100 Questions & Answers is a series of books that addresses patient and family concerns on a variety of health-related topics. To date, however, most books in this series have been on various cancer diagnoses and other physical illnesses. Depression, however, is found in nearly a quarter of persons receiving care in a primary care setting. To that end, it only seemed sensible to develop a similar book on the topic of depression. Writing such a book in this format has been both challenging and rewarding. Many concepts need to be included that are rather abstract and do not always fit neatly within a structure so well suited to physical illnesses with well-defined physical descriptors and anatomy. We believe, however, that we have accomplished the task of communicating difficult-to-understand material on a complex subject that still remains in many ways a mystery. Not so long ago many individuals suffered from depression and mental illness in general, quietly and discreetly. With the introduction of Prozac in the late 1980s, the treatment of depression became a real and tangible option for many people. But, ironically, as antidepressants are becoming one of the most prescribed medications in history, depression remains one of the most misunderstood illnesses of our time. Fear is often behind the misunderstanding. The fear often revolves around an admission of losing one's mind when being diagnosed with depression or of losing one's mind from the prescribed psychotropic medication. Such fears persist because of continued confusion regarding the boundaries between the body and the soul. Fundamental assumptions about what is and is not disease versus personal responsibility are called into question, as are the interaction between mind and brain, the differences between universal human feelings and pathology, and the conceptions of ourselves as being in control over our emotions and behavior. For many people depression continues to be a source of shame because it is believed to suggest a weakness of the will. All these reasons create obstacles for people seeking psychiatric attention and asking questions that may reflect negatively on them. The negative stigma of mental illness, no matter how much modern science has attempted to eradicate it, remains strong in our popular culture. In writing this book we attempted to answer basic questions readers might have after being diagnosed with depression or that families might have regarding their loved one. In starting with basic information about the brain, we hope to place into perspective the role the brain plays in the development of depression and thus its biologic underpinnings. In doing so it is our hope that readers of our book will feel less ashamed and more empowered to attend to their illness, as they would any other medical diagnosis. This is not to undermine, however, the importance of real-life circumstances in the development of depression, because genes do not work in a vacuum. As the environment can influence the likelihood of developing cancer, hypertension, or heart disease, so too the environment influences the development of mental illness, even in the presence of strong genetic influences. A person with heart disease in the family can reduce personal risk by modifying the influence of external stressors on the heart (e.g., quitting smoking, following a low-fat diet). Similarly, a person with depression in the family can reduce personal risk by modifying the influence of stress on the brain (e.g., attending therapy, getting exercise).
We hope to provide the reader with clear, matter-of-fact answers to a multitude of questions that one might have but has been afraid to ask. Some questions have straightforward, simple answers. Others do not. Differences of opinion among clinicians in regard to some of the answers may exist, but we have attempted to present the various aspects that can be considered in any question, so that ultimately the reader can be fully informed when seeking and/or continuing his or her own treatment. There are bound to be questions the reader will have that may not have been fully answered in our book. In today's society there are vast resources available to laypersons to become involved in their own medical care. Take advantage of these resources. Ask your doctor questions. Get the help that you need.
The preceding introduction originally appeared in the first edition of 100 Questions & Answers About Depression. Since publication of our first edition of 100 Questions & Answers About Depression, additional works on other topics in the field of mental health have been published in this series. The expansion of topics in areas of mental health within this series of books is important, because it permits for a trend toward greater acceptance of the need for treatment of mental illnesses in society and, hopefully with that, the reduction of stigma for such treatment. In the years since we published the first edition, depression continues to be misunderstood by many, and undiagnosed depression results in great costs to individuals, families, and society. Despite ongoing research efforts, much remains unknown about the development of depression, its treatment, and reasons for response in some and not in others. Treatment options have not changed for the most part; however, we believed it was time to update the initial volume to include recent FDA-approved treatments for depression and to increase the relevance of some information for more readers. Because most people at some point in life will know someone suffering from depression, we hope that with the second edition of this book more individuals will take the opportunity to learn about depression.
Ava T. Albrecht, MD
Charles Herrick, MD