1. Why did you write Undoing Depression?
Despite the recent avalanche of books and personal accounts of depression,
there is not much available that addresses the issue of preventing
depression. The emphasis is too often focused on treatment after someone
has hit rock bottom. There is a sense that depression is something
that happens to you without warning. I disagree. I think there is
a warning - that people do lead a depressed lifestyle before they
feel depressed - and that people should be encouraged to believe there
is a lot they can do to avoid hitting bottom and to make their recovery
much faster and more effective. And because of my own personal experience
with depression, I feel a strong desire to help prevent people from
suffering what my family and I have gone through. Above all, I wanted
to give people hope. Hopelessness is a symptom of depression; but
there is good reason to be hopeful because 80 to 90 percent of cases
will recover if they get proper treatment.
2. Is the incidence of depression
increasing?
Depression is certainly increasing. It is no exaggeration to call
it an epidemic. At any given time, 20 percent of the population -
one in five Americans - are suffering from some form of depression.
 Take
the phone book and start with the letter A. Go on through to the end
of the E's. That's how many people from your community are clinically
depressed right now. The best research suggests that more people are
depressed, more of the time, more severely, and starting earlier in
their lives, than ever before.
People born after World War II are more likely to develop depression,
and are likely to develop it at a younger age, than the previous generation.
"Baby boomers" seem to be at particular risk.
This is not merely a phenomenon of a growing awareness of this disease,
but a true growth in hard numbers. Nor is it only a phenomenon of
American, or even Western, culture. A recent study comparing incidence
of depression in countries around the world found that for each successive
generation, depression was likely to begin at an earlier age and that
over the course of a lifetime, the risk of depression increases.
3. Do you think there are a lot of
people walking around depressed who don't even know it? How can they
be helped?
Absolutely. Something that touches me deeply at our clinic is the
large number of people who don't know they are depressed. People call
us for help not because of subjective feelings of depression, but
because something is going wrong in their lives: their children won't
listen, there is a marital problem, they are having trouble at work.
It doesn't take much digging to find that the caller has been depressed
for some time - the family problem, the job problem, is a manifestation,
not a cause, of the depression. There are millions of people like
this. They may go to their physician for aches and pains, sleeplessness,
lack of energy, and they get a useless prescription, medical procedure,
or worse, they are dismissed as hypochondriacs.
We need to do much more about educating the public about depression.
Depression is a disease, but the word disease make us think about
infectious diseases. Depression is more like heart disease - it develops
gradually over time. Both are caused by a complex set of factors.
Genetic and biochemical factors may determine a different level of
stress for each of us that, once reached, puts us over the edge into
depression. Childhood trauma, stress, and loss may bring us closer
to the edge.
4. How has recent media attention
affected the public's awareness of this disease?
I certainly don't think the observed increase in depression is due
to media attention. There have been more brave individuals - William
Styron, Mike Wallace, Joan Rivers, Kay Jamison, to name a few - coming
forward to talk about their own depression, which is helping to reduce
the stigma. But depression doesn't receive nearly the media attention
it deserves. It is the second most costly disease there is to American
society - just behind cancer. Depression is a scary subject for most
people and we try to deny its existence. It is difficult to get the
media to pay attention.
5. Why are more children being diagnosed
as depressed?
This is a matter of better observation, not necessarily a real increase.
Until 1980, most mental health professionals were guided by a theory
that said, in essence, depression is caused by a punitive superego;
people don't develop a superego until adolescence; ergo, pre-adolescents
can't suffer depression. Though it sounds silly today, that is the
way the mental health community thought.
Depression is difficult to recognize in children. Estimates are that
10 percent of children will suffer a depressive episode before age
12. Children usually don't have the capacity to step back and recognize
that the way they are feeling is not normal for them. The symptom
picture of depression in children and adolescents is also confusing
because they cannot express their feelings as directly as adults.
Irritability is a key indicator. Children may seem easily frustrated,
cranky or moody. Boys may simply appear unusually angry or sullen.
Other signs may be a change in appetite or energy level; sleeping
a great deal more or less than usual; a drop in school performance;
excessive worrying; or a loss of interest in things or activities
that used to give pleasure. Untreated, depression can be permanently
devastating to children.
6. How does depression impact on
the family?
Depression is very tough on family members. Usually there is not a
dramatic change in personality but often a slow, insidious process
which makes it difficult to recognize that something is really wrong.
As friends or relatives, we may feel uncomfortable around the sufferer.
Living with someone who is depressed can be one of the most helpless-feeling
experiences there is. We want to help the sufferer, but we don't know
how; often it seems that whatever we do makes things worse. The person's
problems do not respond to good advice or common sense. Sometimes
out of frustration we get angry, and feel guilty afterward.
7. How can loved ones help a depressed
person?
What the depressed person needs most is understanding, patience and
acceptance from those close to him. I have a self-help group that
meets every week. We have put together a fine list of how loved ones
can help:
- Try to be considerate, thoughtful, and empathetic. If your spouse
had a broken leg, you would expect that their abilities and energy
would be restricted, that they would be in pain, and that they can't
heal themselves more quickly just because you want them to. Think
about depression the same way.
- Don't be provocative. Every relationship has the little hot buttons
that can start a fight at any time. Dirty socks on the floor, the
remote control misplaced, the car low on gas. You know what your
partner's buttons are. Don't push them while he/she is in a depressed
state.
- Small acts of kindness are appreciated, and do help, even if
the recipient doesn't reciprocate. When I retreat to bed, my wife
makes a point of breaking in to kiss me good night. Even though
I sometimes don't act very glad to see her, I would feel worse,
lonely and unloved, without her attention.
- Easing your partner's burden in small ways can help a great deal.
Offer to do the shopping, empty the garbage, do the laundry, take
the kids out for pizza. It communicates more than words the feeling
that you understand how difficult these mundane chores can seem
at times.
- "Advance directives" can be a contract loved ones arrange while
the sufferer is not depressed, describing what to do when depression
sets in. It can be in stages: stage 1 - leave me alone; stage 2
- be kind, patient, and attentive; stage 3 - insist I call my therapist;
stage 4 - take me to the hospital. One patient loses her ability
to see color when depression sets in. From experience, she has learned
to let her husband know when this happens, because she won't let
him know when it gets worse.
- Take the trouble to educate yourself. Learn all you can about
depression. Be willing to talk to your friend's therapist. It is
amazing how seeing information in print, or hearing from an authority,
can change your perspective. Learning the facts helps you help your
friend, and also shows that you care enough to take some trouble.
8. Do you believe that therapy or
medication is the solution?
Therapy and medication are the solution. I would advise anyone
seeking treatment to be open to both. Medication can help more quickly
than therapy alone, and can help to prevent the out-of-control mood
swings that will come during recovery. Therapy can help us resolve
the problems that led to the depression and help us learn how to prevent
future episodes. Research shows that medication and therapy together
are more effective than either by itself. Some people do recover on
either medication or psychotherapy alone, but I'd really recommend
being open to both. After recovery, sometimes a maintenance dose of
medication or a periodic check-in with a therapist is helpful.
9. How does depression differ from
manic depression?
Manic depression, or bipolar disorder, seems to be a different sort
of animal. It strikes one percent of the population. It is more genetically
linked than other forms of depression and it responds uniquely to
a single medication - lithium. Other forms of depression don't respond
to lithium and don't experience the manic highs that are characteristic
of manic depression. In individual cases sometimes it can be difficult
to differentiate between depression and manic depression immediately.
You have to observe the course of the disease over some period of
time.
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