Latinas and Asians often face language barriers, says Doris Ayala, executive director of the Latino Family Institute in Chicago. Ingrained cultural views, such as the idea that suffering is God's will, may make it hard to seek help. Because the belief in psychotherapy is relatively new for many immigrants, Ayala frequently combines traditional psychotherapy with referrals to folk healers—curanderos for Central Americans, espiritistas for Puerto Ricans, santeros for Cubans. "I say, 'Let's work together.'"

Many minorities are especially wary of antidepressant drugs, fearing addiction. These medications can provide dramatic results for people with major depression and can also help those with a low-grade disorder. They're not addictive. But the confusion is understandable: Certain anti-anxiety medications, such as Valium and Xanax, can be addictive, and general practitioners frequently prescribe these drugs to depressed patients, rather than antidepressants such as Prozac and Zoloft.

Some people are leery of taking anything that alters their brain chemistry, whether it's addictive or not—as if that were cheating. "I had done so many drugs in my life, and I didn't want to numb myself," says Aguirre. "I thought I had to feel the pain. I cried pretty much every night for two years. I look back now and realize that was foolish."

Even though Aguirre thinks she put off trying medication for too long, she's not sorry she put serious effort into therapy first. At the time Aguirre began seeing a therapist, she had just broken up with her daughter's father and was working full-time as a waitress while going to nursing school at night. Her therapist challenged her most basic assumptions about herself. "I supported my daughter's father for six years—he could never hold a job—but all that time I didn't think I could take care of myself," she says. "My therapist asked me, 'What do you need? What do you want?' I was blown out of the water. I had no clue what she was talking about. It took me about six months to find out what I needed."

Once diagnosed, low-grade depression can be a wake-up call to take a hard look at your life, Goodwin says. It can force a woman to acknowledge, say, that there's deep discord in her marriage or that she needs to drastically revise her self-image.

Danquah's soul-searching altered some of her closest relationships. "I had to say to people in my life and my family, 'I invite you into a healthy relationship, but this toxic relationship ends right now.' "

Without the prod of low-grade depression, Goodwin says, "people aren't as likely to take on the job of figuring out what's going on in their lives. That's one of the problems of moving into medications too easily."

Depression is a whole-self illness. Although certain types of depression have a strong hereditary or hormonal component, it's hard to separate the biological from the situational factors. Regaining health often requires attacking the problem on all fronts: spiritual, physical, social and intellectual. Danquah likes to quote The Salt Eaters, by Toni Cade Bambara: "Are you ready to be well? Because being well is a serious thing."


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