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Becoming Unblued

Move over Prozac. Try cognitive therapy for a drug-free way to treat depression.

With this issue, Mother Jones inaugurates a new health column by contributing writer Michael Castleman. He is the author of eight books, including Nature's Cures, which investigates the science behind 33 alternative therapies.

What should you do if you feel persistently blue? These days, people with depression are more likely than ever to be given antidepressant medication. But for those with mild to moderate depression, there's an equally effective alternative: cognitive therapy. Cognitive therapy is a deceptively simple, do-it-yourself approach based on the idea that depression is often triggered by distorted thinking -- and relieved by correcting it.

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Unfortunately, cognitive therapy is ultra-low-tech, and Americans love high-tech -- as do the pharmaceutical companies that spend millions marketing high-tech, high-profit antidepressant drugs. In 1989, they developed a very good one, Prozac, which has hogged the depression spotlight ever since. Within two years, it was the nation's most widely prescribed antidepressant. And for good reason: It was as effective as other drugs, but with fewer side effects.

Prozac's release coincided with a profound shift in scientific thinking about depression. Instead of the traditional belief that the condition resulted from psychological conflicts treatable only through long-term psychotherapy, an insurgent group of biological psychiatrists said depression was caused by a chemical imbalance in the brain and could be cured by medication that normalized brain chemistry. Because pills are so much cheaper than weekly therapy sessions, managed care has enthusiastically embraced Prozac and its newer cousins -- Paxil, Zoloft, Serzone, Effexor, and Wellbutrin -- all chemically known as selective serotonin reuptake inhibitors, or SSRIs. An estimated 17.6 million Americans suffer from depression each year, and last year pharmaceutical companies sold U.S. drugstores $3.5 billion worth of SSRIs.

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