For 20 years Joan* quietly suffered from an unrelenting desire to commit suicide. She held down a job as a special-education teacher and helped care for her family in the northeastern U.S. Yet day after day she struggled through a crushing depression and felt neither joy nor pleasure. Except for the stream of psychiatrists recommending different antidepression treatments—all of which failed to provide relief—Joan kept her condition private. She says it was the fear of hurting her students or abandoning her father that kept her alive. “I really don't know how I survived,” she says.