Antidepressants are now prescribed more often than any other drug for any chronic condition except high blood pressure. But much of the news about those drugs is troubling:

• In December 2006 the U.S. Food and Drug Administration concluded that antidepressants slightly increase the risk of suicidal thoughts and possibly suicide itself in people up to age 25 or so. One month later a study suggested that the drugs might increase the risk of fractures in those age 50 and over.
• Doctors often prescribe drugs for emotional problems when self-help steps or talk therapy would suffice, experts believe. Or they fail to recommend adding those measures to drug treatment. At the same time many experts worry that the suicide and fracture concerns may scare away some patients who do need medication.
• When antidepressants are justified because of major depression--feelings that interfere with sleeping, eating, or working for more than three weeks--doctors often prescribe newer, heavily advertised versions when older, cheaper ones would be at least as safe and effective. And doctors rarely provide the necessary information or schedule the needed follow-ups to ensure safety, compliance, and effectiveness, studies suggest.

The answers to the following nine questions will help ensure that you get the right treatment for depression.

Probably not, unless you suffer from major depression or have been seriously depressed before. If the feelings are milder or have just started, it's usually best to resist rushing to drugs.

Being mildly depressed at times is a normal part of life, especially in the wake of stressful events. And "you want to avoid the risks of medication if you can, and develop the skills to cope with those feelings and triggering situations," says Gail Saltz, M.D., associate professor of psychiatry at the Weill-Cornell Medical College in New York City.

Aerobic-style exercise is one good way to start. In a Consumer Reports survey published in 2005, one-third of the 724 depressed people who started working out said it helped a lot, and half said it helped somewhat.

Being mindful, or attentive to the present moment, during your exercise can be especially effective against the blues. Other activities that encourage awareness, such as yoga, tai chi, meditation, or deep breathing, provide similar emotional benefits.

Religious or civic activities, volunteer work, or just contact with close family members or friends can also help. Opening up to someone can not only provide a sympathetic ear, but also "strengthen your relationship, which can itself provide comfort," Saltz says.

Some people may get relief through cognitive strategies other than mindfulness, such as writing about their problems. Others benefit from the opposite approach, such as interrupting their negative thoughts or feelings by literally telling themselves to stop, or by focusing on good rather than bad memories. Simply reading a book or taking a class on those techniques or the various mindfulness approaches may provide enough guidance. Or consider seeking a therapist who specializes in such methods.

A few may provide modest benefits. The American College of Physicians says that St. John's wort can be considered for short-term treatment of mild depression. Look for products that claim to contain about 0.3 percent hypericin or 5 percent hyperforin. Limited research suggests that fish oil, folic acid, and the nutritional supplement SAM-e may help somewhat, too.

But if you suspect you have major depression, or regularly take any medication, talk with your doctor before taking a supplement. Severely depressed people need regular contact with a health professional. The supplements, especially St. John's wort, can interact with many medications. And the government rarely checks their contents.

That depends partly on personal preference. In addition, decide whether you're more concerned with fast relief or lasting improvement, and whether you're willing to undergo both therapies to maximize the benefits. Another Consumer Reports survey, published in 2004, found that people who said their therapy was "mostly medication" noticed mood improvements sooner than those who had "mostly talk" therapy. But the talk group had better long-term outcomes. The most successful patients received a balance of drug and talk therapies.

It's best to get several candidates from your primary-care doctor and, if possible, several other people. Find out whether your insurer will reimburse you for those practitioners. Then try to speak to each candidate by phone or in person.

It's more important to check whether you'd feel comfortable with a therapist than to focus on credentials. People tend to get equally good results from psychiatrists (medical doctors who can prescribe drugs), psychologists (who have a Ph.D.), or clinical social workers (who have a master's degree), research suggests.

In general, choose a practitioner who uses one or both of the two approaches that offer the best short- and long-term results for depression: interpersonal therapy, which focuses on relationship problems, and cognitive behavioral therapy, which trains you to identify and correct distorted thought patterns.

Probably not. Interpersonal therapy is best suited for depression, while cognitive behavioral therapy works well for either problem. In some cases therapists combine aspects of both approaches. And the first-line drugs for anxiety are selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac and generic) and citalopram (Celexa and generic), the same drug class typically used for depression.


That depends on your age. The 2006 FDA analysis found that the drugs raise the risk of suicidal thoughts and behavior until age 25 or so. But they actually reduce the risk in people over that age, especially after 65, according to the FDA's findings. And the risk of such thoughts and actions before age 25 is relatively small: about 7 per 1,000 on antidepressants compared with 3 per 1,000 taking a placebo. Experts emphasize that medication is still appropriate for young people, provided they clearly have major depression and adequate precautions are taken.

The fracture study, published in the Archives of Internal Medicine in January, found that 13 percent of older people on SSRIs broke a bone during a five-year period, compared with 6 percent of those not taking the drugs. But it's possible that depression itself caused the increase, by making falls more likely or by somehow weakening the bones.

Anyone taking an antidepressant should be monitored regularly for warning signs of suicide, notably talking or thinking about it, giving away possessions, and expressing hopelessness. That's particularly important during the first month or two of treatment or when dosages change. Even older people should be watched, since the depression increases their suicide risk despite the protective effects of medication.

Similarly, people age 50 or over who take an antidepressant should protect their bones by getting plenty of weight-bearing exercise, consuming enough calcium and vitamin D, and talking with their doctor about bone-mineral-density tests and, if necessary, bone-strengthening drugs.

Yes. In our survey, published in 2004, some 40 percent of the antidepressant users reported a drop in sexual interest and performance, and almost 20 percent said they gained weight. Other side effects include nausea, headaches, and drowsiness.

Your doctor may be able to minimize those problems by starting with a very low dose and increasing it only if necessary. If you experience adverse effects, don't stop taking the drug on your own, since that can trigger worse problems.

Usually not. Those drugs include escitalopram (Lexapro), the latest SSRI, as well as duloxetine (Cymbalta) and venlafaxine (Effexor), members of the newest class of antidepressants, serotonin norepinephrine reuptake inhibitors (SNRIs). There's no evidence that they're safer or more effective than older, cheaper drugs for most people. In fact, the SNRIs not only pose the same risks as SSRIs but can also cause sweating, abnormal heartbeats, and urinary retention.

Most people who need antidepressants should start with generic versions of the SSRIs fluoxetine or citalopram, which have long safety records, or generic bupropion, an unrelated drug that appears less likely to cause sexual side effects. One possible exception: People suffering from chronic pain as well as depression could try duloxetine first, since it can ease both problems.

But 30 to 40 percent of people don't respond to their first antidepressant. If you see no improvement within 8 to 12 weeks, ask your doctor about trying a higher dose or adding or switching to a different drug, possibly a new one. For more information about the other antidepressants, go to www.ConsumerReports.org/health and click on the Consumer Reports Best Buy Drugs logo.