influence the transmission of nerve impulses (involving chemicals
called neurotransmitters) in the brain. Too little of certain
neurotransmitters (norepinephrine or serotonin) supposedly results in
depression, too much in mania or overactivity. Helpless rats shocked
repeatedly act depressed and lose their norepinephrine (Ellison, 1977).
Rats in a similar situation but able to turn off the shock themselves do
not act depressed nor get deficient in norepinephrine (Weiss, et
Another theory is that the "general adaptation syndrome" is
responsible for depression as well as stress (see chapter 5).
Remember the third stage in this process, after an alarm reaction and
resistance, is exhaustion. Depressed people feel tired, drained of
energy, "I just can't get going." Other symptoms--poor sleep,
appetite, and sex drive--are regulated by the hypothalamus, so it may
be malfunctioning. The real question is: What causes the stress or the
neurotransmitter or the hypothalamus changes? We don't yet know.
If a person's depression involves radical bipolar mood swings
(feeling high and then low), delusions, and a high risk of suicide, some
form of medical treatment (drugs and hospitalization) in addition to
psychotherapy should be given. If the depression does not include any
of these factors but does include other physical factors mentioned
above (see signs), medication would probably help (Kocsis, 1981).
Even when there are no signs of physical illness, i.e. it seems to be
psychological, the treatment of choice is psychotherapy with
medication as needed. It isn't understood why or how but anti-
depressive medication changes cognition, and cognitive therapy,
believe it or not, changes body chemistry (Free & Oei, 1989).
Other physiological conditions are related to sadness and anxiety,
for example, postpartum conditions, hypoglycemia, and premenstrual
syndrome. Hypoglycemia may have been overemphasized in the
1970's but premenstrual syndrome is a devastating problem for some
women. One woman was hospitalized 13 times for suicidal depression
before someone noticed that each admission was one or two days
before her period (letters, Ms, p. 4, January, l984). More commonly
(estimated from 20% to 80%), women experience increased tension,
headaches, irritability, and sadness prior to their periods. There are
likely to be complex physiological and psychological causes but we
know little about premenstrual stress, thus far. Research is badly
needed (Eagan, 1983).
A word of caution: believing in physical causes, such as
psychiatrists' favorite expression "chemical imbalance," may interfere
with assuming responsibility for changing yourself. Examples: "I'm on
medication" or "I get depression from my mother" or "my system is all
messed up." Lewinsohn & Arconad (1981) reports that many
depressed patients see themselves as physically ill, as victims of some
bodily disorder. Thus, they expect the "doctor" or medicine to
magically remove their sadness--otherwise, they feel helpless. (Of
course, the opposite misunderstanding is equally harmful: when