be difficult to discern or a doctor doesn’t know how to discern between what’s distress and depression,” Kutcher says. “Most doctors and nurses are not being trained in how to tell, so what we really need to do is provide that proper training.”

Despite this, Kutcher was reluctant to admit whether the confusion between distress and depression led doctors to wrongly diagnose a significant number of patients with depression or prescribe them medication they didn’t need.

Dr. Rice Fuller, director of Counselling Services for the University of New Brunswick, was not as cautious to describe the mass misdiagnoses of depression.

“People are very quick these days to diagnose and prescribe,” Fuller says. “And it does result in a significant over-diagnosis of depression. The doctors are under pressure, they only have a short period of time with patients and in addition they’re getting a very strong message from the companies that market these drugs that they’re very safe to use and have very few side effects, and for the most part that’s true, but that still doesn’t mean that you should use them.”

Kutcher says he is not concerned with putting patients who don’t require antidepressants on medication, as they are proven to be safe. He says the risk of denying a patient with depression a prescription is too high, which causes many doctors to prescribe out of fear rather than need.

“The end treatment is a decision of the risk of the treatment and the benefit of the treatment,” he says. “What will happen to this person if I don’t treat them? The risk for not treating someone with antidepressants is suicide, but with treatment you decrease that risk right away, so it’s safer to provide treatment. The benefits outweigh the risks.”

Fuller disagrees with Kutcher’s assessment that antidepressants should be diagnosed in most circumstances.

“It’s the idea of the quick fix, and there really isn’t a quick fix. The idea that if I’m not feeling so good, I should go take some medication,” he says. “Well, you’re not likely to make changes in your life that need to be made if you’re relying on this medication.”

Twenty-six year-old Patty* can attest to the qualms over the quick and dirty solution to depression. She remembers being put on antidepressants at the age of 15 for what she thinks may have only been normal teenage hormones.

“I was going through a lot of things at the time, family deaths and that sort of thing, but I think a lot of it was adolescent hormones and growing up,” the Toronto waitress says. “It’s hard to differentiate between that and clinical depression.”

She says she went to the doctor for chronic fatigue, lethargy and rapid weight loss. She left with a prescription for Paxil.

She says she can’t remember much about the year she was on antidepressants, but she does remember desperately wanting to get off them.

“When I first went on [Paxil] I was a bit skeptical, but I believed what the doctor said,” she says. “He told me it would take six to nine months ‘til it was effective, but after nine months I didn’t notice a huge improvement.”

Patty says she went back to the doctor after nine months to say the medication still wasn’t working, but was encouraged to stay on the pills.

“I thought to myself, ‘Why would I keep with it if it’s not working? Why would I put my body through this?,” she says. “So I said to him ‘Absolutely not,’ and I weaned myself off them after that.”

Rather than depending on a pill to solve her problems, Patty took a more active role in digging herself out of depression, mainly through exercise and forming a close relationship with her mother.

“When my mom took me to see a psychiatrist for the weight loss, and it was evident that I wasn’t on drugs and I didn’t have an eating disorder, that brought us together. Being able to lean on my mom was as helpful as much as anything, and talking to friends about it really helped me too,” she says.

“What worked was knowing and accepting that that’s what I was going through and making a conscious effort to try and do things to bring myself out of it.”

It’s been 12 years since Patty stopped taking Paxil. While she admits she felt ostracized and stigmatized when she was going through depression, she says it’s becoming increasingly common among her peer group, particularly among young women. But what she finds most shocking is the prevalence and severity of depression-like symptoms among school-age girls.

“I’ve been volunteering at a centre for adolescent girls and it’s amazing how many young girls are going through this,” she says. “We have a question box where some of the girls can write a question down that they’re not comfortable asking us face-to-face, and some of the things we’re getting are dealing with suicide and self-harming. These are 12 and 13 year-old girls.”

According to Dr. Kutcher, people who have one episode of clinical depression throughout their life should be medicated for at least a year, while those who experience more than one episode should be medicated for life. But Dr. Fuller says just because there is no evidence to prove antidepressants are unsafe to take for prolonged periods of time doesn’t mean they should be prescribed that way.

“We don’t have a very good idea of what the long term physical consequences of antidepressants are,” Fuller says. “Are there long-term changes that occur in the brain, and are they positive or negative, or are there no changes? We don’t know that yet.”

Fuller says that while he doesn’t doubt the effectiveness of antidepressants in certain circumstances, he does believe there are better treatments for depression that don’t involve medication.

“A particular form of therapy called cognitive behavioral therapy has been shown in head-to-head trials with antidepressant medications to have continuing positive effects after the treatment ends,” he says. “So both medication and therapy when compared to one another work just as well when the treatment is going on, but when the treatment ends, there are lasting effects from therapy and not from medication. So in therapy you actually make changes in your life, whereas with medication you just take this pill every day.

“I’m not opposed to medication, but I do think it’s handed out more than a little too frequently.”

A little too frequently may be an understatement, as an estimated 5.8 per cent of all Canadians were reported to be on antidepressants in 2005. That same year, only 4.8 per cent reported having a major depressive episode, suggesting more people are on antidepressants than are needed.

“There are these advertisements in magazines and on television for antidepressants, so that’s likely to have an effect on people,” Fuller says. “It’s just in the air that we breathe, all this talk about depression and it makes sense that the more people hear about it the more they are to think maybe they’re depressed. If the knee jerk response when you go to your family doctor is to get antidepressants… Well I just don’t think that’s a good thing.”

Fuller points to a group of studies released earlier this year that showed antidepressants to be as effective as placebos in people with mild to moderate depression as proof that medication is not always the right answer. Fuller says the vast majority of Canadians diagnosed with depression are considered to be mild or moderate, so there is no need for such a large per cent of the population to be taking antidepressants.

In line with Kutcher’s assessment, Fuller believes doctors should take a slower and more cautious approach to diagnosing patients with depression and prescribing antidepressants.

“If there are indications that this person is suffering from serious depression, such as disturbing thoughts of suicide, weight loss because they’re not eating or they’re not getting out of bed because they’re so depressed, then they may need more aggressive treatment which may include medication,” he says. “But for a more moderate to mild depression I’m in favour a slower approach, and I think that approach should often involve some therapy first rather than medication.

“The dirty secret of mental health is that most cases of depression remit spontaneously without treatment, so the vast majority of people who are depressed will spontaneously remit over a period of months without any treatment.”

Having overcome depression without the use of antidepressants, Patty agrees with Fuller’s assertion that medication is not always required to treat the mental illness.

“I don’t think medication by itself can help anyone,” she says. “But too many doctors are anxious to give people a quick fix because that’s what most people are looking for.

“But you need to be aware of what you’re going through. Too many people feel guilty about it, and rather than seeing yourself as a victim of depression, you should fight it and get through it.”

* * *

After a year and a half of being on numerous antidepressants, Natalie finally decided it was time to take control. She says she felt like the medication made her ignore the cause of her sadness, masking it with the promise of a quick and easy fix.

“It was like I was dependent on them. I blamed them for my problems. I’d never actually delved into it, it was just like I’m feeling depressed, so they put me on drugs,” she says. “[The doctors] gave me these drugs and expected everything to be okay. It’s a band-aid, really.”

In December, Natalie started weaning herself off her antidepressants. She says her grades started slipping ever since she started taking the pills, and she felt like it was time to quit.

“I was tired of taking them,” she says. “I had been on them forever and I just wanted to be rid of them.”

When Natalie finally stopped taking the medication altogether, she suffered from discontinuation syndrome. After being on a medication that affects the brain for so long, Natalie’s body had a hard time adjusting to being on its own.

“It was really bad,” she says. “I got shaky and my hands went numb. I had these brain shivers. I always felt disoriented.”

Once her body got over the initial shock, Natalie said she was on the lookout for a difference in her mood. But, she says, the biggest surprise was that there was no difference at all.

“It was really weird, because I find no difference at all being off the medication than when I was on the medication,” she says. “I’m in a different state of mind than I was before. I take time for myself and I do things that make me happy. I do have bad days but I just go through them and hope the next day will be better.

“I don’t feel like I need the antidepressants.”

* * *

It’s been four months since I stopped taking Paxil. It took me a little over a year to quit. It’s hard to explain why I wanted to get off the medication; I guess I just didn’t like the idea of taking a happy pill every day for the rest of my life. I felt like I had no control over my own mood or happiness, like I needed a drug to get me through the day. That didn’t seem natural.

I weaned myself off the medication slowly. I took half a pill for the first nine months, then a quarter pill for about four months. My doctors didn’t approve. Every time I went in for an appointment or a prescription refill, I would tell them I was trying to get off the medication. Every one of them gave me a concerning frown and strongly suggested I go back up to the full dosage.

It was one of the hardest, most torturous things I have ever done. I failed quite a few times, like when I was having a bad day. On those days, it seemed simpler to go back up to the full dosage than to deal with whatever was making me sad.

The physical side effects of stopping the medication weren’t what made it so hard. I could handle the confusion, headaches, and what are commonly known as ‘brain zaps.’ But, as Dr. Fuller says, it was the thought process that kept me going back to the bottle. After two years of relying on a pill to make me happy, I came to accept that maybe happiness really did come in a bottle.

I started noticing a difference about a week after I stopped taking Paxil. I guess the biggest shock was that there was no difference at all. I wasn’t more upset or sad, and I didn’t have any major bad days like I had while on medication. My head felt so much clearer, and I knew that when I was happy, it was because of me, not a pill.

It was the greatest feeling in the world.

*names have been changed for confidentiality