Tom Johnstone has battled drug abuse for much of his life. He started taking ecstasy in high school, and by the time he turned 30 he was addicted to cocaine.
Now the gay Houston native is clean and sober and is facing a new battle: depression. Speaking from inside the Alternatives recovery clinic in the Silver Lake neighborhood of Los Angeles, Johnstone said he was diagnosed in 1999 with bipolar disorder, formerly known as manic-depressive illness, characterized by mood fluctuations from extreme highs to extreme lows. "My friends and I," Johnstone says, "we all have issues with depression."
It has been widely reported that the incidence of depression among gay men is higher than in the overall U.S. population. One often-cited study reports that more than 17% of American gay and bisexual men suffer from depression, compared with 9.5% of all adults. According to a biennial survey of high school students in Massachusetts, LGBT teenagers are about four times more likely than their straight peers to have attempted suicide in the prior year.
Measures are now being taken to address the issue. The Medius Institute for Gay Men's Health in New York City, which has been studying gays and depression, recently called for mental health exams to become part of regular checkups and recommended educational programs to teach gay men about the symptoms of mental illness. "I see really great doctors, but my experience is that I get a mental health exam [only] if I walk into the examination room and burst into tears," says Spencer Cox, founder and executive director of the institute. "The first step is to think of it as part of normal health care."
According to Cox, some common factors that cause depression among gays include lacking a romantic partner, experiencing antigay violence, not identifying as gay, or feeling alienated from the gay population. He suggests that gay and bisexual men face multiple epidemics--depression, drug abuse, violence, and HIV--that reinforce one another. "What we have to do is probably tackle each of these things with some understanding of how they're connected," Cox says.
Indeed, a number of recent studies have connected depression with use of ecstasy, a "club drug" that has been around for many years and is wildly popular among gay men. Johnstone believes his mental illness may have resulted from his many years abusing the drug.
He recalls first taking ecstasy with some high school friends at a beach outside of Houston. "I thought it was amazing," he recalls. "Euphoria." That night Johnstone drove home, walked into his parents' bedroom, and woke them up to tell them, "I found God in pill form."
Before long Johnstone and his friends were taking a half tablet every three days. Then he began "stacking"--taking two tablets at once. Within five years he was taking as many as five hits at a time. He gave up "X" in 1998, when he began using cocaine intravenously. But Johnstone, 38, has been clean since August 2006.
Now he blames his depression, at least in part, on ecstasy. "I think taking the amount of ecstasy I started taking at such a young age definitely has been a factor in my depression," says Johnstone, who sought help from Alternatives, a treatment facility that caters to gay, lesbian, bisexual, and transgender clients. "When I'm not on Prozac, I'm suicidal. I've always felt like there was a connection."
Physician David McDowell, founder of the Substance Treatment and Research Service at Columbia University, says the scientific evidence for a link between depression and ecstasy abuse is "very strong." "I don't mean to imply that it always causes depression; it does not," says McDowell, who maintains a private practice and has researched club drugs for 15 years. "But there is a definite correlation between it and feelings of depression as well as increased rates of depression."
Not everyone agrees. The cause-effect findings are challenged by some scientists, who see the studies linking ecstasy and depression as flawed. …