Three courageous people share their secrets for climbing out of the depths of despair.

Striding into the conference room full of writers, artists, and editors, 49-year-old James Clay* whipped off his jacket, draped it around a chair at the front of the room, and picked up a big black marker.

"Okay, people," he announced as he moved toward a giant pad of paper on an easel. "Let's get this project started." And with an irrepressible grin that told everyone in the room just how much he loved what he was doing, James Clay, a man who had been reserved, depressed, and impotent just months before, began to outline an innovative strategy that might well set the publishing industry on its ears.

An Angry Man
Five, ten, even fifteen years ago, James Clay would never have had the energy, the will, or the guts to stand up in front of a room full of people.

"I just couldn't do it," he admits with a steady look from behind his round, wire-rimmed glasses. "I was always an observer, a listener. I couldn't be positive about anything; I just couldn't get going. I was angry a lot of the time, and because I couldn't do much about it, I thought I was a weak person."

In fact, James is anything but weak. He's a bright, energetic man with a passionate heart and a briefcase full of ambition. But he didn't know it until he was diagnosed with clinical depression-and got the right treatment.

Clinical depression is a serious, life-threatening disorder that will affect as many as 20% of women and 10% of men at some time in their life. It's the leading cause of disability not only in the US but around the world.

At any given time, 5 to 10% of women and 3% of men are depressed. And although there are more effective treatments today than ever before, 80% of those who are depressed go undiagnosed and untreated.

Unfortunately, most depressed people think they are the problem- that something's wrong with who they are or how they're made. And actually, they're half right. Scientists suspect that depression is caused by misguided genes that make you vulnerable combined with stress.

"The first time I really heard the word 'depression,' I was in my 30s, and my wife and I went into marital counseling," says James. "I'd been to three shrinks before that, but none of them had actually said I was depressed. It was like, 'Well, I had to put something down on your medical forms, so I put down depression.'"

Then one day while James was attending a therapy session with his wife, he erupted into a white-hot rage, lambasted his wife and therapist, told them to go to hell, and ran out of the room. When he got himself together enough to talk with the therapist several days later, the therapist bluntly told James that such extreme rage was an indication of clinical depression-and that his anger was not just a problem but a symptom.

"It was so hard to recognize," says James. "All my life, there had been so much in the world to really be angry about-the Vietnam War, the upper-class social crap going on around me, the corporate bull I had to put up with every day. The anger hid my depression."

One Solution: Find the Right Antidepressant
James's therapist sent him to a psychiatrist with the recommendation that he start Paxil, a popular antidepressant that not only didn't work for James, but also caused many side effects, including impotence. So he asked for something else.

The something else was Zoloft, a highly effective drug for many people. James was tired most of the time, and he had trouble generating enthusiasm for anything, but at least his sex life was back.

He tolerated the fatigue and emotional blandness for 3 years. Then a new therapist suggested that he might have more energy with Prozac. "I started on 20 mg every other day.

It worked wonders," says James fervently. His energy is high, his sex life intact, his anger under control.

"After all those years," he says with a sigh, "it's wonderful just to be me."

There are more than 30 antidepressant drugs available in the US, including older medications such as monamine oxidase inhibitors (MAO inhibitors), including Nardil and Parnate, and heterocyclic drugs such as Elavil and Remeron. Among the most prescribed drugs are the newer selective serotonin reuptake inhibitor (SSRIs) such as Prozac, Paxil, and Zoloft, which have fewer serious side effects for most people. Each category alters brain chemistry in a slightly different way, which may account for why different antidepressants work for different people and why one antidepressant doesn't work for everyone. All the drugs are equally effective, offering relief to 60 to 80% of those who take them.

Not everyone has the hands-down success with medication that James did. And as New York City businesswoman Jill Brooks* discovered, what works once may not necessarily work a second time.

Jill had her first depressive episode after a messy divorce at age 45. At the time, she tried a combination of medication and psychotherapy, which helped. Then she went back to work, established a wildly successful career, raised her children, traveled all over the world, developed a circle of intelligent, caring friends, and had a rich, wonderful life for 20 years. And she continued with her medication and therapy.

But at age 65, Jill's career came to a crashing halt. The company for which she worked was taken over by another, and she experienced a major depressive episode-"a real breakdown," says Jill grimly. She fought both the takeover and the depression, but when the company offered her a severance package, she took the money and ran. Then she bought a glamorous apartment in New York City to cheer herself up. It didn't work. "I had everything I'd ever dreamed of," says Jill. "I had the apartment of my dreams, wonderful friends, grandchildren-but I was still depressed."

Since her usual medication and therapy weren't working, her internist suggested that she see a cognitive therapist. Studies have found that between 50 and 75% of those with depression improve with cognitive therapy, a figure comparable to medication.

Understanding that the brain is flooded with chemicals that cause depressed individuals to attach a negative spin to every thought, Jill's cognitive therapist taught her to evaluate her thinking, identify this insidious negativity, then counteract it with specific behavioral strategies.

The process worked. No one knows why, although some scientists feel that cognitive therapy affects the same brain chemicals and structures as medication. "I wish I'd gone sooner," says Jill. "I still need medication, and I still need my support group. But cognitive therapy has been a very important piece in my being able to move forward. I intend to see my therapist for the rest of my life."

Therapy At a Glance
Two types of psychotherapy are used to treat depression: cognitive and interpersonal. With cognitive therapy, you learn to identify the inaccurate beliefs that cause your emotional problems and set goals to change them. Fifty to seventy-five percent of depressed people improve with cognitive therapy, a rate comparable to drugs. Interpersonal therapy is a process in which you and a therapist discuss your problems and work out effective solutions. Generally, both types of therapy are equally successful.

Like James and Jill, 50-year-old Merry Stanford,* a Midwestern educational consultant, has also learned how to manage her depression, although by a very different route.

"When I first became aware of my depression back in my 30s, I thought that I was doing life differently than other people because it was such a struggle," says Merry. "So I just tried to grit my teeth and bear it. I tried to be strong and do what I saw other people doing."

Unfortunately, sheer grit and imitation could only go so far. So Merry began to tinker with her lifestyle. She discovered that practicing yoga, exercising, and following a diet without alcohol, sugar, and caffeine made her feel better. But it wasn't enough-at least not until she also worked through some heavy-duty childhood issues, then reached out to her faith community for healing.

"Therapy was a very important part of my healing because I had a lot of early experiences that traumatized me," explains Merry. "I needed to understand what happened to me in the past and to integrate that understanding with my feelings now. But I also chose to go a step further and ask, 'What does God want me to do with this?'"

The Spiritual Cure
"Becoming a Quaker has helped me understand that good can be drawn from depression," Merry says. "The Quaker perspective is that of being in the experience-not withdrawing from it-and asking, 'What am I to learn from this? What is being asked of me?'

"What I've found through my whole healing process is that if I can focus on those two questions-'What am I to learn?' and 'What is being asked?'- it keeps my focus a lot wider. That counteracts depression, because what depression does is narrow your vision. You get totally focused on 'What's happening to me?' And in really serious depression, people can become so focused on how bad they feel that they consider killing themselves. It's a slippery slope that can lead someone off the edge."

Studies show that religious faith and spirituality can contribute to depression recovery-and in dramatic ways. One study done at Duke University in Durham, NC, found that seriously depressed people who put spirituality at the center of their life recovered 70% faster than those who didn't.

When she needs help, Merry can always turn to her religious community. "In our Quaker Meeting, we have a 'Meeting for Healing' in which people pray together for healing that matches the will of God. We don't necessarily say this in words. Our intention is that the person who needs healing is filled with the Holy Spirit, and that her healing process follows the will of God. That could mean relief of symptoms, a total cure, or learning the lessons that come with illness. Or it could mean feeling strengthened and being able to thrive in the midst of a difficult situation.

"For me, healing doesn't necessarily mean cure," she adds. "But it certainly means being at peace."

*Names have been changed for privacy.

Some studies show that practicing your faith can speed recovery from depression, in some cases by 70%. Here are other nontraditional treatments that show promise:

Regular exercise.
A Duke University study found that 30 minutes of brisk exercise three times a week is just as effective as antidepressants in reducing major depression. Another found that exercise is more effective than antidepressants in preventing relapses.

St. John's wort.
Studies from Germany, where this herb has been widely used for many years, suggest that it may be effective at relieving mild or moderate depression.

SAM-e.
In clinical studies, this supplement, at a dose of 400 to 1,600 mg a day, was as effective at reducing depression as prescription antidepressants and with fewer side effects.

If you experience five or more of these symptoms for more than 2 weeks, or they're severe enough to interfere with your daily routine, seek professional help: