I would like some feedback and constructive criticism of a research paper I wrote for my abnormal psychology class last month. The subject is depression, and I tried to give as broad a view as possible of the different theories of depression's roots, and the available treatments. The paper is quite long, but I would like suggestions for improving the content and stuff.

Please respond via e-mail so you don't waste bandwidth.

Thanks,
Ryan Robbins
Aroostook Hall
University of Maine
IO20456@Maine.Maine.Edu

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              |             Depression:               |
              | What it is, Theories, Treatment, Hope |
              |                                       |
              |                 by                    |
              |            Ryan Robbins               |
              |                                       |
              |        (C) 1993 Ryan Robbins          |
              +---------------------------------------+

The statistics are staggering. An estimated 10 million people in the United States suffer from clinical depression each year (Comer, 1992). An estimated 15 percent of American adults will experience depression at some point in their lives (Comer, 1992). In 1980 depression was estimated to have cost Americans $2.1 billion in therapies and care costs, and another $14 billion in lost productivity (Schwartz & Schwartz, 1993).

Depression can be a lonely illness for those who suffer from it. At times it can be frustrating for friends and relatives of depressives. Depression can last as short a period of time as two weeks, or it can last for many years. But it can be treated effectively to cure most and help others to get back on their feet again.

In the following pages, I will describe what depression is, the various explanations given for the existence of depression and the various therapies associated with them.

WHAT DEPRESSION IS AND ITS SYMPTOMS

Depression is an affective, or mood disorder. It is an illness that immerses its sufferers in a world of self-blame, confusion, and hopelessness. It is an illness of the mind and the body. Some could argue depression is a way of coping with life's pressures (Schwartz & Schwartz, 1993).

When most people think of the word depression they think of feeling sad, feeling down. If you do poorly on your physics exam you may feel disappointed and tell your friend, "I'm depressed. I didn't do well on my physics test today."

While you may feel depressed about doing poorly on your exam, chances are your depression isn't overwhelming to a point where your daily functioning is hampered.

Clinical depression is a serious illness that affects most, if not all, facets of a depressive's life. The major component of depression is a loss of interest in activities once found pleasurable. In fact, in order for a person to be diagnosed with having major depression, a loss of interest in activities once found pleasurable must be present (Schwartz & Schwartz, 1993).

For some depressives, there is even a loss of interest in life itself. Each year an average of 5,000 Americans take their lives. How many of these people were suffering from depression is not known, but it is believed a vast majority of them were depressed.

Depression can be disabling to the point where the depressive can no longer function in the daily rigors of life. Absence from work or school is common, for the severely depressed individual does not have enough energy or motivation to get out of bed. Many a depressive will describe his or her illness to having a large and heavy weight on his or her back. Often that heavy weight is an accumulation of stressors, and sometimes the weight is unexplainable.

Physically, a depressive is sluggish. His or her speech is noticeably slow, and motor skills are retarded (Comer, 1992). The depressive may complain of headaches or other ailments that have no explanation (Schwartz & Schwartz, 1993). Cognitively, depressives exhibit confusion and find it difficult to make even what may seem to many people to be the simplest of decisions (Schwartz & Schwartz, 1993). Memory is also impaired.

Depressives are often agitated and irritable. They may perform repetitive motor tasks, like pacing or rubbing their hands together. They may exert a poor disposition and become "aggressively hostile" to others (Wetzel, 1984).

Life can be a lonely experience for depressives. Their sense of humor is lost and they are seldom seen smiling. They are often tired from either too little or too much sleep. Intense feelings of shame and guilt because they believe that everything that goes wrong is their fault are often harbored (Schwartz & Schwartz, 1993). Feelings of inadequacy may lead a depressive to attempt to withdraw from family and friends. Feelings of inferiority may eventually lead to feelings of hopelessness. Nothing can go right and nothing will ever improve, they believe. Often times feelings of inferiority are a result of the depressive's demanding expectations of him or herself (Schwartz & Schwartz, 1993).

While some depressives may shy away from family and friends, some display an overdependence on others. When they are shunned by those they depend on, they become even more depressed. Their world becomes that much more lonely and hopeless.

REACTIVE DEPRESSION & PHYSICAL DEPRESSION

There are two major subcategories of unipolar depression: reactive and physical. Formerly known as exogenous depression, meaning depression from the environment, reactive depression is a response to a particularly stressful or emotionally traumatic event. The death of a loved one, being rejected, divorce, or serious illness can bring about its onset.

Physical depression, formerly known as endogenous depression, meaning depression from within, is the result of deficiencies in neuron communications in the brain (Biomedical Information Corporation, 1985).

REACTIVE & PHYSICAL DEPRESSION: DIFFERENCES

Aside from the obvious difference between reactive depression and physical depression, there are certain characteristics of each type that can lead doctors and their patients to the underlying cause of the depression.

To begin, physical depression's average age of onset is 40 (Biomedical Information Corporation, 1985). Reactive depression can occur at any time. Physical depression tends to run in families and isn't necessarily triggered by a stressful or traumatic event (Biomedical Information Corporation, 1985). Physical depressives are more likely to experience the effects of their depression in the morning than reactive depressives (Biomedical Information Corporation, 1985). Physical depression tends to be more debilitating to the depressive in that its patients are more likely to have their daily functioning severely hindered (Biomedical Information Corporation, 1985). Physical depressives are also more likely than reactive depressives to experience a loss of self-esteem (Biomedical Information Corporation, 1992). They are also more likely to have suicidal tendencies than reactive depressives (Biomedical Information Corporation, 1985).

WHO'S AT RISK FOR DEVELOPING DEPRESSION?

Research has shown that the poor, the unemployed, low- status workers, the physically ill, the young, students, and women have a higher chance of developing depression than others.

The most interesting statistical differences dealing with depression's prevalence rate between different groups occur between men and women. Women are twice more likely than men to suffer from depression (Wetzel, 1984). Women have a 20 percent to 26 percent lifetime risk of developing depression, compared to an 8 percent to 12 percent lifetime risk for men (Wetzel, 1984). Six percent of women who suffer from depression require hospitalization, while half as many men--3 percent--require hospitalization (Wetzel, 1984).

There are several explanations for the discrepancy of rates of depression in men and women. The first explanation is women are more likely than men to seek treatment (Schwartz & Schwartz, 1993). Another theory is psychologists and psychiatrists are more likely to diagnose a woman as having depression than they would diagnose a man as suffering from depression~an extension of the stereotype women are the weaker sex.

Perhaps, though, the difference in rates lies in the fact women are physiologically different than men. This hypothesis has yet to be proven (Schwartz & Schwartz, 1993).

Another theory holds that women are more likely to suffer from depression than men because they confide amongst themselves more than males. In a study conducted by Alan Booth, it was discovered men are more likely to have female confidants than women are to have male confidants (Dean, Dumin, Ensel, Light, Lin, Tausig, & Woelfel, 1986). What does this mean? Well, studies have shown people who are married are less likely to develop depression than single people (Dean, Dumin, Ensel, Light, Lin, Tausig, & Woelfel, 1986). Having an opposite sex confidant may substitute for a spouse with single people.

Age of onset is another difference between the sexes. Men develop depression at about 50 years of age while the average age of onset for women is 35 years of age (Comer, 1992).

CAUSES OF DEPRESSION

There are four major views as to what causes depression. They are: the psychoanalytic theory, behavioral theory, cognitive-behavioral theory, and the biological theory.

The Psychodynamic View

The psychodynamic view of depression, authored by Freud, anchors on the principle of loss. Therapists privy to this view of depression believe the root of all depression lies in the loss of something loved, whether it be a person or an object. The loss can be real or it can be imagined (Lowry, 1984).

In a study done by P. J. Clayton in the late 1970s, widows and widowers were studied for a year after the death of their spouses. While depression brought about by the death of a loved one is excluded as being a depressive episode by the psychological community, Clayton found that 45 percent of his subjects fit the criteria for a diagnosis of depression (Lowry, 1984).

But what about depression in people who haven't lost a loved one?

Freud's definition of what constituted a loss was broad. He deemed depression that didn't evolve in reaction to the loss of a loved one to be the result of "symbolic loss." Thus, rejection for a date could cause a depressive episode because the depressive has "lost" something, even if he or she never had it to begin with.

In reaction to losing the object, Freud believed the depressive then develops feelings of self-hatred (Comer, 1992). The depressive begins to believe he or she is responsible for the loss. Freud also believed feelings of self-hatred develop from the depressive's thoughts about unresolved conflicts (Comer, 1992). As a result of feelings of self-hatred, the depressive feels worthless and loses his or her self-esteem.

It is the loss of self-esteem, many psychodynamic theorists claim, that starts a person down the path of depression (Comer, 1992). Melanie Klein, a neo-Freudian, claims that whether an individual loses his or her self-esteem depends on the quality of the individual's relationship as an infant with his or her mother during the first year of life (Wetzel, 1984.) If an individual doesn't have positive experiences with his or her mother during the first year of life, then a predisposition to depression may be planted (Wetzel, 1984).

Klein's interpretation to the origin of depression closely resembles that of Freud's theory that an individual can develop a predisposition for the illness.

Freud also believed too many positive experiences during the first year of life could set an individual up for developing depression later on in life (Comer, 1992). Freud believed that if an individual is nurtured too much as an infant, he or she won't develop beyond the oral stage of development because there was never a need to. The individual runs into problems in adult life because he or she is used to receiving excessive amounts of attention (Comer, 1992). If an individual is used to receiving 10 points of attention like he or she did when he or she was young, and he or she only receives 6 points of attention, then he or she will feel rejected, unloved, and thus inferior.

The primary criticism of the psychodynamic theory of depression is the same as it is for other psychodynamic theories: there is no way to prove its assumptions. Freud's stages of development occur at an unconscious level. There is no way to tell if an individual is stuck at the oral stage because the psychodynamic theory hinges on subjective interpretations. What is too much or too little nurturing (Comer, 1992)? How can it be measured?

The Behavioral View

Behaviorist theorists and clinicians believe depression is learned. Charles Ferster, one of the first researchers to suggest a link between depression and behavior, hypothesized depression develops as a result of a lack of positive reinforcement for the depressive's actions (Wetzel, 1984).

Ferster hypothesized depressives lack motivation and control and as a result receive negative feedback from others (Wetzel, 1984). Other behaviorists tend to agree with this view and see the presence of negative reinforcements as compounding the depression by causing more and more self-esteem to be lost (Wetzel, 1984). Other behaviorists, like Peter Lewinsohn, believe there may not even be any reinforcements in a depressive's life (Wetzel, 1984).

Behaviorists use the learned helplessness model to explain depression. In a theory much in line with Freud's theory of nurturing, many behaviorists believe that some individuals develop depression because they were overprotected when they were younger (Wetzel, 1984). The pressures and stressors of life out in the "real world" are just too much for them to handle. They have been taught by their parents to be passive because there was always someone looking out for them. The stressors mount and they feel inferior because they believe they are incapable of fending for themselves.

The Cognitive-Behavioral View

An offshoot of the behavioral model is Aaron Beck's cognitive-behavioral view of depression. Beck believes "depressives suffer from a kind of basic thinking that distorts reality" (Papalia & Olds, 1988).

Depressives, according to Beck, distort reality by harboring negative feelings about anything and everything. They tend to take things too personally and believe the future is bleak and dim (Papalia & Olds, 1988). These inferior feelings, Beck believes, lead to more negative experiences for the depressive. In turn, the depressive develops more thoughts of worthlessness and inferiority (Schwartz & Schwartz, 1993). Often a depressive expects too much of him or herself, Beck believes (Papalia & Olds, 1988). Failure is an accepted way of life and the depressive believes there is nothing he or she can do about it (Papalia & Olds, 1988). Learned helplessness is the result.

To demonstrate the learned helplessness theory, Martin Seligman conducted an experiment using two sets of dogs and a shuttle box. The shuttle box was constructed so there were two parts. One half of the box contained electrodes on the floor to emit electricity, while the other half of the box was normal. In the middle of the box a barrier was placed.

The first set of dogs were placed in the box and administered shocks. Initially they would react by jumping around. Eventually they jumped over the barrier to the safe zone. After awhile Seligman installed a warning device for the dogs, such as a light that would dim. The dogs learned that when the light dimmed, the electricity was coming. They were able to jump over the barrier to the other side without getting shocked.

The second set of dogs was also placed in the box, but they were unable to escape the shocks. Seligman then gave them an opportunity to avoid the shocks, but these dogs didn't learn that when the light dimmed they were going to be shocked. Instead, they lied dormant and whimpered when the electricity was turned on.

The second set of dogs, Seligman concluded, had been taught helplessness. They believed that no matter how much they tried to escape the shocks, the shocks were still going to be present (Comer, 1992).

Biological View

Evidence that depression is related to genetics has been growing recently, as more and more research is being done to examine the role the brain and heredity play in the likelihood an individual will develop depression.

For the first time in the early 1980s visible evidence of depression having a biological tie showed up in laboratory tests that examined the brain's functioning in depressives (Lowry, 1984). Studies showed that at least half of the depressives examined had increased levels of activity in the hypothalamic- pituitary-adrenal axis of the brain (Lowry, 1984).

Other medical evidence that supports the biological model of depression are the documentation of higher than normal amounts of cortisol discharges in the adrenal glands of depressives, and eccentric brain wave patterns as recorded by electroencephalograms (EEGs) (Lowry, 1984).

Research has also shown depression has a tendency to run in families. Most published research covers bipolar depression, but researchers have concluded there is reason to believe unipolar depression can be inherited and is thus a biological illness (Schwartz & Schwartz, 1993).

In twin studies done examining bipolar depression, researchers have found the likelihood to be 80 percent both twins will develop bipolar depression if at least one has it (Schwartz & Schwartz, 1993). Adoption studies done in research of affective disorders as a whole have shown there is a strong concordance rate of depression (Schwartz & Schwartz, 1993).

Criticisms of the biological model are it ignores environmental factors when looking at the relationship of depression in family studies, and the concordance rate in identical twin studies is not 100 percent. If depression can be inherited, critics argue, then both identical twins should inherit it (Schwartz & Schwartz, 1993). Proponents of the biological model, however, point out it is the predisposition of depression inherited, not the illness itself (Schwartz & Schwartz, 1993). Even identical twins don't experience the same life events.

Other Views on Depression

In addition to the three major views of what causes depression, the psychological community has explored other potential causes. One avenue researchers are looking at is the effect an individual's diet has on his or her mood.

Studies have shown there is a correlation between the amount of caffeine and carbohydrates a person consumes and how well his or her affect is. While caffeine stimulates the nervous system, too much of it may depress the nervous system (Schwartz & Schwartz, 1993).

The explanation for caffeine's depressive effect on a person's affect lies in what caffeine stimulates. If consumed just before bed time, caffeine alters an individual's sleep/wake cycle by delaying sleep, or preventing an individual from achieving the full benefits of sleep (Schwartz & Schwartz, 1993).

Another explanation for depression~and one that's attracting more and more attention~deals with the chronobiological principle. Studies have shown there may be a correlation between a person's daily schedule in terms of his or her sleep/wake cycle, and affect (Schwartz & Schwartz, 1993). The chronobiological principle centers on the hormone melatonin. A light-sensitive hormone, melatonin is released at night when the body senses darkness. In the morning when light reappears, melatonin levels drop. A high level of melatonin during the day may cause individuals to be fatigued and subsequently depressed. A low level of melatonin at night might disrupt an individual's sleep/wake cycle to the point where the individual doesn't get enough sleep (Schwartz & Schwartz, 1993).

Tied to the chronobiological principle is seasonal affective disorder (SAD). Researchers have found there is a link between the appearance of depression and the seasons. This finding supports the theory melatonin may play an important part in depression (Schwartz & Schwartz, 1993).

There are two categories of SAD: Winter SAD and Summer SAD. The annual onset of Winter SAD occurs in the fall as the days become shorter. It becomes more prominent in the winter months when there is less sunlight. Chronobiologists believe that as the days grow shorter and shorter and sun the sun rises later and later in the day, some people's bodies' biological clocks may not be able to synchronize melatonin's release with the sleep/wake cycle (Schwartz & Schwartz, 1993). This belief has not been proven (Schwartz & Schwartz, 1993). As many as 89 percent of Winter SAD patients in one study reported experiencing hypomania when spring rolled around (Schwartz& Schwartz, 1993).

The explanation for Summer SAD is quite different than the explanation for Winter SAD, for melatonin plays no role.

Temperature is the main character in Summer SAD (Schwartz & Schwartz, 1993). Summer SAD patients have reported relief from their depression when in an airconditioned environment (Schwartz & Schwartz, 1993). Ironically, some Summer SAD patients have reported relief also when placed in a darkened environment (Schwartz & Schwartz, 1993).

Other ways in which Summer SAD differs from Winter SAD is the tendency for its patients to display symptoms more favorable to endogenous depression, in regards of frequent thoughts of death and suicide (Schwartz & Schwartz, 1993).

TREATMENT

While depression can be a debilitating illness, the odds of successfully treating it are encouragingly high. As many as 85 percent to 90 percent of depressives who seek treatment get better (Hegg, 1991). Unfortunately, only approximately 30 percent of the estimated 10 million depressives in the United States receive therapy (Hegg, 1991). Overall, it is believed 64 percent of all depressives in the United States recover within six months, many without receiving treatment (Comer, 1992).

There are essentially two types of treatment for depression: psychotherapy and drug therapy.

Psychotherapy has the clinician acting as a confidant to the depressive. The psychotherapist will often employ counseling techniques from each of the three major views of depression, rather than rely on one technique, like psychoanalysis. Some patients respond better to behavioral therapy while others may respond better to psychoanalysis. The key to successful therapy is using the right mix of techniques from the different models.

Psychodynamic Techniques

Because psychodynamic theorists contend depression develops in response to a loss--often a loss at the unconscious level-- psychodynamic clinicians make extensive use of free association (Comer, 1992). The hope is that by having the depressive talk about whatever is on his or her mind the identity of the lost object will be revealed, or at least hints of what the object is will come to the surface. The therapist and patient discuss events that may have led to a loss or losses and attempt to interpret the events. The interpretations are intended to provide the patient with some insight into his or her self-anger that Freud believed is present with a loss that precipitates a depressive episode.

Sometimes, however, a patient is so depressed he or she is unable to motivate him or herself to think of things to talk about. When this happens the therapist will usually take an active role in the therapy by introducing different topics, with the hope the patient will be sparked enough to want to talk about things (Comer, 1992).

Psychodynamic theorists also like to interpret dreams depressives experience as a means of unlocking the unconscious mind. By gaining insight from the interpretation of free association topics and dreams, the goal of the psychodynamic technique is to have the patient understand what his or her loss is and how it and future losses can be confronted now and in the future.

If there is a drawback to psychodynamic therapy, it is its nature of being a slow moving approach. By nature, depressives are often frustrated and this technique may lead some to give up on therapy altogether (Comer, 1992).

Behavioral & Cognitive-Behavioral Techniques

Followers of the behavioral and cognitive-behavioral schools believe depression is learned and then negatively reinforced because there are little or no positive reinforcements available to depressives. Because of this, depressives are likely to have a deficiency in social skills. As a result, behaviorist clinicians focus on positive reinforcement as a means of treating depressives.

Beck encourages patients to get involved with their therapy (Schwartz & Schwartz, 1993). Having the patient talk about present events, Beck believes, is the key to determining the cause of the depression. Past events are discussed only to the extent of their relationships with present events. The therapist and the patient then collaborate to develop homework assignments that will hopefully provide the patient with positive reinforcements in his or her development of social skills (Wetzel, 1984).

For example, if the patient is depressed because he or she doesn't have many friends or the patient is socially withdrawn, the therapist will work with the patient to develop a schedule for the patient to follow in the patient's quest to get out, be with, and meet people. The first step in meeting new people would be for the patient to put him or herself in a situation where potential friends could be made. If the patient likes to run, he or she might plan to go to a track the first day. The second day the patient might make it a goal to introduce him or herself to another runner, and so on.

As each item on the schedule is reached, the patient comments in a log, which is then brought to the next therapy session for review by the therapist and discussion.

Similar to Beck's treatment technique is Peter Lewinsohn's technique for promoting positive experiences through role playing (Comer, 1992). Used primarily in group settings, role playing allows the patient an opportunity to learn how to be assertive in social situations (Comer, 1984). The patient's own non- assertiveness is also demonstrated. While the role plays take place, the therapist takes notes on each patient's strengths and weaknesses, allowing for the patient to see what he or she needs to work on (Comer, 1992).

Lewinsohn has even gone so far as to develop a class for depressives, complete with text books and all. One study found an 80 percent success rate in treating patients' depression this way (Comer, 1992).

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy, also known as shock treatment, is the most controversial form of therapy in treating depression. First used in 1938, ECT calls for the patient to be administered low-voltage shocks to the brain. ECT was widely used in the 1950s and 1960s, but today it is used only as a last resort to treat the severely depressed who have demonstrated suicidal tendencies.

How ECT works isn't clear, but it has proven to be a quick and effective means of treatment (Comer, 1992). It is believed that by administering shocks to the brain, chemical imbalances are affected. Another theory for ECT's effectiveness is it helps the patient eliminate destructive thoughts that may prompt depression. The shocks to the brain render the patient unconscious and with no recollection of the treatment.

When a patient undergoes ECT, he or she is administered sedatives or tranquilizers first to alleviate anxiety and resistance. In its infancy, ECT did not use sedatives or tranquilizers and the frequent result was patients suffering from fractured bones.

The patient is then strapped onto a padded table, given a mouthpiece to prevent broken teeth, and administered anesthesia to block out pain. It is then electrodes are attached to the head and the shocks given. Some therapists use two electrodes to administer shock to both sides of the brain, and some use one electrode to administer shock to only one side of the brain. The shocks prompt the brain to go into convulsions for a few minutes, and the treatment is done. ECT is usually administered for two weeks, spread out over three to six sessions (Papalia & Olds, 1988).

When patients wake up, there is no recollection of the therapy and a noticeable change in affect. It is not uncommon for patients to experience memory loss of events up to six months before therapy (Papalia & Olds, 1988).

Drug Therapy

Since the discovery drugs can have a positive effect on a person's affect in the 1950s, drug therapy has come to the forefront as a major means of fighting depression. The success of drug therapy has also boosted the belief depression results from chemical imbalances in the brain (Papalia & Olds, 1988). There are two types of drugs used to treat depression: tricyclics and monoamine oxidase inhibitors.

Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors, or MAO inhibitors, work on monoamine oxidase, an enzyme the body uses to regulate the body's blood pressure by breaking down tyramine, a chemical found in fermented and aged foods, and foods containing cheese (Comer, 1992). When MAO levels get too high, the neurotransmitters norepinephrine and serotonin are destroyed (Comer, 1992). Low levels of norepinephrine or serotonin are believed to be responsible for physical depression.

MAO inhibitors break down the production of MAOs, but this leaves the patient susceptible to dangerous levels of high blood pressure. As a result, patients of MAO inhibitors must adhere to a strict diet to prevent too much tyramine from entering the body and causing high blood pressure (Comer, 1992).

Because of the dietary restrictions MAO inhibitors place on patients, clinicians tend to prescribe tricyclics more often (Comer, 1992).

Tricyclics

Imipramine became the first anti-depressant drug when Swiss researchers looking for a drug to treat schizophrenia discovered it boosted people's affects by increasing the uptake of the neurotransmitter norepinephrine.

Tricyclics, named because of their three-ring chemical structure, work by improving communication amongst brain cells. Researchers believe that tricyclics work by blocking the reuptake of norepinephrine, increasing its uptake in receiving neurons. When a neuron releases norepinephrine, it immediately tries to retrieve (reuptake) the neurotransmitter to prevent overstimulation of the receiving neuron. It is believed that in depressives, too much of the neurotransmitter is reuptaken, resulting in a chemical imbalance that causes brain activity to become stunted, or more appropriately, depressed (Comer, 1992).

Some critics questions why it takes as long as two weeks for tricyclics to kick into action (Comer, 1992). One theory is tricyclics work on the sensitivity of neuron receptors themselves, not the neurotransmitters.

A deficiency in serotonin, another neurotransmitter, has also been shown to be related to depression. Fluoxetine hydrochloride, or Prozac, has been shown to be quite effective in increasing serotonin levels in neuron receptors. A second generation tricyclic, Prozac works specifically on serotonin. Since its introduction in the late 1980s, Prozac has been hailed by many as a "miracle" drug because of its few and less severe side effects. Others claim the drug causes depressives to become suicidal. The Food & Drug Administration has found no such evidence.

The introduction of drugs in the fight against depression has brought a better understanding to researchers studying the biological roots of the disease. Researchers have found that decreased levels of norepinephrine coincide with lethargy, inattentiveness, and loss of appetite. A decrease in serotonin, on the other hand, coincides with agitation, lack of confidence and self-esteem, and an increased susceptibility to suicide (Comer, 1992).

HOPE

For depressives, life is a struggle. They are psychologically paralyzed, trapped in a dark tunnel, with the end seemingly too far away. Some depressives see the light at the end of the tunnel, but they cannot run or walk. Frustration reigns and self-blame is a way of life. While research to unlock the mysteries of the disease is an ongoing process and treatments are being refined, there are some basic principles depressives and their family and friends should keep in mind.

Depression is not a sign of weakness. While many depressives tend to keep their illness to themselves, the Biological Information Corporation encourages depressives to "Get it out in the open and treat [sic] it like any other disease." Psychologists also encourage depressives to get out and relax and not try to do too much too soon (American Mental Health Fund, 1989). Depressives shouldn't hesitate to consult with family and friends when faced with important decisions that must be made immediately.

Family and friends of depressives should be supportive and non-judgmental. A person can't "snap out of it." For many depressives, the difference between a good day and a bad day is as little as a friend or family member taking a walk with them or listening to their frustrations.

Depression may not be preventable, but its effects can be alleviated.

REFERENCES

Biomedical Information Corp. (1985). Patient information on depression. Biomedical Information Corp.

Comer, R. J. (1992). Abnormal psychology. New York: W. H. Freeman & Company.

Dean, A., Dumin, M. Y., Ensel, W. M., Light, S. C., Lin, N., Tausig, M., & Woelfel, M. (1986). Social support, life events, & depression. New York: Academic Press, Inc.

Hegg, A. (1991, December). More than a blue mood. NEA Today. 23.

Lowry, M. E. (1984). Major depression: Prevention & treatment. St. Louis: Warren H. Green, Inc.

National Institute of Mental Health. (1989). Plan talk about depression. Rockville, MD: U.S. Department of Health & Human Services.

Papalia, D. E, & Olds, S. W. (1988). Psychology. New York: McGraw-Hill Book Company.

Sacra, C. (1990, September). The new cure-alls. Health. 36-37, 86.

Schwartz, A., & Schwartz, R. (1993). Depression: Theories & treatments. New York: Columbia University Press.

Wetzel, J. W. (1984). Clinical handbook of depression. New York: Gardner Press.

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