Q. If a patient comes to you who is mildly to moderately depressed, what are some other means you would use to treat this particular patient?

A. In that situation, there is often a reaction of opinion from the general medical provider's perspective. Here's a situation that has an emotional component, and I have eight minutes to spend with this patient, which is unfortunate. One way to effectively deal with this situation is to write a prescription for an antidepressant that might make someone feel better. But patients who have gone through this experience often tell me that they only feel better about feeling bad. They still feel bad.

Maybe a more effective route would be to look at what is contributing to the process. This culture keeps us so busy with so much stress that for a lot of people, it is often a situational issue. I think that you have to step back in a responsible way and look at the life experience of the individual and ask, What's going on and what could change here? Is there a light at the end of the tunnel when this process is going to shift? Then you look at simple things, as well. You ask if they are exercising. Exercise is such a big key. Our bodies are designed to be very physically active, and when they are not, it changes our perspective, our immune system, and many other parameters about living an optimal life. We then look at the social-support structure and at the emotional issue with a counselor. All these things have a bearing on the individual. There is often an assumption of looking for salvation in a pill. It doesn't occur. Salvation comes from our own responsibility. The pill can be a transitional piece that can certainly help with depression.

There are individuals with a genetic predisposition to possessing an altered genetic neurologic chemistry. Many of the people in this class might be looking at taking medication for a lifetime in order to more effectively cope with day-to-day existence. But they are not the majority of patients whom I or most other doctors see.

Q. What if a bipolar, or manic-depressive, patient came to you? They are on lithium but prefer something else, or maybe didn't get enough results from the lithium. Does St. John's Wort help with the depression period of a manic-depressive?

A. Lithium is a good step. It certainly has a lot of side effects, but it does offer effective therapy. That's a very reasonable approach. You have to look at what phase of the illness that person might be going through. If it is coupled with a lot of anxiety, you might look at another herbal medicine like kava or valerian root. Other types of approaches include biofeedback training, meditation, and exercise.

Q. Is valerian root available in health-food stores?

A. Yes. Valerian root used to be harvested and manufactured by pharmaceutical companies at the turn of the century. It was used as an effective treatment for insomnia, anxiety, and related disorders. You can buy it today in most health-food stores; even Sam's Club now has a fair supply of many of these natural compounds. You can always identify valerian root by its odor because the isovaleric acid--thought to be the active component--smells like dirty socks. Fortunately, it doesn't make the person smell like that, but the smell tends to decrease one's compliance with the medicine.

Q. What are some other pharmaceutical approaches to depression?

A. One of the compounds that I have found very useful in my own practice is a medicine that is approved by the FDA in this country for the treatment of Parkinson's disease. It is known as deprenyl, or Eldepryl. Another name for it is selegiline hydrochloride. It is used in Europe and elsewhere as a treatment for depression. It works by a different mechanism than more popular drugs like Prozac and Paxil, which work on the serotonin system in the bodies. Eldepryl works on dopamine. Dopamine is a neurotransmitter that regulates much of our behavior--motivation, memory, and so forth.

The most common side effects one sees with antidepressants, especially of the serotonin type, are the sexual side effects---difficulty in achieving orgasm, for example, and other sexual dysfunction. Deprenyl, on the other hand, tends to actually have a libido-enhancing property. It seems to be more noticeable for men, but in my clinical experience, I have noticed it occurs in both genders, which is a significant plus for a lot of people looking at a medicine that would help with managing depression.

Another thing about deprenyl that I find fascinating is that it seems also to improve memory significantly. There is a growing interest in what is called life-extension medicine, which I am sure will become a medical subspecialty. Deprenyl is one of those very interesting compounds that when given to laboratory animals seems to increase their maximum lifespan, which is a fascinating concept. If you extrapolate the data from animal models to human experience, it would suggest that we might all live to be 160 or 180 years old--a significant event.

Q. Are there side effects to deprenyl?

A. Everything has side effects. The most common ones that I have seen with deprenyl are stomachache, nausea, lightheadedness, and headaches. Those are infrequent, but not unusual. Deprenyl belongs to a class of medicines called MAO (monoamine oxidase) inhibitors. Some problems can occur when patients on MAO type A inhibitors consume cheese or other foods that contain an amino acid called tyramine. Deprenyl, however, belongs to a different class. It is an MAO type B selective inhibitor, so the tendency to have those side effects is not really present until one gets to a very high dose. For the doses required to treat as an antidepressant or as memory-enhancing medicine--life- extension medicine--doses are very low, but you always have to be cautious and attentive to what's going on.

Q. Any cheese or just aged cheese?

A. Mostly aged cheeses.

Q. The large population of senior citizens should be very interested in life extension. With the year 2000 approaching, many 80-year-olds will want to get there and beyond to see what happens.

A. Some people ask, "Why would I want to live to be 160 years old if I'm going to have all the associations of aging?" In the animal studies to date, they maintained a very active lifestyle. How you gauge that for a rat is a challenge, but you can say that they ran mazes as fast as the younger animals, didn't lose their hair, and remained sexually active until the day they died.