The depressed seek solace on the net

As many as two thirds of those in chat rooms and online support groups get no other help

Giancarlo La Giorgia

"I suffer from depression, OCD, and social generalized anxiety disorder. I was first diagnosed in 1993 and was hospitalized. Since that time, I have not been able to 'hold down' a job... My doctor suggested I put a claim in for disability benefits, since I was fired again from my last job due to taking too many medical leaves. [Are] depression and anxiety a disability? Please help me with this question. "-- From a message posted by Nick Dipetta, a.k.a. 'Boomer2uall', a 32-year-old native of Welland, Ontario, on [email protected].

Everyday over one million Canadians who suffer from depression struggle with the same kinds of questions as Nick. And, like Nick, more and more of them are looking for answers on the internet. A ballooning number of chat rooms and online message boards cater to the depressed. The question is what effect does this amateur counseling have on a clinically depressed person?

Dr Rima Styra, a psychiatry professor at the University of Toronto, thinks she knows: "It can help supplement treatment, but I think (patients) still need formal face-to-face meetings with someone outside of their support group, especially if they have clinical depression. " She believes sharing stories is an important tool in coping with depression but worries about the potential for vulnerable patients to be misled. "The information (obtained from chat room buddies) may be incorrect and some individuals in the group might have a specific stance -- that medication may be harmful, for instance, " she cautions.

Her familiarity with online depression groups stems partly from having patients who participate in them, by and large, with positive results. "They can provide emotional support and people know they're not alone. It helps to counter the whole stigma of mental illness, " she says but concedes she still isn't familiar enough with the groups to feel comfortable referring her patients to one.

WHAT'S A CHAT ROOM?
According to Dr Gunther Eysenbach, mental health professionals need to become a lot more web-savvy about self-treating depression on the web. The senior scientist at Toronto's Centre for Global eHealth Innovation helped conduct a survey for BioMed Central Psychiatry among over 2,000 internet depression users, in six Northern European countries last December. The findings were both encouraging and disturbing. The good news was that so many were trying to help themselves. The bad news? Up to two thirds of respondents weren't receiving any other treatment.

Dr Eysenbach is currently reviewing guidelines on internet mental health care for Health Canada and predicts that the day when anyone will be able to obtain billable mental health services on the internet is perhaps five years away. It's an evolution he welcomes. "These communities constitute excellent public health intervention opportunities to steer patients who are undiagnosed towards health professionals, " he says.

PEER-TO-PEER
The Mood Disorders Society of Canada is one of a handful of advocacy groups in this country that offers depression and bipolar disorder sufferers the opportunity to engage in peer-to-peer support online. Its website has links to both a chat room (where users converse in real-time) and a message board (where comments are posted and can be read and replied to anytime.) It will soon be one of the only internet health portals in Canada to employ an 'Ask the expert' feature, where users can communicate directly with a health care professional.

Phil Upshall, the society's president, says the main reason for creating a virtual discussion forum was the almost insurmountable challenge of conquering depression alone. "The reality is there are an awful lot of people who try to treat themselves or to somehow make it through a depressed day -- because to identify themselves as depressed would engage them in some pretty substantial stigma, particularly at the workplace, " he says.

Mr Upshall is concerned that marginalization of both the illness and the ill is being abetted by the health system. He cites statistics which show that depression is one of the main causes of workplace absence in Canada. WHO predicts that by the year 2020, it will be the leading cause of employee disability. In Mr Upshall's opinion, "we have to convince governments, and doctors -- especially those who practice in remote areas, to hone their mental health diagnosis and treatment skills. These services are as essential as delivering babies and setting fractured limbs. "

Though Mr Upshall acknowledges the $30 billion dollars a year it costs Canada to deal with mental illness is a staggering sum, not surprisingly, he rejects the idea that further mental health expenditures would break the bank. "It really would be cheaper to identify and treat people with mental health problems early, when treatment can be a lot less expensive and a lot less invasive, " he says.

Further information: The Mood Disorders Society of Canada: www.mooddisorderscanada.ca. Other interesting sites: the Canadian Network for Mood and Anxiety Treatments website with a special section for GPs/Fps: www.canmat.org. Canadian psychiatrist, Dr Phillip W Long's website, with information on disorders, medication, and links to web communities for depression, bipolar disorder and schizophrenia sufferers: www.mentalhealth.com