Depression didn't settle quietly into Mary's life.

It tormented virtually every moment of her day, making even the smallest household duty an uncomfortable and tearful task. It frightened her into wakefulness night after night. It left her confused, scared, defeated.

"I felt as if I were drowning," the 49-year-old New York woman recalled recently.

That was a year ago. Now, things are different.

The clinical depression that clouded Mary's life for more than a year has lifted. Her energy has returned. She smiles. She gives credit to a tiny pill that she began taking last year in an ongoing study at the State University of New York at Stony Brook.

Had Mary suffered these classic signs of depression even as recently as the mid-1980s, doctors would not have so readily prescribed a pill to lift her mood. She may have spent years on an analyst's couch with little relief of her symptoms. The antidepressants available then were fraught with troublesome side effects and carried the danger that depressed people could overdose on them and commit suicide.

But 10 years ago, Prozac was born and with it a change in how depression was viewed: not as a complex psychological problem to be treated with psychotherapy but as a symptom that might be eliminated with some adjustments in brain chemistry. Prozac is the first generation of drugs called selective serotonin re-uptake inhibitors, or SSRIs, which help the brain make better use of the neurochemical serotonin. Depressed people seem to have an imbalance in how their brains regulate serotonin.

But as prescriptions for antidepressants surge--tens of millions are written a year now--experts are working hard to figure out just how safe it is for millions of people to be taking these medicines for the long term. The current theory, based on following formerly depressed people, is that staying on medicine prevents future episodes. (And patients can't overdose on SSRIs.)

But experts also point to convincing evidence that certain forms of psychotherapy can help brain chemistry right itself. Brain-scan studies at Washington University in St. Louis of patients undergoing cognitive therapy for depression show the brain regions normalize with talk therapy just as they do with medicines. And there is new evidence that even monthly psychotherapy sessions may help prevent relapse just as effectively as antidepressants.

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