For UW-Madison sophomore Becky*, the decision was easy.
Becky sat upright, her hands clasped together and resting on the table. The tension in her body matched the tension in her voice as she recounted the details of the depression she suffered her sophomore year of high school.
Her eyes darted from me to the floor, she fidgeted nervously, recalling how even the most trivial things would make her angry.
[I felt] sad, lonely and I didn't really care about anything,"" she said. ""I didn't want to do anything. I just wanted to sleep all day.""
After seeing a psychologist for a few months with little improvement in her mood, Becky was referred to a psychiatrist who prescribed her antidepressants. Although her parents and her psychiatrist encouraged her to try the medication, it was ultimately her decision.
As soon as she began taking the medication, Becky noticed her mood gradually improving.
""You just notice some things don't make you as depressed as you were,"" she said. ""You're able to do things you couldn't do before - things other people wouldn't think of as big things - but when you're so depressed you can't do anything like go out with friends.""
According to a 2007 article on CNN.com, 25 percent of adults and 8 percent of adolescents will experience at least one major depressive episode in their lifetime.
As of 2004, 10 percent of women and 4 percent of men over 18 take antidepressants, according to the Centers for Disease Control and Prevention. A 2004 article in Knot Magazine reported more than one million teenagers take antidepressants.
Furthermore, the article cited a government study that concluded antidepressants are the most commonly prescribed drugs in the United States. In fact, the CDC conducted a study showing out of 2.4 billion drugs prescribed in 2005, 118 million were antidepressants.
According to UW-Madison educational psychology lecturer Hugh Johnston, depression has multiple causes, including genetic factors, environmental factors and chemical imbalances. Any one or a combination of these factors can cause depression.
Despite frequent success in treating depression, UW-Madison clinical assistant professor of pharmacology Eric Heiligenstein said no one is entirely sure exactly how antidepressants work.
""There is a very broad hypothesis that they affect neurotransmitters ... [but] the true mechanisms are probably much more complex,"" Heiligenstein said.
In fact, Heiligenstein said most antidepressants were discovered accidentally ""in the sense of knowing a certain substance elevates someone's mood and not knowing why.""
But antidepressants can do a lot more than just elevate someone's mood. Some physicians are concerned the side effects commonly associated with antidepressants are reason enough to have second thoughts before prescribing them. While there are several classes of antidepressants, and even distinct variability between drugs in the same class, a few overarching side effects are prevalent in many antidepressants. These side effects are sleep disruption, anxiety, agitation and nausea. The most controversial side effect, however, is the increased risk of suicidal thoughts and behavior.
According to a July 2007 article in the Harvard University Gazette, a 2004 Food and Drug Administration study observed a group of children and adolescents taking antidepressants, and another group taking a placebo. Of the subjects taking antidepressants, 4 percent admitted having suicidal thoughts. Only 2 percent of those taking the placebo reported the same.
The article also cited a study from the Archives of General Psychiatry that found of 263 suicidal patients, 46 percent of the patients under 18 had taken antidepressants before their attempted suicide while 36 percent did not.
In 2004, the FDA administered a black box warning - a mandatory label on prescription drugs warning of possible adverse side effects - for all antidepressants. The warning informed children and adolescents of the drugs' potential to drive patients to think about or attempt suicide.
However, the FDA recently suggested expanding the warning to adults up to age 24.
Despite the FDA's warning, the threat antidepressants actually pose remains a highly controversial topic among experts.
UW-Madison pharmacology professor and psychiatrist Barry Gidal explained one theory of why antidepressants may lead to such desperate measures.
""One of the problems is that sometimes the patient can be very down, very depressed and have really low energy,"" Gidal said. ""The fear is that we've [given antidepressants to] this very depressed patient who may have been thinking about harming themselves, but just didn't have the energy or the motivation to go out and do that. Well, now they've got more energy.""
However, Johnston had a different idea about the controversy behind the black box warning.
""There is a set of behaviors that people label as suicidality,"" he said, examples include scratching at the wrists and writing suicide notes.
Johnston said that while some people exhibit these behaviors because they truly intend to kill themselves, others just want attention.
""You want to make that boyfriend who was smooching the cheerleader feel guilty,"" he said. ""That's a much different goal than trying to get dead.""
Consequently, Johnston said there is quite a bit of confusion ""about the data and the terminology and what the data actually means.""
Johnston remains concerned the black box warning discourages some depressed individuals from taking antidepressants and, as a result, many of them committed suicide because they did not receive the help they needed.
One possible solution to counter this fear of suicide is to closely monitor patients on antidepressants in addition to providing them with psychotherapy.
""The medication turns things around enough that you can in fact address some of their ... perfectionism or relationships that aren't going right and so on,"" said Robert Mcgrath, director of counsel services at University Health Services. ""It's like some of the other stuff is improving [to the point] where you can in fact address some of the things that are not going right in their life.""
However, Johnston pointed out some people don't have the resources to see a therapist for an extended period of time. He believes it is generally safer for these people to take the medication than to go untreated.
""It's very easy to stand up and say it should be this way, it should be that way, but the world is a practical place and sometimes things aren't always as they should be,"" he said.
While depressed patients lives' often have dysfunctional aspects needing attention, depression still contains certain biological components that antidepressants are used to correct.
""It's important for people to realize it's a medical disorder, it's a neuro-chemical, biological disorder and it can be treated,"" Gidal said. ""There are medical resources on this campus that can help, and people shouldn't have to suffer through it.""
*Name changed for privacy
