Everybody feels depressed sometimes. A bad exam grade, a bad haircut, rejection by a college, or rejection by somebody you asked out on a date can ruin your mood for hours or days. Yet these temporary changes in mood are not what psychologists mean by “depression.” To a psychologist, the term refers to a condition that is more severe. Depression is a psychological disorder that includes feelings of sadness, hopelessness, and fatigue; a loss of interest in activities; and changes in typical patterns of eating and sleep. In depression, these symptoms last for weeks (National Institute of Mental Health [NIMH], 2011).

The term “depression” does not refer to a single disorder. Rather, there is a family of depressive disorders, that is, distinct psychological conditions that each include depressive symptoms. Let’s explore two prominent depressive disorders: Major Depressive Disorder and Bipolar Disorder (previously called Manic-Depressive Disorder). As we review them, and also when we review anxiety disorders later in this chapter, we will cover two main topics: (1) the given disorder’s defining features and its prevalence (i.e., the number of people in a population who have the disorder), and (2) therapies that effectively treat the disorder.

681

“It hit me what a complete mess I had made of my life. That hit me quite hard. We were as skint [poor] as you can be without being homeless and at that point I was definitely clinically depressed. That was characterized by a numbness, a coldness and an inability to believe you will feel happy again. All the color drained out of life” (ABC News, 2009).

The woman quoted above was suffering from major depression. But it didn’t ruin her life. She managed to cope quite successfully, in part—by writing a novel, and then another novel, and another. They constituted the Harry Potter series. J. K. Rowling’s epic novels (and their associated movies) originated in her need to overcome a psychological disorder, major depression.

DEFINING FEATURES AND PREVALENCE. Major depressive disorder is defined by a set of symptoms; a person is diagnosed with major depressive disorder only if these symptoms last two weeks or longer. They include the following:

No one symptom is necessary in order to be diagnosed with the disorder. Individuals with major depression are people who exhibit a majority of the symptoms for at least a two-week period.

Major depression is a relatively prevalent disorder. A survey of U.S. adults indicated that 6.7% of the population suffered from major depressive disorder at some point during the previous year (Kessler et al., 2005). That’s about 15 million people experiencing a disorder that brings despair and lethargy that can utterly disrupt one’s life. Furthermore, the lifetime prevalence of the disorder—that is, the percentage of people who experience the disorder at least once in their life—is even higher, about 15% (Kessler et al., 1997).

Different groups have varying chances of becoming depressed. Major depression is more frequent among people living in poverty than among those above the poverty line (Riolo et al., 2005). Ethnic groups also differ. In one large-scale study of Americans of European, African, and Mexican ancestry, European Americans were the most likely to experience severe major depression. African Americans and Mexican Americans had higher rates of dysthymic disorder, a prolonged period of low mood whose symptoms are not as severe as those of major depression (Riolo et al., 2005). Finally, in the population at large, women are more likely to experience depression at some point in their lifetime than are men (Kessler et al., 1997).

TREATMENT. A number of the treatment strategies discussed earlier in this chapter have been used successfully to treat major depression. Let’s now look at four options: behavior therapy, cognitive therapy, interpersonal therapy (which draws from psychodynamic and humanistic therapies), and drug therapy.

682

Behavioral therapists emphasize that the environment affects people’s psychological life. Some environmental events make almost anyone feel bad, whereas others make virtually everyone feel good. People become depressed, according to the behavioral approach, when they do not experience enough pleasant activities (Lewinsohn & Graf, 1973). If you sit around by yourself doing nothing at all, day after day—and thereby experience no pleasant events—you’ll eventually feel depressed.

What, then, should you do to alleviate depression? The behavioral strategy involves two steps. First, therapists instruct clients to keep track of both their daily activities and their mood during these activities; this enables clients to see how environmental events trigger good and bad moods. Second, therapists devise strategies that enable clients to avoid events that trigger depression and to engage in more activities that improve mood. One team of behavior therapists applied this approach when working with a depressed single mother. They found that the woman had eliminated virtually all positive social events from her life in order to cope with the demands of parenting. Therapists showed her how to increase her social contacts while also handling depressing household chores more efficiently so that she would have time for a social life. After a few weeks, her mood substantially improved (Lewinsohn, Sullivan, & Grosscup, 1980).

A second approach is cognitive therapy. Aaron Beck (1987) identified a “cognitive triad”—three interconnected types of thoughts—that contribute to depression. People who are depressed tend to have excessively negatively thoughts about (1) themselves, (2) the world, and (3) the future. If a relationship breaks up and you think (1) “I’m unattractive,” (2) “The dating scene is a cruel meat market,” and (3) “I’ll never be in a relationship again,” you are exhibiting the cognitive triad of negative beliefs. In therapy, cognitive therapists challenge these thoughts and help clients replace them with ones that are more accurate and adaptive.

Good news for people suffering from depression is that cognitive therapy works. Meta-analyses that summarize the effectiveness of therapy have long shown that cognitive therapy significantly reduces symptoms of depression (Dobson, 1989). As we’ve seen, cognitive therapy is not the only effective therapy strategy, and there is some question about whether cognitive therapy is superior to all alternative approaches to psychotherapy (Cuijpers et al., 2008). Nonetheless, there is no question that cognitive therapy substantially reduces depressive symptoms.

Another effective approach is interpersonal therapy. In interpersonal therapy, therapists try to identify, and change, interpersonal problems that contribute to a client’s current depression. A key aim is to reduce the client’s social isolation by expanding his or her network of relationships (Klerman et al., 1984). Interpersonal therapy is inspired by two of the broad therapy strategies you learned about earlier: the psychodynamic approach, which, in developments made after Freud’s lifetime, began to emphasize the importance of analyzing client’s interpersonal relationships (Sullivan, 1953); and the humanistic approach, whose central tenet is that strong interpersonal relationships are the foundation of healthy psychological growth. In practice, interpersonal therapy is similar to cognitive therapy for depression, with both approaches targeting irrational thoughts about interpersonal relationships (Ablon & Jones, 2002).

A fourth strategy to combat depression is drug therapy. Antidepressants are among the most widely prescribed of all prescription drugs in the United States. Nearly 1 in 10 women, and about half as many men, take antidepressants (Barber, 2008; Breggin & Breggin, 2010).

683

THIS JUST IN

684

685

Because both drug therapies and psychotherapy are available to treat depression, a significant question for people experiencing the disorder is how the different therapy strategies compare. Much research has investigated this question. Findings commonly indicate either that cognitive therapy is superior to drugs in relieving major depression or that the two approaches are about equally effective (Butler et al., 2006; Cox et al., 2012). Drug therapy rarely is found to be superior. In light of recent findings comparing antidepressant drugs to placebo medications (see This Just In), this result is not surprising. Antidepressant medications have proven to be less effective than the pharmaceutical industry, and depression sufferers, had hoped.

CULTURAL OPPORTUNITIES

“I have two moods. One is … rollicking … the wild ride of a mood. [The other] stands on the shore and sobs … Sometimes the tide is in, sometimes it’s out.”

The writer suffers from bipolar disorder, also known as manic-depressive disorder. Bipolar disorder is a depressive disorder characterized by extreme variations in mood. People’s mood “swings” from severe depression to mania, which is a period of abnormally high energy, arousal, and positive mood.

Intense positive mood might sound like fun. But to people with bipolar disorder, both depression and mania bring difficulties (Gruber, 2011). In manic states, people sometimes engage in reckless behavior they later regret. It’s “a world of bad judgment calls,” the writer above continues. During the manic periods, “[I display] every kind of bad judgment because it all seems like a good idea at the time. A great idea. … So if it’s talking, if it’s shopping, if it’s—the weirdest one for me is sex. That’s only happened twice. But then it’s wow, who are you?”

Like J. K. Rowling, this writer also overcame her depressive disorder and achieved great professional success. She is Carrie Fisher—Star Wars ’s Princess Leia, one of the great heroines of film history. “I outlasted my problems,” says Fisher. “I am mentally ill. I can say that. I am not ashamed of that. I survived that, I’m still surviving it, but bring it on. Better me than you” (Prime Time, 2000).

DEFINING FEATURES AND PREVALENCE. To be categorized according to the DSM as a person with bipolar disorder, an individual must display two types of symptoms:

687

These mood swings, from depression to mania and back, distinguish bipolar disorder from major depression. Note that a person with bipolar disorder generally will experience substantial periods of normal mood state; the deviations from this state are what characterize the disorder.

About 1% of adults suffer from bipolar disorder (NIMH, 2007). In terms of overall numbers of people, then, bipolar disorder is quite prevalent; in the United States alone, 1% of adults translates into about 2 million people. Bipolar disorder is a long-term illness for which there is no surefire cure. The personal and social costs of the disorder are huge and include high risks of suicide; estimates of suicide rates among persons diagnosed with the disorder range from 8 to 20% (Nakic, Krystal, & Bhagwagar, 2010). Because it is prevalent, severe, and chronic, the World Health Organization ranks it as the sixth most severe of all medical disorders in terms of years of life lost to disability and death (Nakic et al., 2010).

TREATMENT. The primary form of treatment for bipolar disorder is drug therapy. The reasoning behind drug therapy is that bipolar disorder’s mood swings may stem from abnormal variations in brain functioning. The brain’s neurotransmitter systems generally are seen as the biological culprits (Nakic et al., 2010). Mood stabilizers, which are drugs designed to influence neurotransmitters in the brain in a manner that calms and steadies the patient’s swinging mood states, thus are a major form of treatment (Stahl, 2002).

Three types of drugs are most commonly used as mood stabilizers (Stahl, 2002):

The best evidence that these drugs work comes from meta-analyses of studies that compared the experiences of people receiving a mood stabilizer to those of people receiving a placebo drug. One such meta-analysis has documented the effectiveness of lithium, which was particularly effective in reducing manic episodes (Geddes et al., 2004). Another indicates that some antipsychotics can reduce bipolar symptoms particularly rapidly (Cruz et al., 2010).

Major depression and bipolar disorder are not the only depressive disorders. In postpartum depression, which affects 10 to 15% of women who give birth (Pearlstein et al., 2009), women experience symptoms akin to those of major depression beginning within a few weeks of childbirth (NIHM, 2011). In seasonal affective disorder, individuals tend to experience depressed mood during late autumn and winter, periods when there is less sunlight (Rosenthal, 2009). Light therapy can help sufferers. Exposure to bright light for about half an hour a day relieves symptoms, an effect that may be due to the influence of intense light on neurotransmitters in the brain (Virk et al., 2009).

688