It was a little after midnight on July 4 when Michael Efthimiakopoulos went for a walk on the Jacques Cartier Bridge. A McGill commerce graduate, Efthimiakopoulos loved Pink Floyd, reading and mountain climbing. Summer nights, he'd been known to hike up Mount Royal to watch the sunrise with friends. Winter afternoons, he might hang out in a café reading the newspaper or meet pals for a beer.

But for the last four years, the 47-year-old banker had been struggling with a deepening depression. When his illness began to affect his work, his employer offered to put him on medical leave, providing he enrolled in therapy.

"He refused, because of the stigma," his father recalls. "He didn't want others to know. He was a very proud boy."As his condition worsened and he still refused treatment, the bank let Efthimiakopoulos go.

John Efthimiakopoulos, who retired from the restaurant business last winter, tried to persuade his older son to seek help. " 'If you were a little boy, I would do what has to be done. But now, it's up to you. I have always been proud of you. And I would be so proud of you the moment you take the first step."

"Give me time," Michael told his father. "I'm not ready yet."Michael didn't want to see other people, not even his brother, Peter, on a visit home from his job overseas. Michael's illness wasn't something the family discussed with others.

"When a loved one has a problem with mental illness, even the family does not want to spread it around. In our case, we kept it between us. Why? Because of that stigma," his father says.

"It's so hard when you are there to help your children and you know there is nothing you can do."On the Jacques Cartier Bridge that July night, Efthimiakopoulos was carrying a knapsack in which he had packed a small stepladder. Stopped by police patrolling the bridge, Efthimiakopoulos said he was out for a stroll on a beautiful night. When they asked about the ladder, he said he was moving and had borrowed it from a friend. Suspicious, the officers decided to take Efthimiakopoulos to Notre Dame hospital for observation.

Over the next six hours, Efthimiakopoulos would see three psychiatrists. According to his father, the medical team concluded he was depressed, but did not appear suicidal. Michael Efthimiakopoulos wanted to leave and told the hospital not to call his family. By law, they had no right to keep him.

That evening, Michael met his parents, a Monday ritual John and Anna Efthimiakopoulos had begun after their son became ill. He said nothing of his stroll on the bridge, or his visit to Notre Dame. "To us, he was the same as every other time," his father recalls. Unlike other meetings, when they might make small talk about the stock market, Michael had little to say. He didn't stay long.

Early on the morning of July 12, Michael Efthimiakopoulos climbed to a precipice on Mount Royal, and jumped off. He was alive and able to speak when Urgences Santé brought him to the Montreal General just after 3 a.m. On his way to the operating room, he told hospital staff not to call anybody. He died a few hours later.

In his wallet was a slip of paper with two phone numbers, his own and his parents. Yet it would take a full day before his parents received the call telling them their son was dead. "I've faced mountains in my life. Nothing bothered me. But this is not the same. This is the worst thing that can happen to a father or a mother," John Efthimiakopoulos said.

"When my son was born, I was 20 years old and a waiter at the Queen Elizabeth Hotel. And when Michael was born, I felt so rich. - To me, wealth is what you are, not what you have. Family is a very important thing. When Michael died, I felt like I had lost half of my world."He would like to see Quebec review laws governing mental illness to allow family members more say when a loved one is in distress.

"When doctors realize that the person is mentally ill, depressed, there must be an exception. There are always exceptions in life."More urgent, he argues, is greater education, awareness and sensitivity in our society toward people who are suffering from mental illness.

"I'm not an expert. I'm nobody. The only thing I know is that I'm a father whose son committed suicide because of the stigma," said John Efthimiakopoulos, who hopes to launch a website to rally support among others who would like to change laws and attitudes toward mental illness.

"We live in 2011. We have to stop calling these people crazy, erratic, twisted. We have to accept it as a disease of the brain. Condemnation does not liberate. It oppresses," he said.

"My wife said there is nothing we can do. Yes, there is nothing we can do for Michael. But if I can do something to save other lives, other sons and daughters, sisters and brothers, fathers and mothers, that would be a consolation for me."

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Medication, which Americans favor over other forms of therapy, poses risks to a developing fetus, but so does having a depressed mother. There's no denying that we pass diseases down from one generation to the next, thanks to our genes and/or the climate in which we raise our children. The classic example is overweight parents with overweight kids. They have inherited a gene linked to obesity or picked up poor eating habits, or both. But this phenomenon doesn't just apply to physical diseases and disorders. Oh no. We also pass our mental health issues down to our kids, from little personality quirks to more serious problems, like worry, anxiety, obsessions, compulsions, and depression.

Depression is a prime example of a disorder that runs through both genes and the environment. When a woman is pregnant, the chemical environment in her body and brain has an effect on her fetus' development. And when this "climate" is off, as in the case of depression, it seems to lead to a specific set of psychological and physiological risks to the child -- from premature birth to emotional and social problems -- that are distinct from those associated with mental health issues in other periods of maternal life. And new research is asking whether, when it comes to the child's health, it's better to treat depression during pregnancy or just leave it alone.

Antidepressants, which Americans are increasingly favoring over other forms of therapy, come with a significant set of risks to the developing fetus, which are expressed in both the brain and behavior of the offspring. A recent study found that one of the most widely used classes of antidepressants, selective serotonin uptake inhibitors (SSRIs), given to rats in the perinatal period -- just before and after birth -- had a significant effect on brain development. This "critical period" in rodents is thought to correspond to the third trimester in humans.

The fetal and neonatal rats exposed to SSRIs showed altered electrical activity in the brain, and reductions in a major serotonin circuit, the raphe system. They also had deformations in the corpus callosum, the bundle of fibers that allows the transfer of information between the two hemispheres of the brain: specifically, there were deficiencies in the cells' insulation, the myelin sheath, which swathes nerve fibers to speed communication. Physiological changes are usually expressed in behavioral changes, and this was true here, too: The animals given SSRIs showed a reluctance to explore new environments and an exaggerated fear response to a novel sound. These alterations in rodent behavior are thought, significantly, to mirror autism in humans.

This SSRI-autism connection is not new, and it's not distinct to rodents. In fact, a study earlier in the year suggested that using antidepressants during pregnancy is linked to a greater risk of autism in human children. The mothers of children on the autism spectrum were three times as likely to have been on antidepressants during the first trimester of pregnancy. While this doesn't nail down cause-and-effect, the researchers controlled for enough variables -- like maternal age and education, sex of the child, birth weight, and how complicated the birth -- that the link seems likely, particularly in light of the new study.

Of course, there are other ways to treat depression in pregnant women. But another new study, or at least in one interpretation of it, raises the possibility that not treating depression in a mother may be the best option for her fetus. In the study, mothers-to-be, whether or not they were depressed before giving birth, had kids that progressed through the developmental stages normally if they stayed with the mental state with which they started. That is, it was actually better for the baby if his or her mother's depression stayed consistent between pregnancy and giving birth than if it lifted. But women who went from happy to depressed or depressed to happy after giving birth had kids with slowed development.

Despite their findings, the authors of this study say that it is better to treat depression in pregnant women, since leaving it untreated can lead to a host of problems for their children later on. Though consistency in the move from prenatal to postnatal environments is a possible explanation for their findings, it's suspect, since it seems intuitive that improved maternal mood should benefit the child. Perhaps the real issue here is how we choose to treat depression. Therapies that use different means to alter the brain (like talk therapy or cognitive behavior therapy) can be as effective as antidepressants, and would not likely pose much risk to the fetus.

Mood disorders, possibly during pregnancy and certainly after a child is born, are somewhat unique in the sense that not treating them in a parent can increase the child's risk for developing them. This is not strictly true for other medical issues, like arthritis or high blood pressure. For example, the mother of an eight-year-old child who treats her hypertension with medication does not reduce her child's risk of developing it, but, because of the additional environmental factor, she would decrease her child's risk for depression if she treated her own. That said, leaving medical conditions untreated in pregnancy is generally not good for the fetus, though the list of medications that can affect the development of the fetus when used during pregnancy is long. Deciding whether it is better to pass on a disorder or the side effects of the treatment to our kids is a decision many of us must make.

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Working mothers have better health and fewer symptoms of depression than stay-at-home moms, a new study indicates. The researchers also found that mothers with part-time jobs can balance work and nurturing their children better than those with full-time jobs.

For the study, published in the December issue of the Journal of Family Psychology, researchers analyzed data collected from over 1,300 mothers in the United States who were interviewed shortly after their child’s birth and underwent further interviews and observation over more than 10 years of follow-up.

The women were enrolled in the US National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Mothers who worked either full-time or part-time reported better overall health and fewer symptoms of depression than stay-at-home moms, according to the researchers at the University of North Carolina at Greensboro.

Mothers with part-time jobs were just as involved in their child’s school as stay-at-home moms, and more involved than mothers with full-time jobs, the investigators found. The study authors also noted that mothers with part-time jobs appeared more sensitive with their preschool children and provided more learning opportunities for toddlers than stay-at-home moms and mothers with full-time jobs.

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It’s time to start calling the current situation what it is: a depression. True, it’s not a full replay of the Great Depression, but that’s cold comfort. Unemployment in both America and Europe remains disastrously high. Leaders and institutions are increasingly discredited. And democratic values are under siege.

On that last point, I am not being alarmist. On the political as on the economic front it’s important not to fall into the “not as bad as” trap. High unemployment isn’t O.K. just because it hasn’t hit 1933 levels; ominous political trends shouldn’t be dismissed just because there’s no Hitler in sight.

Let’s talk, in particular, about what’s happening in Europe — not because all is well with America, but because the gravity of European political developments isn’t widely understood. First of all, the crisis of the euro is killing the European dream. The shared currency, which was supposed to bind nations together, has instead created an atmosphere of bitter acrimony.

Specifically, demands for ever-harsher austerity, with no offsetting effort to foster growth, have done double damage. They have failed as economic policy, worsening unemployment without restoring confidence; a Europe-wide recession now looks likely even if the immediate threat of financial crisis is contained. And they have created immense anger, with many Europeans furious at what is perceived, fairly or unfairly (or actually a bit of both), as a heavy-handed exercise of German power. Nobody familiar with Europe’s history can look at this resurgence of hostility without feeling a shiver. Yet there may be worse things happening.

Right-wing populists are on the rise from Austria, where the Freedom Party (whose leader used to have neo-Nazi connections) runs neck-and-neck in the polls with established parties, to Finland, where the anti-immigrant True Finns party had a strong electoral showing last April. And these are rich countries whose economies have held up fairly well. Matters look even more ominous in the poorer nations of Central and Eastern Europe.

Last month the European Bank for Reconstruction and Development documented a sharp drop in public support for democracy in the “new E.U.” countries, the nations that joined the European Union after the fall of the Berlin Wall. Not surprisingly, the loss of faith in democracy has been greatest in the countries that suffered the deepest economic slumps. And in at least one nation, Hungary, democratic institutions are being undermined as we speak.

One of Hungary’s major parties, Jobbik, is a nightmare out of the 1930s: it’s anti-Roma (Gypsy), it’s anti-Semitic, and it even had a paramilitary arm. But the immediate threat comes from Fidesz, the governing center-right party.

Fidesz won an overwhelming Parliamentary majority last year, at least partly for economic reasons; Hungary isn’t on the euro, but it suffered severely because of large-scale borrowing in foreign currencies and also, to be frank, thanks to mismanagement and corruption on the part of the then-governing left-liberal parties. Now Fidesz, which rammed through a new Constitution last spring on a party-line vote, seems bent on establishing a permanent hold on power.

The details are complex. Kim Lane Scheppele, who is the director of Princeton’s Law and Public Affairs program — and has been following the Hungarian situation closely — tells me that Fidesz is relying on overlapping measures to suppress opposition. A proposed election law creates gerrymandered districts designed to make it almost impossible for other parties to form a government; judicial independence has been compromised, and the courts packed with party loyalists; state-run media have been converted into party organs, and there’s a crackdown on independent media; and a proposed constitutional addendum would effectively criminalize the leading leftist party.

Taken together, all this amounts to the re-establishment of authoritarian rule, under a paper-thin veneer of democracy, in the heart of Europe. And it’s a sample of what may happen much more widely if this depression continues.

It’s not clear what can be done about Hungary’s authoritarian slide. The U.S. State Department, to its credit, has been very much on the case, but this is essentially a European matter. The European Union missed the chance to head off the power grab at the start — in part because the new Constitution was rammed through while Hungary held the Union’s rotating presidency. It will be much harder to reverse the slide now. Yet Europe’s leaders had better try, or risk losing everything they stand for.

And they also need to rethink their failing economic policies. If they don’t, there will be more backsliding on democracy — and the breakup of the euro may be the least of their worries.

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It makes no difference to a woman's mental health whether she chooses to have an abortion or continue with the pregnancy, researchers found. Women with unwanted pregnancy do have a higher incidence of mental health issues than those in the general population, but the rates of problems are the same whether a woman opts for a termination or goes on to give birth, according to the report commissioned and published by the Academy of Medical Royal Colleges.

The report, which included data on hundreds of thousands of women in 44 previous studies, was carried out by the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists. Professor Tim Kendall, director of the National Collaborating Centre for Mental Health, said 11% to 12% of the general population suffer depression and anxiety. But this rises to about a third of women who have an unwanted pregnancy.

Prof Kendall said that having an unwanted pregnancy may cause mental health problems, a woman may already have problems before becoming pregnant, or it could be a combination of the two. The experts found that women who had a history of mental health problems before having an abortion were more likely to suffer problems after the procedure. Factors that may potentially increase the risk of mental health issues after an abortion included women being pressurised by a partner to have an abortion, stressful events, or the woman herself having a negative attitude towards abortions.

Prof Kendall said the future focus of research should be on dealing with the impact of unwanted pregnancy rather than on whether abortion itself causes mental health problems. The team behind today's report had looked purely at the mental health aspects of abortion, he added. ''There is a separate debate, which is about the ethics and about legal abortion, illegal abortion, the physical consequences, which are not part of our report.

''We are simply saying that with regard to the mental health outcomes, we should now shift our attention to the problems associated with unwanted pregnancy, not abortion.''A three-month consultation was held on today's findings so interested groups including pro-life charities and members of the public could comment.

Dr Roch Cantwell, a consultant perinatal psychiatrist and chairman of the steering group, said: ''Our review shows that abortion is not associated with an increase in mental health problems. ''Women who are carrying an unwanted pregnancy should be reassured that current evidence shows they are no more likely to experience mental health problems if they decide to have an abortion than if they decide to give birth.''Professor Sir Neil Douglas, chairman of the Academy of Medical Royal Colleges, said: ''The Academy recognises that this is a complex and controversial area, where there have been many conflicting research findings.

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The cost of treating Medicaid patients with depression increased substantially over a 10-year period, but it resulted in just a minimal improvement in the quality of their care, according to a report in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"During the 1980s and 1990s, the number of adults diagnosed with and treated for depression increased, and the modality of treatment shifted," the authors explain as background information in the article."The percentage of adults with depression who received antidepressants increased, and the percentage who received psychotherapy or were hospitalized for depression decreased."

Catherine A. Fullerton, M.D., M.P.H., of Harvard Medical School and Cambridge Health Alliance, Boston, and colleagues examined data from Medicaid claims in Florida to evaluate changes in depression health service utilization, spending, and quality of care from July 1996 through June 2006.

Using Medicaid claims data, the authors identified annual cohorts of adults with depression consisting of enrollees age 18 to 64 years having one or more hospitalizations with a principal diagnosis of depression or having at least two outpatient claims of depression on different days.

The number of enrollees identified annually varied from 8,970 to 13,265 with more persons identified toward the end of the study period. Total number of individuals with depression identified over the study period was 56,805.

The authors found that during the study period, mental health care spending increased from a mean (average) $2,802 per enrollee to $3,610 per enrollee, reflecting a 29 percent increase.

This increase appears to result from a large increase in pharmacotherapy spending (110 percent increase), majority of which was due to spending on antipsychotics (949 percent increase).

During the study period, the percentage of enrollees with depression who received psychotherapy decreased from 56.6 percent to 37.5 percent and the percentage of individuals who were hospitalized decreased from 9.1 percent to 5.1 percent.

Conversely, the percentage of individuals who filled prescriptions within any mental health medication classes remained stable or increased, depending on the type of prescription filled.

Antidepressant use increased from 80.6 percent to 86.8 percent, anxiety medication use was unchanged at 62.7 percent and 64.4 percent, and antipsychotic use increased from 25.9 percent to 41.9 percent, during the study period.

However, the authors also found that changes in quality of care were mixed, with antidepressant use improving slightly, psychotherapy utilization fluctuating, and follow-up visits decreasing.

"In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care," the authors conclude.

"Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community."This study was supported by grants from the National Institute of Mental Health.

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QUICK READThe good news is that lifestyle changes may lower your risk for all three conditions, experts say When people with type 2 diabetes also struggle with depression, their odds for a third worrisome condition -- dementia -- goes up markedly, a new study suggests. Specifically, patients with type 2 diabetes are twice as likely to develop dementia three to five years after being diagnosed with depression compared to nondepressed people with diabetes, researchers found.

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In 1931, the Sandy Bay Historical Society in Rockport asked several local choirs to perform a Christmas concert together, aimed at uplifting the town during the Depression. Chorus North Shore was formed and has been performing ever since. This is the group’s 80th year, and Sonja Dahlgren Pryor’s 50th year as artistic director.

The 130-member chorus presents Handel’s “Messiah’’ Saturday in Ipswich and next Sunday in Danvers. The singers are joined by soloists Andrea Matthews, soprano; Ray Bauwens, tenor; John Whittlesley, bass; the Honors Youth Choir; and the Festival Orchestra.

Performances are 8 p.m. Saturday in Our Lady of Hope Church in Ipswich and 3 p.m. next Sunday in St. Mary’s Church in Danvers. Tickets are $20; $17 students and senior citizens; free for children 12 and younger. Call 978-525-4831 or visit chorusnorthshore.org.

CLASSIC CHRISTMAS: The Paul Madore Chorale presents A Classic Christmas at the First Church Congregational in Swampscott next Sunday.

The concert includes three major works: “Magnificat’’ by Mark Hayes; “Gloria’’ by Francis Poulenc, and “Gloria’’ by Randol Alan Bass. Traditional Christmas music and sing-a-long carols are also on the program. Soprano Danielle Vayenas (pictured on flier) is featured soloist.

Hayes is a new American composer who spent his first years arranging traditional church music. His “Magnificat’’ is an original composition. The concert continues with “Gloria’’ by Poulenc, a French composer. This is one of his most celebrated works and was commissioned by the Boston Symphony Orchestra.

The final work is the Bass “Gloria,’’ which has become a regular part of the Boston Symphony Pops Christmas programs. The Paul Madore Chorale has been performing since 1966. Its music director is Paul Madore and its principal accompanist is pianist Jeffrey Brody. Based in Salem, it has a membership of approximately 60 singers from 15 area communities.

The performance begins at 3 p.m. Tickets are $22; $18 for seniors citizens and students ages 18 and younger.

HOLIDAY DANCING: The Joppa Dancers present “Gift of the Magi and Other Stories’’ at the Firehouse Center for the Arts in Newburyport, Friday through next Sunday. The program includes favorite holiday stories and poems, such as “Stopping by Woods on a Snowy Evening’’ by Robert Frost, as interpreted through dance. Dancers of all ages perform a variety of styles including ballet, modern, and contemporary.

Performances are 8 p.m. Friday and Saturday and 3 p.m. next Sunday. Tickets are $14; $12 for students, senior citizens, and Firehouse members. Call 978-462-7336 or visit firehouse.org.

AUTHOR’S CORNER: Folk artist and children’s storybook author Will Moses signs his new book, “Mary and Her Little Lamb,’’ and an illustrated adaptation of “The Night Before Christmas,’’ from 1 to 4 p.m. today at Smolak Farms in North Andover. . . . A book launch of “On Opposite Tacks: When Artist John Sloan & Capt. Solomon Jacobs Crossed Wakes in Wartime Gloucester,’’ by local author Chester Brigham, is at 3 p.m. Saturday in Cape Ann Museum in Gloucester. There will be a slide presentation, book signing, and reception.

IN LOCAL GALLERIES: An exhibit of little pieces of art - 8-by-8 inches or smaller - is at Time & Tide Fine Art in Ipswich through Jan. 4. The works, all produced by local artists, lean toward nontraditional styles and subjects. Collage and mixed-media pieces are displayed alongside pastels, watercolors, photographs, abstract images, and landscapes. Some pieces are small enough to hang on a tree as ornaments. Accentuating the small works are four large pieces by other local artists: John Geesink, Priscilla Serafin, Kristina Brendel, and Judy Metcalfe. . . . The Newburyport Art Association holds its annual members holiday art show and sale through Dec. 24. The sale includes a variety of affordable art by the association’s members, including paintings, drawings, photographs, fine crafts, ceramics, sculpture, and jewelry. It also includes works created by artists participating in a collaborative program between the association and Opportunity Works Inc., a nonprofit committed to enhancing the quality of life for people with disabilities. Items include jewelry, cards, and pillows. A reception is 6 to 9 p.m. Friday.

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A 52-year-old woman jumped off her the terrace of her building at Ghodbunder Road in Thane on Friday afternoon, allegedly due to depression. The body of Damyanti Upadhyaya, a resident of Devdarshan society, was found by the society’s security guard. The Upadhyayas reside on the ground floor of the building. While Damayanti’s husband was away at work in Bhiwandi, her son Ankur, 22, was at home when the incident took place.

“She told me she was going out for a stroll. Sometime later, the watchman told me she had jumped off the terrace. She had been depressed for quite some time and had been diagnosed with schizophrenia just six months ago. She was taking medicines for it,” said Ankur, who has completed his graduation and is now learning foreign languages.

Security guard Saber Ali had handed over the terrace keys to Damyanti around 2 pm. “She had been asking me for the keys from the morning saying she wanted to take a stroll. I refused twice, but she kept insisting, so, I relented and gave her the keys. I was sitting outside the building gate when I heard a loud thud and found her on the ground,” said the watchman.

The deceased’s body has been sent for a post-mortem to the civic hospital. The Kasarwadavli police station has filed an accidental death report. “She committed suicide as she was depressed and was suffering from schizophrenia,” said senior inspector Pramod Khade.

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Sir, – As a sufferer from depression, anything written about depression is worth reading. Peter Murtagh’s contribution (Weekend Review, November 26th) is revealing about a good human being who decided to leave this world.

Depression is all over the place, in so many people, dragging them down except they refuse to give up. It’s not really giving up: life is not there to be argued for, you either want it or it destroys you and there you live, somewhere in the middle, wondering will it be you the next day or even today to decide enough is enough, the black hole is too intense to resist. That’s a personal choice, despite the people it might destroy that you love and devote yourself to. But there it is. I hate this parasite inside me that makes another day insufferable, despite my beautiful child and fantastic wife and the people who know where I am some days when I don’t, even though I’m talking to them. Of course it’s a fight and staying alive is not winning, it’s just staying alive hoping the glass wall between you and beauty can be smashed some day, some day.

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