About Depression.

There are several distinct meanings of the the word "depression." In ordinary usage it describes a temporary low mood or a sense of despondency or distress, e.g., "I was depressed when I got the bad news." This is a normal experience of everyone, and usually passes fairly quickly. Individuals experiencing this kind of depression can often be cheered up or distracted from their distress.

Sometimes the low mood that results from a significant loss or stressful life situation may last for an extended time, from a week or two to several months. This understandable but lingering response would be considered a "depressive reaction" or "adjustment reaction with depressed mood" and would typically be mild to moderate in severity. Individuals experiencing this condition will probably recover without treatment, but they often benefit from counseling and social support. People vary greatly in their susceptibility to depression, and this vulnerability may be due to early life experiences or genetics or a combination of known and unknown factors.

Major depressive disorder refers to a more serious condition requiring treatment. (Other names include clinical depression or depressive illness.) This would be a persistent abnormal depressed mood (sadness, dejection, hopelessness, despair) and other symptoms that significantly interfere with one's functioning in work, family, or social responsibilities. Approximately 30 million people in the US experience major depression every year (5% to 8% of the general population). About one person in five will experience depression during their lifetime (25% of women and 10% of men). Depression is the most common cause of disability among professionals. Most depressive episodes will eventually clear in six to 12 months without treatment. One third of all major depressions are severe enough to require medical treatment, sometimes hospitalization. For some people experiencing major depression, there appears to be a significant genetic factor, with depression affecting a number of family members across generations.

in depth

Diagnosis
Treatment for depression
Books on depression. [Support your local bookstore!]
Organizations and Resources for Additional Information and Services
Internet resources regarding depression
Short Videos
Articles on psychotherapy and depression

Diagnosis

The diagnosis of depression must be made by a professional, a physician or a mental health professional. If you feel that you may be suffering from depression, please seek appropriate evaluation and treatment. The following is provided for information only.

Individuals vary in how they experience depression, but the following will help you understand the nature of major depressive disorder. According to the Diagnostic and Statistical Manual (4th Ed.) of the American Psychiatric Association (DSM-IV), the criteria for a diagnosis of a major depressive episode are as follows:

A. At least one of the following three abnormal moods which significantly interfered with the person's life:

Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks.
Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.
If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.

B. At least five of the following symptoms have been present during the same 2 week depressed period.

Abnormal depressed mood (or irritable mood if a child or adolescent).
Abnormal loss of all interest and pleasure.
Appetite or weight disturbance, either:
Abnormal weight loss (when not dieting) or decrease in appetite.
Abnormal weight gain or increase in appetite.
Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
Activity disturbance, either abnormal agitation or abnormal slowing.
Abnormal fatigue or loss of energy.
Abnormal self-reproach or inappropriate guilt.
Abnormal poor concentration or indecisiveness.
Abnormal morbid thoughts of death (not just fear of dying) or suicide

C. The symptoms are not due to a mood-incongruent psychosis.

D. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.

E. The symptoms are not due to physical illness, alcohol, medication, or street drugs.

F. The symptoms are not due to normal bereavement.

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Treatment for depression

Treatment for depression is usually very effective. Psychotherapy and medication are the two most common forms of treatment. Many people do best with a combination of both.

Follow the links below to get more information:
Abstracts of articles regarding psychotherapy
Anti-depressant drugs

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Books on depression. [Support your local bookstore!]

There are many books on depression. Those listed here are a small but varied sample.

Feeling Good: The New Mood Therapy. David D. Burns, Avon, 1992.
Feeling Good Handbook. David D. Burns. Plume, 1990.
Understanding Depression: A Complete Guide to Its Diagnosis and Treatment. D. F. Klein and P. H. Wender, Oxford University Press, NY, 1993.
Depression Is a Treatable Illness: A Patient's Guide. Department of Health and Human Services, Agency for Health Care Policy and Research, Rockville, MD 20852, Publication No. AHCPR 93-0553, April, 1993.
Mind over Mood: Change How You Feel by Changing the Way You Think. Dennis Greenberger, Christine A. Padesky. Guilford Pr,1995.
Prozac and the New Antidepressants : What You Need to Know About Prozac, Zoloft, Paxil, Luvox, Wellbutrin, Effexor, Serzone, and More. William S. Appleton. Plume, 1997
Psychiatric Drugs. Stuart Yudofsky, American Psychiatric Press, Washington, D.C., 1991.
Natural Prozac : Learning to Release Your Body's Own Anti-Depressants. Joel C. Robertson, Tom Monte. Harper San Francisco, 1997.
Hypericum (St. John's Wort) and Depression. Peter McWilliams, Mikael Nordfors, Harold H. Bloomfield. Prelude Pr, 1997

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Organizations and Resources for Additional Information and Services

National Mental Health Association (NMHA)
1021 Prince Street
Alexandria, VA 23314-2971
Phone: 1-800-969-6642
National Depressive and Manic-Depressive Association
730 North Franklin Street, Suite 501
Chicago, IL 60610
Phone: 1-800-82-NDMDA, (312) 642-0049, FAX (312) 642-7243
Offers information, one-to-one support, referrals by telephone. Local
groups: 190. Publications, audio and video tapes available.
Depressives Anonymous: Recovery From Depression
329 East 62nd Street
New York, NY 10021
Phone: (212) 689-2600
Publications available.
Emotions Anonymous
P.O. Box 4245
St. Paul, MN 55104-0245
Phone: (612) 647-9712, FAX (612) 647-1593
Telecommunications services: Telephone referrals to local chapters.
Regional groups: 48. Local groups: 1600.
Publications available.

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Some internet resources regarding depression:

Dr. Ivan's Depression Central
American Psychological Association
American Psychiatric Association
National Institute of Mental Health - Depression
NIMH-Questions about St. John's Wort

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Short Videos

Articles on psychotherapy and depression

The Effectiveness of Psychotherapy: The Consumer Reports Study
Martin E. P. Seligman
University of Pennsylvania

Abstract

Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse. The methodological virtues and drawbacks of this large-scale survey are examined and contrasted with the more traditional efficacy study, in which patients are randomized into a manualized, fixed duration treatment or into control groups. I conclude that the Consumer Reports survey complements the efficacy method, and that the best features of these two methods can be combined into a more ideal method that will best provide empirical validation of psychotherapy.

To obtain the entire article on the world wide web, follow this link:
http://www.apa.org/journals/seligman.html

The following article is from
Professional Psychology: Research and Practice, December 1995 Copyright © 1995 by the American Psychological Association, Inc., 0735-7028/95/$3.00 Vol. 26, No. 6, 574585 .

Psychotherapy Versus Medication for Depression: Challenging the Conventional Wisdom With Data
David O. Antonuccio and William G. Danton
University of Nevada School of Medicine and Reno Veterans Affairs Medical Center
Garland Y. DeNelsky Cleveland Clinic Foundation

Abstract

This article reviews a wide range of well-controlled studies comparing psychological and pharmacological treatments for depression. The evidence suggests that the psychological interventions, particularly cognitivebehavioral therapy, are at least as effective as medication in the treatment of depression, even if severe.

The prevalence of unipolar depression is estimated to be between 3% and 13%, with as much as 20% of the adult population experiencing at least some depressive symptoms at any given time (Amenson & Lewinsohn, 1981; Kessler et al., 1994; Oliver & Simmons, 1985). The lifetime incidence of depression is estimated to be between 20% and 55%. Women are consistently found to have rates of depression twice as high as those of men. Somewhere between 9% and 18% of all depressions are the result of an underlying medical condition, suggesting that a physical examination is important in the comprehensive treatment of depression (Hall, Popkin, Devaul, Fallaice, & Stickney, 1978; Koranyi, 1979). However, the vast majority of depressions are not attributable to identifiable medical causes. Other data (Gatz, Pedersen, Plomin, Nesselroade, & McClearn, 1992) suggest that genetic influences account for only 16% of the variance in total depression scores and that life experiences are the most statistically important influence on self-reported depressive symptoms.

Conclusions and Recommendations
The preponderance of the evidence suggests that the psychological interventions, particularly cognitivebehavioral therapy, are at least as effective as medication in the treatment of depression, even if severe. These treatments are effective for both vegetative and social adjustment symptoms, especially when outcome is assessed with patient-rated measures and when long-term follow-up is considered. It should be noted that these general conclusions are consistent with findings drawn from the psychiatry literature (e.g., Beck et al., 1985; Murphy et al., 1984; Wexler & Cicchetti, 1992) as well as the psychology literature. Pharmacologic approaches do not directly affect psychosocial factors. Medications result in relatively poorer compliance than psychotherapy, have a higher dropout rate, and result in as much as a 60% nonresponse rate with some patient populations. Many antidepressants are cardiotoxic, have dangerous side effects, and are often used in suicide attempts. Psychotherapy can teach skills to help prevent depression, making such treatment an attractive, cost-effective alternative to drug treatments.

To obtain the entire article on the world wide web, following this link: http://www.apa.org/journals/anton.html

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