**Causes** (cont.)
- What initiates the alteration in brain chemistry?
- Is a tendency to depression inherited?

**Treatment**
- What sorts of psychotherapy are effective for depression?

**Medication**
- Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?
- How do you tell when a treatment is not working? How do you know when to switch treatments?
- How do antidepressants relieve depression?
- Are Antidepressants just “happy pills?”
- What percentage of depressed people will respond to antidepressants?
- What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
- What are the major categories of anti-depressants?
- What are the side-effects of some of the commonly used antidepressants?
- What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
- Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
- What should I do if my antidepressant does not work?

Causes (cont.)
————–

Q. What initiates the alteration in brain chemistry?

It can be either a psychological or a physical event. On the physical  side, a hormonal change may provide the initial trigger: some women dip into depression briefly each month during their premenstrual phase; some find that the hormone balance created by oral contraceptives disposes them to depression; pregnancy, the end of pregnancy, and menopause have also been cited. Men’s hormone levels fluctuate as deeply but less obviously.

It is well known that certain chronic illnesses have depression as a frequent consequence: some forms of heart disease, for example, and Parkinsonism. This seems to be the result of a chemical effect rather than a purely psychological one, since other, equally traumatic and serious illnesses don’t show the same high risk of depression.

Q. Is a tendency to depression inherited?

It seems there are some people whose brain chemistry is predisposed to the depressive response, and others who are at much lower risk of depression even if exposed to the same physical or psychological triggers. The genetic relations of manic-depressives are at a higher risk for unipolar depression than the population at large or their adopted/by marriage relations. There seems to be a link between high creativity and the gene for manic-depression: artists and writers often are not manic-depressive themselves, but have a family member who is. Studies of families in which members of each generation  develop manic-depressive illness found that those with the illness have a somewhat different genetic make-up than those who do not get ill. However, the reverse is not true: not everybody with the genetic make-up that causes vulnerability to manic-depressive illness has the disorder. Apparently additional factors, possibly a stressful environment, are involved in its onset.

Major depression also seems to occur, generation after generation, in some families. However, depression can occur in people with no family history of any form of mental illness. And I would be reluctant to suggest that there is any human who is entirely immune to depression under all possible conditions.

Psychological triggers: many, if not most, people with depression can point to some incident or condition which they believe is responsible for their unhappiness. Of course, people with severe depression are prone to astonishingly virulent and inappropriate guilt and self-hatred.

The (genuine) life events that most often appear in connection with depression are various, but there is one distinguishing feature that appears in many cases, over and over: loss of self-determination, of empowerment, of self-confidence. More profoundly: a loss of self, of the abilities or activities that a person identifies with herself.  Stereotypically: a man loses the job that had defined him to himself and others, whether that definition was “executive” or “breadwinner”; a woman who had spent her whole life preparing for and living the role of wife, supporter, caretaker, is suddenly left alone by divorce or death. In general, any life change, often caused by events beyond  one’s control, which damages the structure that gave life meaning.

The ability of a person to respond to such an event will depend on many factors, including genetic predisposition, support from friends, physical health, even the weather. It can also depend on internal psychological factors which may best be explored in talk therapy: why is the person’s self-esteem so bound up in the position or state that has been lost? Can she find a new source of self-esteem? Therapy can be immensely helpful here.

Obviously, not everyone to whom this sort of event happens becomes depressed, and not every person who becomes depressed has had this sort of catastrophe befall them. In fact, if a person suffers a loss and then becomes depressed, it may well be that they weathered the loss in fine style and then succumbed to a much less obvious trigger, psychological or physical.

Some depressions may well be caused by a spontaneous aberration in brain chemistry, with no trigger that we can currently identify, just as a seizure or migraine may have an obvious trigger or be apparently spontaneous.

However, once the depressive state has set in, both physical and psychological problems will be generated in abundance. What faster way to lose a job or a spouse than to be too depressed to work or to communicate? What worse psychological state for coping with a blow to identity can there be than a chemically promoted, pathological self-hatred? And what can be worse for self-esteem than watching one’s appearance and household disintegrate as one loses the motivation to shower, straighten up, wash dishes or laundry, or choose attractive clothes? Health deteriorates as well: some depressed people can’t sleep or eat, others sleep constantly (a real help on the job!) and eat incessantly, sometimes in order to stay awake, sometimes because it’s the only thing that gives a little pleasure or comfort. (Carbohydrates induce production of serotonin, so there may be an element of self-medication here); almost no one has the impulse to exercise or get fresh air and sunshine. Most if not all of these effects form feedback loops, increasing in magnitude and becoming triggers for further depression.

The question, “Is depression mostly physical or psychological,” is rather beside the point. Depression may be triggered by either physical or psychological events. Most commonly, both seem to be involved, though it is often difficult to separate the two when one is talking about psychology and neurochemistry. But however it begins, depression quickly develops into a set of physical and psychological problems which feed on each other and grow. This is why a combination of physical and psychological intervention has been shown to give the best results for most patients, regardless of any classifications that doctors may have tried to impose on their depression and its cause.

Treatment
———

Q. What sorts of psychotherapy are effective for depression?

Two effective methods of psychotherapy for people with depressions are cognitive therapy and interpersonal therapy. Both psychoanalysis, and insight oriented psychotherapy have not been shown to be effective treatments for people with a depressive disorder. Cognitive (and cognitive-behavioral) therapists can be found in most major cities.

For a referral to a properly trained cognitive therapist practicing close to your location, contact:

Aaron T. Beck, MD.
The Center for Cognitive Therapy
3600 Market Street
Philadelphia, PA 19101
(215) 898-4100.

While many therapists call themselves cognitive therapists and interpersonal therapists, only a few have had proper training. To find an interpersonal therapist with the best training, contact:

Myrna Weissman, Ph.D.
New Your State Psychiatric Institute
722 West 168th Street
New York, NY 10032
(212) 996-6390

Medication
———-

Q. Do certain drugs work best with certain depressive illnesses? What are the guidelines for choosing a drug?

There are very few kinds of depression for which there are specific antidepressant treatments. When it comes to people with Bipolar Disorder who are depressed there are some major problems. Most importantly, with any antidepressant, there is a possibility that the antidepressant treatment will cause depressed bipolar people not just to come out of their depressions, but to develop manic episodes. The possibility of an antidepressant causing mania is least when the antidepressant is bupropion (Wellbutrin). The possibility of mania is greatly reduced if depressed bipolar folks are on a mood stabilizer such as lithium, Tegretol or Depakote when they are started on an antidepressant.

Q. How do you tell when a treatment is not working? How do you know when to switch treatments?

Antidepressant treatment is clearly not working when the individual receiving the treatment remains depressed or becomes depressed again. When a recently started antidepressant fails to cause improvement, the depressed individual often asks that the medication be stopped, and a new one started. It generally does not make sense to change antidepressants until 8-weeks at the maximum tolerated dose have elapsed. With some tricyclic antidepressants, it is important to check the blood level of the antidepressant before it is stopped. The blood test can tell if the amount in the blood has been adequate. Only after an adequate trial of one antidepressant should another be tried. To have been on four antidepressants in an 8-week period means that one has not had an adequate trial on any of them.

Q. How do antidepressants relieve depression?

There are several classes of antidepressants, all of which seem to work by increasing levels of certain neurotransmitters (most commonly serotonin, norepinephrine, and dopamine) in the brain. It is not entirely clear why increasing neurotransmitter levels should reduce the severity of a depression. One theory holds that the increased concentration of neurotransmitters causes changes in the brain’s concentration of molecules, receptors, to which these transmitters bind. In some unknown way it is the changes in the receptors that are thought responsible for improvement.

Q. Are Antidepressants just “happy pills?”

No matter what their exact mode of action may be, it is clear that antidepressants are not “happy pills.” There is no street-market in antidepressants, for unlike “speed” which will improve the mood of almost everybody, antidepressants only improve the mood of depressed people. Also unlike the almost instant effects of speed, the mood-improving effects of antidepressants develop slowly over a number of weeks. “Speed” induces a highly artificial state, antidepressants cause the brain to slowly increase its production of naturally occurring neurotransmitters.

Q. What percentage of depressed people will respond to antidepressants?

Generally, about 2/3 of depressed people will respond to any given antidepressant. People who do not respond to the first antidepressant they have taken, have an excellent chance of responding to another.

Q. What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?

The most common description of the effects of antidepressants is that of feeling the depression gradually lift, and for the person to feel normal again. People who have responded to antidepressants are not euphoric. They are not unfeeling automatons. The are still able to feel sad when bad things happen, and they are able to feel very happy in response to happy events. The sadness they feel with disappointments is not depression, but is the sadness anyone feels when disappointed or when having experienced a loss. Antidepressants do not bring about happiness, they just relieve depression. Happiness is not something that can be had from a pill.

Q. What are the major categories of anti-depressants?

There are many classes of antidepressants. Two kinds of antidepressants have been around for over 30 years. These are the tricyclic antidepressants and the monoamine oxidase inhibitors. While there are newer antidepressants, many with fewer side-effects, none of the newer antidepressants has been shown to be more effective than these two classes of drugs. In fact, many people who have not responded to newer antidepressants have been successfully treated with one of these classes of drugs.

The tricyclic antidepressants (TCAs) include such drugs as imipramine (Tofranil, amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Aventyl and Pamelor).

The monoamine oxidase inhibitors (MAOIs) include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan) which has recently been taken off the market in the U.S.A. for marketing rather than safety or efficacy reasons.

One of the popular new classes of antidepressants are the selective serotonin reuptake inhibitors (SSRIs). The first of these drugs to be marketed in the USA was fluoxetine (Prozac). Sertraline (Zoloft), and paroxetine (Paxil) soon followed, and fluvoxamine (Luvox) is scheduled to be marketed in late 1994, or early 1995.

Bupropion (Wellbutrin) is the only drug in its class, as is trazodone (Desyrel). The most recently marketed antidepressant (4/94) is venlafaxine (Effexor), the first drug in yet another class of drugs.

Q. What are the side-effects of some of the commonly used antidepressants?

Below is a list of some of the more frequently prescribed antidepressants, and their most common side effects. The figure following each side effect is the percentage of people taking the medication who experience that side effect.

Aventyl (nortriptyline): Dry mouth (15); Constipation (15);
Weakness-fatigue (10); Tremor (10).

Effexor (venlafaxine) Nausea (35); Headache (25); Sleepiness (25);
Dry mouth (20); Insomnia (20); Constipation (15).

Elavil (amitriptyline): Dry mouth (40); Drowsiness (30); Weight gain
(30); Constipation (25); Sweating (20).

Nardil (phenelzine): dry mouth (30); insomnia (25); Increased heart
rate (25); Lowered blood pressure (20); Sedation (15); Over
stimulation (10);

Norpramin (desipramine): dry mouth (15); increased pulse (15);
constipation (10); reduced blood pressure (10).

Pamelor – see Aventyl

Parnate (tranylcypromine) Dry mouth (20); Insomnia (20); Increased
pulse rate (20); Lowered blood pressure (15); Over stimulation (15);
Sedation (15).

Paxil (paroxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (25); Sedation (25); Dizziness (15)
Insomnia (15)

Prozac (fluoxetine): Decreased sexual interest and/or problems
achieving orgasm (30); Nausea (20); Headache (20); Nervousness (15);
Insomnia (15); Diarrhea (15).

Sinequan (doxepin): Dry mouth (40); Sedation (40); Weight gain (30);
Lowered blood pressure (25); Constipation (25); Sweating (20).

Tofranil (imipramine): Dry mouth (30), Reduced blood pressure (30),
Constipation (20), Difficulty with urination (15).

Wellbutrin (bupropion): Agitation (30); Weight loss (25), Dizziness
(20); Decreased appetite (20);

Zoloft (sertraline): Decreased sexual interest and/or problems
achieving orgasm (30);Nausea (25); Headache (20); Diarrhea (20);
Insomnia 15); Dry mouth (15); Sedation (15).

Q. What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?

Listed below are some frequent side effects of antidepressants, and some techniques to reduce their severity:

Dry mouth: Drink lots of water, chew sugarless gum, clean teeth daily, ask the dentist to suggest a fluoride rinse to prevent cavities, visit the dentist more often than usual for tooth and gum hygiene

Constipation: Drink at least six 8-ounce glasses of water every day, eat bran cereals, eat salads twice a day, exercise daily (walk for at least 30 minutes a day), ask your doctor about taking a bulk producing agent such as Metamucil, also ask about taking a stool softener such as Colace, be sure to avoid laxatives such as Ex-Lax.

Bladder problems: The effects of some antidepressants, especially the tricyclic medications may make it difficult for you to start the stream of urine. There may be some hesitation between the time you try to urinate and the time your urine starts to flow. If it takes you over 5-minutes to start the stream, call your doctor.

Blurred vision: The tricyclic antidepressants may make it difficult for you to read. Distant vision is usually unaffected. If reading is important to you the effects of the antidepressant can be compensated for by a change in glasses. As you may compensate for the change in your vision, try to postpone getting new glasses as long as possible.

Dizziness: Dizziness when getting out of bed or when standing up from a chair, or when climbing stairs may be a problem when taking tricyclic antidepressants and monoamine oxidase inhibitors. Changing posture slowly may help prevent this kind of dizziness. Drinking adequate amounts of liquid and eating enough salt each day is important. Be sure to speak to your doctor if this side-effect is severe.

Drowsiness: This side effect often passes as you get used to taking the antidepressant that has been prescribed for you. Ask your doctor if it is safe for you to increase your intake of caffeine, and if so, by how much. If you are drowsy be sure not to drive or operate dangerous machinery.

Q. Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?

Both lowered sexual desire and difficulties having an orgasm, in both men and women, are particularly a problem with the selective serotonin re-uptake inhibitors (Prozac, Zoloft, Paxil and Luvox), and the monoamine oxidase inhibitors (Nardil and Parnate). There is no treatment for decreased sexual interest except lowering the dose or switching to a drug that does not have sexual side effects such as bupropion (Wellbutrin). Difficulty having orgasms may be treated by a number of medications. Among those medications are: Periactin, Urecholine, and Symmetrel. None of these are over-the-counter drugs and they must be prescribed by a physician. Unfortunately, many psychiatrists are not familiar with using these medications to treat the sexual side-effects of antidepressants.

Q. What should I do if my antidepressant does not work?

Many people decide that their antidepressant is not working prematurely. When one starts an antidepressant the hope is for rapid relief from depression. What must be remembered is that for an antidepressant to work, you must be on an adequate dose of the drug for an adequate length of time. A fair trial of any antidepressant is at least two months. Prior to a two month trial the only reason to abandon an antidepressant trial is if the medication is causing severe side effects. With many antidepressants the dose has to be increased at intervals far above the starting dose. Unfortunately, the two-month period mentioned above, refers to two months following the most recent increase in the dose, not the time from starting the particular antidepressant.

**Self-care** (cont.)
- How can I help myself get through depression on a day-to-day basis?

**Books**
- What are some books about depression?

Self-care (cont.)
—————–

Q. How can I help myself get through depression on a day-to-day basis?

On a day-to-day basis, separate from, or concurrently with therapy or
medication, we all have our own methods for getting through the worst
times as best we can. The following comments and ideas on what to do
during depression were solicited from people in the
alt.support.depression newsgroup. Sometimes these things work,
sometimes they don’t. Just keep trying them until you find some
techniques that work for you.

* Write. Keep a journal. Somehow writing everything down helps keep
the misery from running around in circles.

* Listen to your favorite “help” songs (a bunch of songs that have
strong positive meaning for you)

* Read (anything and everything) Go to the library and check out
fiction you’ve wanted to read for a long time; books about
depression, spirituality, morality; biographies about people who
suffered from depression but still did well with their lives
(Winston Churchill and Martin Luther, to name two;).

* Sleep for a while

* Even when busy, remember to sleep. Notice if what you do before
sleeping changes how you sleep.

* If you might be a danger to yourself, don’t be alone. Find people.
If that is not practical, call them up on the phone. If there is no
one you feel you can call, suicide hotlines can be helpful, even if
you’re not quite that badly off yet.

* Hug someone or have someone hug you.

* Remember to eat. Notice if eating certain things (e.g. sugar or
coffee) changes how you feel.

* Make yourself a fancy dinner, maybe invite someone over.

* Take a bath or a perfumed bubble bath.

* Mess around on the computer.

* Rent comedy videos.

* Go for a long walk

* Dancing. Alone in my house or out with a friend.

* Eat well. Try to alternate foods you like ( Maybe junk foods) with
the stuff you know you should be eating.

* Spend some time playing with a child

* Buy yourself a gift

* Phone a friend

* Read the newspaper comics page

* Do something unexpectedly nice for someone

* Do something unexpectedly nice for yourself.

* Go outside and look at the sky.

* Get some exercise while you’re out, but don’t take it too seriously.

* Pulling weeds is nice, and so is digging in the dirt.

* Sing. If you are worried about responses from critical neighbors,
go for a drive and sing as loud as you want in the car. There’s
something about the physical act of singing old favorites that’s
very soothing. Maybe the rhythmic breathing that singing enforces
does something for you too. Lullabies are especially good.

* Pick a small easy task, like sweeping the floor, and do it.

* If you can meditate, it’s really helpful. But when you’re really
down you may not be able to meditate. Your ability to meditate will
return when the depression lifts. If you are unable to meditate,
find some comforting reading and read it out loud.

* Feed yourself nourishing food.

* Bring in some flowers and look at them.

* Exercise, Sports. It is amazing how well some people can play
sports even when feeling very miserable.

* Pick some action that is so small and specific you know you can do
it in the present. This helps you feel better because you actually
accomplish something, instead of getting caught up in abstract
worries and huge ideas for change. For example say “hi” to someone
new if you are trying to be more sociable. Or, clean up one side of
a room if you are trying to regain control over your home.

* If you’re anxious about something you’re avoiding, try to get some
support to face it.

* Getting Up. Many depressions are characterized by guilt, and lots
of it. Many of the things that depressed people want to do because
of their depressions (staying in bed, not going out) wind up making
the depression worse because they end up causing depressed people
to feel like they are screwing things up more and more. So if
you’ve had six or seven hours of sleep, try to make yourself get
out of bed the moment you wake up…you may not always succeed,
but when you do, it’s nice to have gotten a head start on the day.

* Cleaning the house. This worked for some people me in a big way.
When depressions are at their worst, you may find yourself unable
to do brain work, but you probably can do body things. One
depressed person wrote, “So I spent two weeks cleaning my house,
and I mean CLEANING: cupboards scrubbed, walls washed, stuff given
away… throughout the two weeks, I kept on thinking “I’m not
cleaning it right, this looks terrible, I don’t even know how to
clean properly”, but at the end, I had this sparkling beautiful
house!”

* Volunteer work. Doing volunteer work on a regular basis seems to
keep the demons at bay, somewhat… it can help take the focus off
of yourself and put it on people who may have larger problems (even
though it doesn’t always feel that way).

* In general, It is extremely important to try to understand if
something you can’t seem to accomplish is something you simply CAN’T
do because you’re depressed (write a computer program, be charming
on a date), or whether its something you CAN do, but it’s going to
be hell (cleaning the house, going for a walk with a friend, getting
out of bed). If it turns out to be something you can do, but don’t
want to, try to do it anyway. You will not always succeed, but try.
And when you succeed, it will always amaze you to look back on it
afterwards and say “I felt like such shit, but look how well I
managed to…!” This last technique, by the way, usually works for
body stuff only (cleaning, cooking, etc.). The brain stuff often
winds up getting put off until after the depression lifts.

* Do not set yourself difficult goals or take on a great deal of
responsibility.

* Break large tasks into many smaller ones, set some priorities, and
do what you can, as you can.

* Do not expect too much from yourself. Unrealistic expectations will
only increase feelings of failure, as they are impossible to meet.
Perfectionism leads to increased depression.

* Try to be with other people, it is usually better than being alone.

* Participate in activities that may make you feel better. You might
try mild exercise, going to a movie, a ball game, or participating
in religious or social activities. Don’t overdo it or get upset if
your mood does not greatly improve right away. Feeling better takes
time.

* Do not make any major life decisions, such as quitting your job or
getting married or separated while depressed. The negative thinking
that accompanies depression may lead to horribly wrong decisions.
If pressured to make such a decision, explain that you will make the
decision as soon as possible after the depression lifts. Remember
you are not seeing yourself, the world, or the future in an objective
way when you are depressed.

* While people may tell you to “snap out” of your depression, that is
not possible. The recovery from depression usually requires
antidepressant therapy and/or psychotherapy. You cannot simple make
yourself “snap out” of the depression. Asking you to “snap out” of a
depression makes as much sense as asking someone to “snap out” of
diabetes or an under-active thyroid gland.

* Remember: Depression makes you have negative thoughts about
yourself, about the world, the people in your life, and about the
future. Remember that your negative thoughts are not a rational way
to think of things. It is as if you are seeing yourself, the world,
and the future through a fog of negativity. Do not accept your
negative thinking as being true. It is part of the depression and
will disappear as your depression responds to treatment. If your
negative (hopeless) view of the future leads you to seriously
consider suicide, be sure to tell your doctor about this and ask for
help. Suicide would be an irreversible act based on your
unrealistically hopeless thoughts.

* Remember that the feeling that nothing can make depression better
is part of the illness of depression. Things are probably not
nearly as hopeless as you think they are.

* If you are on medication:
a. Take the medication as directed. Keep taking it as directed
for as long as directed.
b. Discuss with the doctor ahead of time what happens in case of
unacceptable side-effects.
c. Don’t stop taking medication or change dosage without discussing
it with your doctor, unless you discussed it ahead of time.
d. Remember to check about mixing other things with medication. Ask
the prescribing doctor, and/or the pharmacist and/or look it up
in the Physician’s Desk Reference. Redundancy is good.
e. Except in emergencies, it is a good idea to check what your
insurance covers before receiving treatment.

* Do not rely on your doctor or therapist to know everything. Do some
reading yourself. Some of what is available to read yourself may be
wrong, but much of it will shed light on your disorder.

* Talk to your doctor if you think your medication is giving
undesirable side-effects.

* Do ask them if you think an alternative treatment might be more
appropriate for you.

* Do tell them anything you think it is important to know.

* Do feel free to seek out a second opinion from a different
qualified medical professional if you feel that you cannot get what you
need from the one you have.

* Skipping appointments, because you are “too sick to go to the
doctor” is generally a bad idea..

* If you procrastinate, don’t try to get everything done. Start by
getting one thing done. Then get the next thing done. Handle one
crisis at a time.

* If you are trying to remember too many things to do, it is okay to
write them down. If you make lists of tasks, work on only one task
at a time. Trying to do too many things can be too much. It can be
helpful to have a short list of things to do “now” and a longer
list of things you have decided not to worry about just yet. When you
finish writing the long list, try to forget about it for a while.

* If you have a list of things to do, also keep a list of what you
have accomplished too, and congratulate yourself each time you get
something done. Don’t take completed tasks off your to-do list. If
you do, you will only have a list of uncompleted tasks. It’s useful
to have the crossed-off items visible so you can see what you have
accomplished

* In general, drinking alcohol makes depression worse. Many cold
remedies contain alcohol. Read the label. Being on medication may
change how alcohol affects you.

* Books on the topic of “What to do during Depression”: “A Reason to
Live,” Melody Beattie, Tyndale House Publishers, Wheaton, IL. 167
pages. This book focuses on reasons to choose life over suicide,
but is still useful even if suicide isn’t on your mind. In fact, it
reads a lot like this portion of the FAQ. An excerpt:

* Do two things each  day. In times of severe crisis, when you don’t
want to do anything, do two things each day. Depending on your physical
and emotional condition, the two things could be taking a shower and
making a phone call, or writing a letter and painting a room.

* Get a cat. Cats are clean and quiet, they are often permitted by
landlords who won’t allow dogs, they are warm and furry.

Books
—–

Q. What are some books about depression?

This is an shorter version from a list of books compiled from the
personal recommendations of the members/readers/participants of the
Walkers-in-Darkness mailing list, the alt.support.depression
newsgroup, and the Mood Disorders Support Network on AOL.

The full list is available at the Walkers ftp site (see Internet
Resources) and at the MIT *.answers site, rtfm.mit.edu;
pub/usenet/alt-support-depression/books

If you have any additions, updates, corrections, etc. for this list,
please send email to “danash@aol.com” (Dan Ash).

~A Brilliant Madness: Living with Manic Depressive Illness.~ Patty
“Anna” Duke and Gloria Hochman. Bantam Books 1992 Comments: Patty
Duke’s very personal account of her account of her struggle with
manic-depression.

~The Broken Brain: The Biological Revolution in Psychiatry.~ Nancy
Andreasen, MD, Ph.D.. Harper. Perennial. 1984

~Care of the Soul.~ Thomas Moore. Harper. Perennial. 1992

~The Consumers Guide to Psychotherapy.~ Jack Engler, Ph.D. and Daniel
Goleman, Ph.D. Fireside-Simon & Schuster. 1992

~Cognitive Therapy & The Emotional Disorders.~ Aaron T. Beck, MD
Penguin. Meridian. 1976

~Darkness Visible: A Memoir of Madness.~ William Styron. Vintage. 1990.

~The Depression Handbook.~ Workbook. Mary Ellen Copeland

~Depression and it’s Treatment.~ John H. Greist, MD.. and James W.
Jefferson, MD.. Warner Books. 1992

~The Essential Guide to Psychiatric Drugs.~ Jack Gorman. St. Martin’s
Press. 1992

~Everything You Wanted to Know About Prozac.~ Jeffrey M. Jonas, MD and
Ron Schaumburg. Bantam. 1991

~Feeling Good: The New Mood Therapy.~ David Burns, MD. Signet. 1980
Self-help cognitive therapy techniques for depression, anxiety, etc.

~The Feeling Good Handbook.~ David D. Burns, MD. Plume. 1989

~Good Mood: The New Psychology of Overcoming Depression.~ Julian L.
Simon. Open Court Press. 1993.

~The Good News About Depression.~ Mark S. Gold. Bantam. 1986

~Listening To Prozac.~ Peter D. Kramer, M.D. Viking. 1993 A
psychiatrist explores some of the implications of anti- depressants,
and especially of Prozac’s unusual effects on the personality. Kramer
also discusses the recent research on depression, as well as several
other issues which seem linked to depression.

~How to Heal Depression.~ Harold H. Bloomfield, MD and Peter
McWilliams. Prelude Press. 1994

~Manic-Depressive Illness.~ Fredrick K. Goodwin, MD, & Kay Redfield
Jamison, Ph.D.. Oxford. 1990

~Munchausen’s Pigtail.~ Psychotherapy and ‘Reality’: Essays & Lectures.
Paul Walzlawick, Ph.D.. Norton

~On The Edge Of Darkness.~ Kathy Cronkite. Doubleday. 1994

~Overcoming Depression.~ Demitri F. and Janice Papolos. Harper.
Perennial. 1992. Good basic text on the various aspects of depression
and manic depression. Considered by some to be a “classic” in the
field.

~A Primer of Drug Action: A Concise, Non technical Guide to the”
“Actions,Uses and Side Effects of Psychoactive Drugs.~ Robert M.
Julien. W.H. Freeman. 1992. 6 ed.

~Prozac: Questions and Answers for Patients, Families and Physicians.~
Dr. Robert Fieve, MD… Avon. 1993

~Questions and Answers about Depression and its Treatment.~ Dr. Ivan
Goldberg. The Charles Press in Philadelphia. 1993. A 112-page FAQ on
depression that has appeared in book form. Dr. Goldberg has also
contributed to the FAQ for a.s.d. and frequently posts to
Walkers-in-darkness.

~A Reason to Live.~ Melody Beattie (General Editor).. Tyndale House
Publishers, Inc.. 1992. This is a book that explores reasons to live
and reasons not to commit suicide. It also contains suggestions for
life-affirming actions people can take to help themselves get through
those times when they’re struggling to find a reason to live.

~From Sad to Glad.~ Nathan S. Kline, MD. Ballantine Books.. 1991 20th
printing. Out of date pharmacologically “but excellent otherwise.”
Kline says: “Psychiatry has labored too long under the delusion that
every emotional malfunction requires an endless talking out of
everything the patient ever experienced.”

~Season of the Mind.~ Norman Rosenthal, MD.. This book explores
Seasonal Affective Disorder.

~Talking Back to Prozac.~ Peter Breggin. St. Martins Press. 1994

~Touched with Fire: Manic-depressive Illness and the Artistic~
~Temperament.~ Kay Jamison. A look at a number of 19th century poets,
writers, and composers who were Bipolar. This book in quoted
liberally in this FAQ under “Who are some famous people with
depression?”

~Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace Drugs,~
~Electroshock, and the Biochemical Theories of the ‘New Psychiatry’.~
Peter Breggin. St. Martin’s Press. 1991

~We Heard the Angels of Madness: One Family’s Struggle with Manic~
~Depression.~ Diane and Lisa Berger This book was written by a mother
who had a son stricken by manic-depression at 19 and documents the
rough road they walked to get him the help he needed. Very heartfelt
and well written.

~Understanding Depression.~ Donald Klein, MD, and Paul Wender, MD
(founders of the National Assn. for Depressive Illness). Oxford,
1993 Melvin Sabshin, MD, Medical Director, American Psychiatric Assn.
writes: “A very good source of information that will be
extraordinarily useful to patients and their families.”

~The Way Up From Down.~ Priscilla Slagle, M.D. This book stresses a
nutritional approach heavy on the amino acid tyrosine, and a complete
vitamin supplement program.

~What You Need to Know About Psychiatric Drugs.~ Stuart C. Yudofsky,
MD; Robert E. Hales, MD; and Tom Ferguson, MD. Ballantine. 1991

~When am I Going to Be Happy?~ Penelope Russianoff, Ph.D.. Bantam.
1989

~When the Blues Won’t Go Away.~ Robert Hirschfeld, MD… 1991 Concerns
new approaches to Dysthymic Disorder and other forms of chronic
low-grade depression.

~Winter Blues: Seasonal Affective Disorder and How to Overcome It.~
Norman Rosenthal, MD… The Guilfold Press. 1993

~You Are Not Alone.~ Julia Thorne with Larry Rothstein. Harper Collins.
1993 Comments: The writings of depressives, for both depressives and
those who need to understand them. Shervert Frazier, MD, former
director of    the National Institutes of Mental Health says: “A
ground breaking book that…reveals the impact of depression on the
lives of everyday people. This little book is must reading for
sufferers, those associated with depression, and mental health
professionals”

~You Mean I Don’t Have To Feel This Way?~ Collette Dowling. Bantam.
1993 Comments: Jeffrey M. Jonas, MD writes: “An important book that
is filled with information helpful to sufferers of mood and eating
disorders and other illnesses. It should be read not only by lay
people but also by professionals who deal with these illnesses.”

Here you will find the FAQ from the alt.support.depression newsgroup. I have made no changes other than formatting. As you can see, the FAQ has not been updated since 1994, therefore some of the information, especially regarding antidepressants available, is somewhat out of date. However, this does not greatly diminish its usefulness.

Archive-name: alt-support-depression/faq/part1
Posting-Frequency: bi-weekly
Last-modified: 1994/08/07
alt.support.depression FAQ
==========================
Introduction
————

Alt.support.depression is a newsgroup for people who suffer from all forms of depression as well as others who may want to learn more about these disorders. Much the information shared in this newsgroup comes from posters’ experience as well as contributions by professionals in many fields. The thoughts expressed here are for the benefit of the readers of this group. Please be considerate in the way you use the information from this group, keeping in mind the stigma of depression still experienced in society today.

The following Frequently-Asked-Questions (FAQ) attempts to impart an understanding of depression including its causes; its symptoms; its medication and treatments–including professional treatments as well as things you can do to help yourself. In addition, information on where to get help, books to read, a list of famous people who suffer from depression, internet resources, instructions for posting anonymously, and a list of the many contributors is included.

Updated and corrected versions will be posted periodically. Please send suggestions to <cf12@cornell.edu>.

This FAQ, and many other FAQ’s, are available via anonymous ftp from <rtfm.mit.edu>. To get the latest edition of this FAQ: ftp://rtfm.mit.edu/pub/usenet/news.answers/alt-support-depression/faq/part1

The directory and file name is located in the “Archive-name:” line in the header. A mail server also exists for accessing the FAQ archives. Send a message to <mail-server@rtfm.mit.edu>, with the command “help” in the body of your message.

Table of Contents

=================

Key:
- No change.
+ Added since last posting.
& Updated since last posting.

Part 1 of 5
———–
**Depression Primer**
**Types**
- What is depression?
- What is major depression?
- What is dysthymia?
- What is bipolar depression (manic-depressive illness)?
- What is Seasonal Affective Disorder (SAD)?
- What is Post Partum Depression
- How is bereavement different from depression?
- What is Endogenous Depression
- What is atypical depression?

**Symptoms**
- What are the typical symptoms of depression?
- What are the diagnostic criteria for depression?

**Causes**
- What causes depression?

Part 2 of 5
———–

**Causes** (cont.)
- What initiates the alteration in brain chemistry?
- Is a tendency to depression inherited?

**Treatment**
- What sorts of psychotherapy are effective for depression?

**Medication**
- Do certain drugs work best with certain depressive illnesses? What
are the guidelines for choosing a drug?
- How do you tell when a treatment is not working? How do you know
when to switch treatments?
- How do antidepressants relieve depression?
- Are Antidepressants just “happy pills?”
- What percentage of depressed people will respond to antidepressants?
- What does it feel like to respond to an antidepressant? Will I feel euphoric if my depression responds to an antidepressant?
- What are the major categories of anti-depressants?
- What are the side-effects of some of the commonly used antidepressants?
- What are some techniques that can be used by people taking antidepressants to make side effects more tolerable?
- Many antidepressants seem to have sexual side effects. Can anything be done about those side-effects?
- What should I do if my antidepressant does not work?

Part 3 of 5
———–

**Medication** (cont.)
- If an antidepressant has produced a partial response, but has not fully eliminated depression, what can be done about it?

**Electroconvulsive Therapy**
- What is electroconvulsive therapy (ECT) and when is it used?
- Exactly what happens when someone gets ECT?
- How do individuals who have had ECT feel about having had the treatments?
- How long do the beneficial effects of ECT last?
- Is it true that ECT causes brain damage?
- Why is there so much controversy about ECT?

**Substance Abuse**
- May I drink alcohol while taking antidepressants?
- If I plan to drink alcohol while on medication, what precautions should I take?
- What’s the relationship between depression and recovery from substance abuse?
- What does the term “dual-diagnosis” mean?
- Is it safe for a person recovering from substance abuse to take drugs?
- How do you know when depression is severe enough that help should be sought?

**Getting Help**
-Where should a person go for help?
-Where can I find help in the United Kingdom?
-Where can I find out about support groups for depression?
-How can family and friends help the depressed person?

**Choosing A Doctor**
-What should you look for in a doctor? How can you tell if he/she really understands depression?

**Self-care**
- How may I measure the effects my treatment is having on my depression?

Part 4 of 5
———–

**Self-care** (cont.)
- How can I help myself get through depression on a day-to-day basis?

**Books**
- What are some books about depression?

Part 5 of 5
———–

**Famous People**
- Who are some famous people who suffer from depression and bipolar disorder?

**Internet Resources**
- What are some electronic resources on the internet related to depression?

**Anonymous Posting**
- How can I post anonymously to alt.support.depression?

**Sources**
- Sources

**Contributors**
- Contributors

Depression Primer
=================

Types
—–

Q. What is depression?

Being clinically depressed is very different from the down type of feeling that all people experience from time to time. Occasional feelings of sadness are a normal part of life, and it is that such feelings are often colloquially referred to as “depression.” In clinical depression, such feelings are out of proportion to any external causes. There are things in everyone’s life that are possible causes of sadness, but people who are not depressed manage to cope with these things without becoming incapacitated.

As one might expect, depression can present itself as feeling sad or “having the blues”. However, sadness may not always be the dominant feeling of a depressed person. Depression can also be experienced as a numb or empty feeling, or perhaps no awareness of feeling at all. A depressed person may experience a noticeable loss in their ability to feel pleasure about anything. Depression, as viewed by psychiatrists, is an illness in which a person experiences a marked change in their mood and in the way they view themselves and the world. Depression as a significant depressive disorder ranges from short in duration and mild to long term and very severe, even life threatening.

Depressive disorders come in different forms, just as do other illnesses such as heart disease. The three most prevalent forms are major depression, dysthymia, and bipolar disorder.

Q. What is major depression?

Major depression is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, sleep, eat; and enjoy once-pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.

Q. What is dysthymia?

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep you from functioning at “full steam” or from feeling good. Sometimes people with dysthymia also experience major depressive episodes.

Q. What is bipolar depression (manic-depressive illness)?

Another type of depressive disorder is manic-depressive illness, also called bipolar depression. Not nearly as prevalent as other forms of depressive disorders, manic depressive illness involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when in a manic phase.

Q. What is Seasonal Affective Disorder (SAD)?

SAD is a pattern of depressive illness in which symptoms recur every winter. This form of depressive illness often is accompanied by such symptoms as marked decrease in energy, increased need for sleep, and carbohydrate craving. Photo therapy – morning exposure to bright, full spectrum light – can often be dramatically helpful.

Q. What is Post Partum Depression?

Mild moodiness and “blues” are very common after having a baby, but when symptoms are more than mild or last more than a few days, help should be sought. Post part depression can be extremely serious for both mother and baby.

Q. How is bereavement different from depression?

A full depressive syndrome frequently is a normal reaction to the death of a loved one (bereavement), with feelings of depression and such associated symptoms as poor appetite, weight loss, and insomnia. However, morbid preoccupation with worthlessness, prolonged and marked functional impairment, and marked psychomotor retardation are uncommon and suggest that the bereavement is complicated by the development of a Major Depression. The duration of “normal” bereavement varies considerably among different cultural groups.

Q. What is Endogenous Depression?

A depression is said to be endogenous if it occurs without a particular bad event, stressful situation or other definite, outside cause being present in the person’s life. Endogenous depression usually responds well to medication. Some authorities do not consider this to be a useful diagnostic category.

Q. What is atypical depression?

“Atypical depression” is not an official diagnostic category, but it is often discussed informally. A person suffering from atypical depression generally has increased appetite and sleeps more than usual. An atypical depressive may also be able to enjoy pleasurable circumstances despite being unable to seek out such circumstances. This contrasts with the “typical” depressive, who generally has reduced appetite and insomnia, and who is often unable to find pleasure in anything. Despite its name, atypical depression may in fact be more common than the other kind.

Symptoms
——–

Q. What are the typical symptoms of depression?

A depressive disorder is a “whole-body” illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help over 80% of those who suffer from depression. Bipolar depression includes periods of high or mania. Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals.

Symptoms of Depression:

* Persistent sad, anxious, or “empty” mood
* Feelings of hopelessness, pessimism
* Feelings of guilt, worthlessness, helplessness
* Loss of interest or pleasure in hobbies and activities that you once enjoyed, including sex
* Insomnia, early-morning awakening, or oversleeping.
* Appetite and/or weight loss or overeating and weight gain
* Decreased energy. fatigue, being “slowed down”
* Thoughts of death or suicide, suicide attempts
* Restlessness, irritability
* Difficulty concentrating, remembering, making decisions
* Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Symptoms of Mania:

* Inappropriate elation
* Inappropriate irritability
* Severe insomnia
* Grandiose notions
* Increased talking
* Disconnected and racing thoughts
* Increased sexual desire
* Markedly increased energy
* Poor judgment
* Inappropriate social behavior

Q. What are the diagnostic criteria for depression?

Depression comes in many forms and in many degrees. Below, you will find some of the most common depressive types, along with some of the diagnostic criteria from the DSM-III-R (the official diagnostic and statistical manual for psychiatric illnesses).

**Major Depression:** This is a most serious type of depression. Many people with a major depression can not continue to function normally. The treatments for this are medication, psychotherapy and, in extreme cases, electroconvulsive therapy (ECT).

Diagnostic criteria:
A. At least five of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood, or (2) loss of interest or pleasure. (Do not include symptoms that are clearly due to a physical condition, mood-incongruent delusions or hallucinations, incoherence, or marked loosening of associations.)
1. depressed mood most of the day, nearly every day, as indicated either by subjective account or observation by others
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others of apathy most of the time)
3. significant weight loss or weight gain when not dieting (e.g. more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. (1) It cannot be established that an organic factor initiated and maintained the disturbance (2) The disturbance is not a normal reaction to the death of a loved one
C. At no time during the disturbance have there been delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms (i.e..- before the mood symptoms developed or after they have remitted).
D. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder

**Dysthymia:** This is a mild, chronic depression which lasts for two years or longer. Most people with this disorder continue to function at work or school but often with the feeling that they are “just going through the motions.” The person may not realize that they are depressed. Anti-depressants or psychotherapy can help.

Diagnostic criteria:
A. Depressed mood (or can be irritable mood in children and adolescents) for most of the day, more days than not, as indicated either by subjective account or observation by others, for at least two years (one year for children and adolescents)
B. Presence, while depressed, of at least two of the following:
1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self-esteem
5. poor concentration or difficult making decisions
6. feelings of hopelessness
C. During a two-year period (one-year for children and adolescents) of the disturbance, never without the symptoms in A for more than two months at a time.
D. No evidence of an unequivocal Major Depressive Episode during the first two years (one year for children and adolescents) of the disturbance.
E. Has never had a Manic Episode or an unequivocal Hypo manic Episode.
F. Not superimposed on a chronic psychotic disorder, such as Schizophrenia or Delusional Disorder.
G. It cannot be established that an organic factor initiated or maintained the disturbance, e.g., prolonged administration of an antihypertensive medication.

**Adjustment Disorder with Depressed Mood:** This is the type of depression that results when a person has something bad happen to them that depresses them. For example, loss of one’s job can cause this type of depression. It generally fades as time passes and the person gets over what ever it was that happened.

Diagnostic criteria:
A. A reaction to an identifiable psycho social stressor (or multiple stressors) that occurs within three months of onset of the stressor(s).
B. The maladaptive nature of the reaction is indicated by either of the following:
1. impairment in occupational (including school) functioning or in usual social activities or relationships with others
2. symptoms that are in excess of a normal and expectable reaction to the stressor(s)
C. The disturbance is not merely one instance of a pattern of overreaction to stress or an exacerbation of one of the mental disorders previously described (in the entire DSM).
D. The maladaptive reaction has persisted for no longer than six months.
E. The disturbance does not meet criteria for any specific mental disorder and does nor represent Uncomplicated Bereavement.

Causes
——

Q. What causes depression?

The group of symptoms which doctors and therapists use to diagnose depression (“depressive symptoms”), which includes the important proviso that the symptoms have manifested for more than a few weeks and that  they are interfering with normal life, are the result of an alteration in brain chemistry. This alteration is similar to temporary, normal variations in brain chemistry which can be triggered by illness, stress, frustration, or grief, but it differs in that it is self-sustaining and does not resolve itself upon removal of such triggering events (if any such trigger can be found at all, which is not always the case.)

Instead, the alteration continues, producing depressive symptoms and through those symptoms, enormous new stresses on the person: unhappiness, sleep disorders, lack of concentration, difficulty in doing one’s job, inability to care for one’s physical and emotional needs, strain on existing relationships with friends and family. These new stresses may be sufficient to act as triggers for continuing brain chemistry alteration, or they may simply prevent the resolution of the difficulties which may have triggered the initial alteration, or both.

The depressive brain chemistry alteration seems to be self-limiting in most cases: after one to three years, a more normal chemistry reappears, even without medical treatment. However, if the alteration is profound enough to cause suicidal impulses, a majority of untreated depressed people will in fact attempt suicide, and as many as 17% will eventually succeed. Therefore, depression must be thought of as a potentially fatal illness. Friends and relatives may be deceived by the casual way that profoundly depressed people speak of suicide or self-mutilation. They are not casual because they “don’t really mean it”; they are casual because these things seem no worse than the mental pain they are already suffering. Any comment such as, “You’d be better off if I were gone,” or “I wish I could just jump out a window,” is the equivalent of a sudden high fever; the depressed person must be taken to a professional who can monitor their danger. A formulated plan, such as, “I’m going to jump in front of the next car that comes by,” is the equivalent of sudden unconsciousness: an immediate medical emergency which may require hospitalization.

Depression can shut down the survival instinct or temporarily suppress it. Therefore, depressed suicidal thinking is not the same as the suicidal thinking of normal people who have reached a crisis point in their lives. Depressive suicides give less warning, need less time to plan, and are willing to attempt more painful and immediate means, such as jumping out of a moving car. They may also fight the impulse to suicide by compromising on self-injury — cutting themselves with knives, for example, in an attempt to distract themselves from severe mental pain. Again, relatives and friends are likely to be astonished by how quickly such an impulse can appear and be acted upon.