Examining the broad reach of depression

Bayard said people would ask him, "How's it working?" and he would reply, "Fine, I guess. I don't know."

"There was no 'Eureka!' moment where the sun burst open into the room," he laughed.

According to Dr. Friedman, the answer to the question of whether antidepressants work depends on whom they are given: "If you give them to people who have sadness but not depression, they aren't going to do anything, because they don't have the disease for which the drugs are designed. And in general, if you give them to more severely-depressed people, they're highly effective."

But he says, unfortunately, THOSE people - the severe cases - too often don't get help, while the mildly-depressed (and the just plain sad) may end up on an antidepressant. One possible problem: 65 percent of all such prescriptions are written not by psychiatrists but by primary care doctors.

Bayard went to his primary care physicians, who was away on vacation, and so another doctor (who did not know him) prescribed his medication. "They didn't know me at all - and it was actually the most efficient medical transaction I think I've ever had," he laughed. "I walked in and within 20 seconds I had a prescription for Lexapro. And I think even a prescription for three refills after that. So I was ready to roll."

That was four years ago. Bayard says he feels much better today, but has no idea if Lexapro has anthing to do with it. "I ask myself why because I don't necessarily think the pill works. And I think it's the same reason an agnostic would go to church: Just in case. I'm going to cover my bases."

Louis Bayard is not alone in his uncertainty. Depression is almost as big a mystery today as it was at the dawn of medicine.

Wakefield says even today we still do not know why people get depressed. "We are putting drugs into people's bodies that may be helpful, and that's necessary sometimes in medicine. But if you ask, can we say for sure what the mechanism is that caused the depression, and by which these drugs are helping, and what the long-term effects if you stay on it for endless years - we just don't know. That's the reality."