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Summary
Summary
Recent studies have found that one woman in five, and one man in ten, will suffer from depression or manic depression sometime during the course of their lives. This is a disturbing statistic, but there is hope, because more and more evidence has surfaced to indicate that many psychiatric disorders are biological diseases that can be successfully treated with medication. Most people, however, know little about these recent findings. They don't know how to tell if the depression they are suffering from is biological or not, nor what they can do to recover from it if it is.
In Understanding Depression, Donald Klein and Paul Wender offer a definitive guide to depressive illness--its causes, course, and symptoms. They clarify the difference between depression (which is a normal emotion) and biological depression (which is an illness), and include several self-rating tests with which readers can determine whether or not they should seek psychiatric evaluation to determine if they have a biological depressive illness. They describe the symptoms of biological depression, among them loss of energy, changes in eating habits, sleep disturbances, decreased sex drive, restlessness, poor concentration and indecisiveness, and increased use of intoxicants and drugs. And they paint a clear picture of how depressive illness can affect people's lives, using excerpts from patient histories to show the progress of each patient from the onset of depression to treatment and recovery. The authors also discuss the different types of treatment available, including antidepressant drugs, electroconvulsive therapy, and psychotherapy, and they examine the benefits and side effects of psychopharmacological drugs (including the new antidepressants, lithium, and the controversial Prozac), related disorders (such as panic attacks, atypical depression, seasonal affective disorder, and PMS), and how to get the right kind of help.
Most victims of biological depression often fail to seek help, whether out of guilt or ignorance, and many are often misdiagnosed by physicians or psychotherapists who fail to recognize the symptoms of the illness. Understanding Depression seeks to make the public (both lay and medical) aware of the issues of biological depression, providing a highly informed and readable guide to this much misunderstood disease.
Author Notes
Donald F. Klein is Professor of Psychiatry at the Columbia University College of Physicians and Surgeons and Director of Research at New York State Psychiatric Institute
Paul H. Wender is Distinguished Professor Emeritus of Psychiatry at the University of Utah School of Medicine and a Lecturer in Psychiatry at Harvard Medical School
Table of Contents
| 1 Introduction | p. 1 |
| 2 Symptoms of Mood Disorders: Recognizing Biological Depression | p. 9 |
| The Question of Names | p. 9 |
| Recurrent Problems in Patients' Illnesses | p. 14 |
| Treatment | p. 46 |
| Mild Forms of Depression and Manic-Depression (Bipolar Disorder) | p. 59 |
| The Interpersonal Consequences of Depression and Manic-Depression | p. 67 |
| 3 What Happens to the Depressive or Manic-Depressive Individual Over Time? | p. 69 |
| The Symptoms of Depression in Children and Adolescents | p. 71 |
| The "Natural History" of Depression and Manic-Depression | p. 74 |
| 4 What Causes Depression and Manic-Depression? | p. 83 |
| Hereditary Factors: Patterns of Depressive and Manic-Depressive Illness in Families | p. 83 |
| Heredity Versus Environment | p. 84 |
| Genes Plus Events Can Equal Depression | p. 88 |
| Can Upbringing and Life Experience Cause Depressive Illness? | p. 90 |
| Chemistry and Depression | p. 93 |
| Other Illnesses and Depression | p. 97 |
| Predicting Depressive Illness | p. 97 |
| 5 Diagnosis and Treatment of Depression | p. 99 |
| Diagnosis | p. 99 |
| The Effectiveness of Medical Treatment of Depression | p. 101 |
| The Decision to Use Drugs, Psychotherapy, or Both: Relative Costs and Benefits | p. 102 |
| Drug Treatment | p. 106 |
| Electroconvulsive Therapy (ECT) | p. 112 |
| Psychological Management of Depression | p. 114 |
| The Relationship of the Doctor and the Patient | p. 117 |
| The Family's Role in the Treatment of Depression and Manic-Depression | p. 117 |
| Self- and Family Monitoring of Depression | p. 120 |
| 6 A Brief Guide to Psychopharmacological Drugs | p. 125 |
| Side Effects and the Physician's Desk Reference (PDR) | p. 131 |
| The Second-Generation Antidepressants | p. 132 |
| The First-Generation Antidepressants | p. 137 |
| Mood-Stabilizing Drugs | p. 140 |
| Anticonvulsants | p. 142 |
| Neuroleptics | p. 145 |
| Atypical Antipsychotics | p. 146 |
| Minor Tranquilizers: Benzodiazepines | p. 147 |
| Newer Sleeping Agents | p. 148 |
| Herbal Remedies | p. 149 |
| Monitoring Drug Treatment | p. 149 |
| 7 Illnesses Related to Depression | p. 151 |
| Panic and Depression | p. 151 |
| Atypical Depression | p. 162 |
| Seasonal Affective Disorder | p. 164 |
| Premenstrual Syndrome | p. 166 |
| 8 How to Get Help | p. 169 |
| Who Is Most Qualified to Diagnose and Treat? | p. 169 |
| Finding a Psychiatrist with Training in Biological Disorders | p. 174 |
| Meeting with the Psychiatrist for the First Time | p. 175 |
| Second Opinions | p. 176 |
| Psychotherapy for the Depressed Patient | p. 178 |
| Conclusion | p. 178 |
| Epilogue | p. 181 |
| What Don't We Know? What's Blocking Progress? What to Do? | p. 181 |
| Recent Progress | p. 182 |
| Negative Trends | p. 183 |
| Drug Discovery | p. 185 |
| The Current State of Psychiatry | p. 191 |
| Index | p. 199 |
