Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: I've had PPS for eight years and I just got a brace and a cane. I know I waited too long because I had to go on long term disability and SSDI last year. I cry sometimes when I think about what's happened. My doctor says I am very depressed and wants to give me medication. I am sad that I had to stop work and that I didn't do more for myself sooner. But I don't think I'm depressed. Should I just take his pills?

A: If you weren't depressed about having PPS or leaving work, you would be crazy. Imagine someone having to wear a brace, get a cane and stop working and liking it!

But feeling "depressed" and depression are not the same. In our 1990 international survey, just over half of the polio survivors told us they were sad while nearly a quarter said they had been diagnosed with depression. Depression--what's clinically called a "major depressive episode"--is a medical condition with specific symptoms in addition to feeling sad or "depressed." A diagnosis of depression requires that you experience decreased enjoyment, an inability to sleep or an inclination to sleep too much, decreased activity during the day, fatigue or loss of energy, inability to think clearly or concentrate, decreased appetite, feelings of worthlessness or guilt, and maybe even thoughts of suicide, in addition to feeling sad. Just over 60 percent of our patients report that they don't enjoy life they way they used to; about half report they're sad, anxious, critical of and disappointed in themselves; just over a third say they have decreased interest in other people and cry frequently; and about a quarter report decreased appetite and increased guilt. In spite of these symptoms, only 15 percent of our patients report enough symptoms to be diagnosed as having a major depressive episode.

It's also notable that polio survivors don't report that they are sad, let alone depressed, just because they develop muscle weakness, muscle pain or joint pain, even if these symptoms are severe. Sadness and symptoms of a major depressive episode--decreased enjoyment, poor appetite and increased guilt--appear only when PPS symptoms interfere with polio survivors' ability to work, meet social obligations and care for themselves or their homes.

You may have noticed that all of the symptoms of a major depressive episode--except decreased appetite, thoughts of suicide and possibly worthlessness--are also commonly reported symptoms of PPS. So, if your doctor thinks you're depressed, it is vital that he understand the overlap between symptoms of depression and PPS, and that he rule out all treatable causes for depression, such as having a slow thyroid, anemia and sleep apnea. These conditions should be treated before an antidepressant is prescribed. And what about antidepressants, you ask? We treat depression with psychotherapy and the overwhelming majority of patients get better quickly without medication.

But there is no reason that polio survivors shouldn't take an antidepressant if they truly need it. The newer antidepressants, the SSRIs--selective serotonin reuptake inhibitors such as Prozac, Paxil, Zoloft and Celexa--are effective and have fewer side effects than the older tricyclic antidepressants. Tricyclics such as Elavil (amitriptyline) cause dry mouth, constipation, can make your blood pressure drop when you stand up and make you sleepy. SSRIs, on the other hand, are somewhat stimulating but can cause insomnia, nausea and decreased sexual interest or ability.

The even newer, non-SSRI antidepressants are also effective. Wellbutrin is stimulating and has fewer sexual side effects, while Remeron, Serzone and Trazodone are sedating and may help polio survivors for whom insomnia is a symptom of depression. They may also be used to treat insomnia in those very few circumstances when polio survivors need a sleeping pill, such as when they start using a positive airway pressure machine (CPAP or BiPAP) to treat sleep apnea.

Regardless of the approach--therapy alone or therapy plus medication--treating depression is doubly important in polio survivors, not only because depression should always be treated, but also because depression is a major cause of patients refusing treatment for PPS. We found that just over 60 percent of patients who refused to be treated at all, and 50 percent of those who started treatment but quit or were discharged, had a major depressive episode. If a polio survivor is too depressed to begin or continue treatment, psychotherapy and even an antidepressant should be started right away.

You've had big life changes. Why not see a psychotherapist while your doctor is ruling out other causes for depression? And if you do take an antidepressant, keep in mind that it can take up to six weeks to kick in and help you feel better.