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better. Severe depression can be over-whelming. It is easily seen by
relatives, friends, and doctors—and they also feel helpless.
Moderate degrees of depression are often missed by families and doctors.
These people are generally unhappy, have trouble sleeping, feel tense and
overloaded, fret about many worries, lack energy and often lose interest in
work, friends, current events, sex, and so on. They sense something isn’t
right because they often medicate themselves with pills from the family
doctor or with drugs from the street as well as alcohol. But they don’t know
what to do about their moods and are reluctant to see a psychiatrist or a
psychologist or a therapist. The life time risk of moderate depression is 25%
for all women and about 12% for all men.
A discussion of more specific types of depression is given in Chapter 9. There
are dysthymic disorders, bipolar disorders (manic-depressive), adjustment
disorders, depression associated with physical or medical problems, seasonal
affect disorders, and DDNOS. And just grouchy pessimists.
What age group is the most depressed? At this time it looks like it is going to
be the “Baby Boomer” generation. We don’t know why depression is so
common. That generation grew up in good economic times, had two loving,
“involved” parents, had only one or two competing siblings, and certainly had
far better educational opportunities that any previous generation. People born
between 1945 and 1960 also had the best ever medical care, including
pediatric care and school counseling when young and in their adulthood they
had an array of tranquilizers, anti-depressive medications, and
psychotherapies prescribed by attentive psychiatric/psychological doctors.
This same generation in their youth was involved in world affairs and actually
responsible for fantastic social changes—civil rights laws, voter registration,
resistance to the war, improved and equal education, equal rights for women,
and so on. I consider them the greatest generation, certainly in terms of
righting social injustice. Yet, depression hits them in middle age. Why? We
don’t know. Their own middle-class, advantaged children (born 1970-1990)
will be studied; perhaps they will be depressed too. Maybe one price of
unfairly having more than others is depression. Maybe having high
expectations increases the chances of failing for some people.
A major revolution in the treatment of depression has occurred after 1990 or
so when drug manufacturers started massive ad campaigns urging people to
go ask their doctor for a certain drug. This was highly effective (in terms of
selling drugs) and the medicalization of the treatment of mental illness may
have reduced the stigma of having a psychological or emotional problem. It
also reduced the self-blame and the parent-blame for such problems. These
are healthy changes, but the implication that depression (and other
psychological disorders) is strictly a physical disorder—a brain disorder—is
unfortunate. Just because depression can sometimes be reduced by drugs
doesn’t mean depression is caused by chemicals. How to use antidepressants
is covered in the next section.
The research is clear. The combination of medication (taking special
precautions with children and teens) with psychotherapy is usually the best
treatment for most depression. The rationale is that anti-depressive
medication will improve troubled thinking, increase energy and optimism, and
