118 Considerable care must be taken in prescribing antidepressants of any kind to people with manic-depressive illness. In general, people with manic-depressive illness need to take a mood stabilizer—lithium or an anticonvulsant—with antidepressants.
119 I thank Dr. David McDowell of Columbia University for his discussion regarding the problem of benzodiazepine addiction.
120 Numbers concerning the efficacy of ECT vary: Peter Whybrow in his book A Mood Apart cites a rate of 85–90 percent, page 216; Francis Mondimore, in his book Depression: The Mood Disease, estimates a higher rate of over 90 percent, page 65. The numbers I have given reflect an approximate average of many published efficacy rates.
121 That right unilateral ECT is less impairing than, while just as effective as, bilateral ECT is reported in Harold Sackein et al., “A Prospective, Randomized, Double-Blind Comparison of Bilateral and Right Unilateral Electroconvulsive Therapy at Different Stimulus Intensities,” Archives of General Psychiatry 57, no. 5 (2000). They report that right unilateral ECT, when given at 500 percent of seizure threshold, is as effective as bilateral ECT, but causes less than one-sixth of the cognitive side effects of bilateral ECT.
122 For a general discussion of the methods of ECT, see Francis Mondimore’s Depression: The Mood Disease, and Elliot Valenstein’s Great and Desperate Cures.
122 The statistic on death from ECT-based complications comes from Stacey Pamela Patton, “Electrogirl,” Washington Post, September 19, 1999.
122 The quotation from Richard Abrams comes from his book Electroconvulsive Therapy, page 75.
123 Manning described these pickets to me, which included groups of people organizing together and handing out leaflets against “electronic mind control.” Opposition such as this took place at an event sponsored by a private Northampton, Massachusetts, bookstore, but held at the Smith College library.
125 The passage from the Unabomber, Ted Kaczynski, is taken from his manifesto. I would like to affirm that I admire his insights and deplore his methods.
133 Charlotte Brontë’s words appear in Juliet Barker’s The Brontës, page 599. I thank the artist Elaine Reichek for calling my attention to this passage.
CHAPTER IV: ALTERNATIVES
135 I have taken the Chekhov quotation from the epigraph to Jane Kenyon’s poem “Having It Out with Melancholy,” in the volume Constance, page 21.
137 There are many studies on exercise and depression: one of the most rigorous is J. A. Blumenthal et al., “Effects of exercise training on older patients with major depression,” Archives of Internal Medicine 159 (1999).
138 An extremely accessible discussion of the role of diet in combating depression may be found in The Food Doctor, by Vicki Edgson and Ian Marber, pages 62 –65.
139 The relationship of fish oil and omega-3 fatty acids to depressive symptoms is described in J. R. Calabrese et al., “Fish Oils and Bipolar Disorder,” Archives of General Psychiatry 56 (1999).
139 TMS and rTMS have been plagued simultaneously by low efficacy rates and high rates of depressive relapse. For a general introduction to the process, theory, and method of TMS, see Eric Hollander, “TMS,” CNS Spectrums 2, no. 1 (1997). For more specific academic and research-oriented information, see W. J. Triggs et al., “Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold,” Biological Psychiatry 45, no. 11 (1999), and Alvaro Pascual-Leone et al., “Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression,” Lancet 348 (1996).
140 Norman Rosenthal lays out his views on SAD in his book Winter Blues.
140 The figures on light levels under artificial and actual light can be adduced from Michael J. Norden’s Beyond Prozac: Brain Toxic Lifestyles, Natural Antidotes and New Generation Antidepressants, page 36. Calculations were based on 300 lux for domestic interior lighting; 10,000 lux for new light boxes; and 100,000 lux for a sunny day.
140 The literature on EMDR is spotty, but the best book on the subject as it relates to depression is Extending EMDR, edited by Philip Manfield.
141 My treatments in Sedona were at the Enchantment Resort.
142 Callahan’s interesting ideas appear, summarized, in Fred Gallo’s Energy Psychology. For Callahan’s discussion of his techniques in reference to trauma, see Roger J. Callahan and Joanne Callahan, Stop the Nightmares of Trauma: Thought Field Therapy. I am not persuaded that his work has real clinical significance, though his modes of thinking are useful to people practicing more conventional therapies.
142 The passage from Kurt Hahn is from Readings from the Hurricane Island Outward Bound School, page 71, a wonderful commonplace book published by Hurricane Island Outward Bound and sold through its store, the School Locker.
144 Michael Yapko has written an impressive and helpful monograph on the subject of hypnosis and mood disorders entitled Hypnosis and the Treatment of Depression.
144 For theories of sleep and depression, see the work of Michael Thase at the University of Pittsburgh and David Dingle of the University of Pennsylvania. Thomas Wehr at the NIMH is also an expert in the field. The description of altered sleep phases comes from a number of sources, both printed and verbal. See Thomas Wehr, “Phase Advance of the Circadian Sleep-Wake Cycle as an Antidepressant,” Science 206 (1979); his “Reply to Healy, D., Waterhouse, J. M.: The circadian system and affective disorders: Clocks or rhythms,” Chronobiology International 7 (1990); his “Improvement of Depression and Triggering of Mania by Sleep Deprivation,” Journal of the American Medical Association 267, no. 4 (1992); and M. Berger et al., “Sleep deprivation combined with consecutive sleep phase advance as fast-acting therapy in depression,” American Journal of Psychiatry 154, no. 6 (1997). For more on this topic, see also the review chapter entitled “Biological Processes in Depression: An Updated Review and Integration,” by Michael Thase and Robert Howland in The Handbook of Depression, edited by E. Edward Beckham and William Leber, pages 213 –79.
144 The quotation from F. Scott Fitzgerald comes from The Crack-Up, page 75. I thank the ever-vigilant Claudia Swan for suggesting this passage.
146 On arctic resignation, see A. S. Blix’s material in Symposium on Living in the Cold, edited by André Malan and Bernard Canguilhem.
146 There is a vast literature on Saint-John’s-wort, most of it repetitive, some of it sensationalist, and much of it goopy. I have drawn here on Norman Rosenthal’s book St. John’s Wort. The information regarding hypericum and interleukin-6 was taken from the National Institutes of Health’s National Center for Complementary and Alternative Medicine’s Web site at www.nccam.nih.gov/nccam/fcp/factsheets/stjohns wort/stjohnswort.htm.
147 I find Andrew Weil’s writing intensely annoying and cannot recommend any of it. His views on these subjects are nicely summed up in Jonathan Zuess’s The Natural Prozac Program, pages 66–67.
147 Dr. Thomas Brown of Tulane University has objected to Saint-John’s-wort as “touted somewhat illogically by many as natural and therefore safe.” See Thomas Brown, “Acute St. John’s Wort Toxicity,” American Journal of Emergency Medicine 18, no. 2 (2000). Like other antidepressants, the plant has triggered episodes of acute mania. See Andrew Nierenberg et al., “Mania Associated with St. John’s Wort,” Biological Psychiatry 46 (1999). There is evidence that the plant may cause skin sensitivities at high dosages in cows and sheep. See O. S. Araya and E. J. Ford, “An investigation of the type of photosensitization caused by the ingestion of St. John’s Wort (Hypericum perforatum) by calves,” Journal of Comprehensive Pathology 91, no. 1 (1981).
147 For information about Saint-John’s-wort and drug interactions, see the NIMH’s Web site at www.nimh.nih.gov/events/stjohnwort.cfm. A recent article also reviews the current data on the subject; see A. Fugh-Berman, “Herb-drug interactions,” Lancet 355, no. 9198 (2000).
147 The catalog of drugs whose efficacy is reduced when they are taken with Saint-John’s-wort is from Consumer Reports, “Emotional �
�Asprin’?” December 2000, pages 60 –63.
147 For controlled studies of S-adenosylmethionine (SAMe), see G. M. Bressa, “S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies,” Acta Neurologica Scandinavica 89, suppl. 154 (1994).
148 The tendency of SAMe to precipitate mania is described in Consumer Reports, “Emotional ‘Asprin’?” December 2000, pages 60–63.
148 The information about SAMe and animal neurotransmitter levels may be found in Richard Brown et al., Stop Depression Now, pages 74–75.
148 The connection between SAMe and methylation is proposed in Joseph Lipinski et al., “Open Trial of S-adenosylmethionine for Treatment of Depression,” American Journal of Psychiatry 143, no. 3 (1984).
148 The figure on annual American expenditure on acupuncture may be found on the National Institutes of Health’s National Center for Complementary and Alternative Medicine’s Web site at www.nccam.nih.gov/nccam/fcp/factsheets/acupuncture/acupuncture.htm.
149 Claudia Weaver’s homeopathic treatments were prescribed and administered by Pami Singh.
158 Hellinger’s seminal book is Love’s Hidden Symmetry. Reinhard Lier runs the Linderhof Therapy Center in Bavaria, which is where he conducts most of his practice. Reinhard Lier’s visit to America was arranged by Regine Olsen.
162 The quotations from Frank Rusakoff’s writings are taken from unpublished manuscripts.
166 For a discussion of the tradition of witchcraft among the Senegalese, see William Simmons’s Eyes of the Night.
171 Reboxetine has passed all testing to date and awaits approval from the Food and Drug Administration. In a recent E-mail, Pharmacia writes: “With regard to reboxetine, we have not received Food and Drug Administration (FDA) approval in the United States, and we cannot speculate on a date when this medication may be available. Based on the approval letter Pharmacia received from the FDA on February 23, 2000, additional U.S. clinical trials must be conducted before the product can be approved.” For further information, I recommend visiting Pharmacia’s Web site at www2.pnu.com.
171 For more on substance P, see Merck’s Web site at www.dupontmerck.com. An introduction to substance P as an antidepressant is provided by David Nutt, “Substance-P antagonists: A new treatment for depression?” Lancet 352 (1998).
172 I take the number “about thirty thousand” from Craig J. Venter, “The Sequence of the Human Genome,” Science 291, no. 5507 (2001), which said, in part, “Analysis of the genome sequence revealed 26,588 protein-encoding transcripts for which there was strong corroborating evidence and an additional 12,000 computationally derived genes with mouse matches or other weak supporting evidence.” I thank Edward R. Winstead for bringing this article to my attention. I thank Polly Shulman for her advice on the mathematical meaning of ten variations for each of thirty thousand genes.
CHAPTER V: POPULATIONS
173 That women suffer depression twice as often as men is repeated throughout the general literature. The statistical work to support this assertion was done and collated internationally by Myrna Weissman at Columbia University and was published as “Cross-National Epidemiology of Major Depression and Bipolar Disorder,” Journal of the American Medical Association 276, no. 4 (1996).
173 That sex differences for depression begin at puberty is a fairly common idea, prevalent in most of the literature on the subject. See Susan Nolen-Hoeksema’s Sex Differences in Depression.
173 While arguments about the biological components of women’s depression are inconclusive, it is undeniably the case that mood effects result from fluctuations of estrogen and progesterone in the hypothalamic and pituitary hormone systems. A discussion of these phenomena may be found in Susan Nolen-Hoeksema’s Sex Differences in Depression, pages 64–76.
174 The statistics on suicide among women who are pregnant or have just given birth are from E. Clare Harris and Brian Barraclough, “Suicide as an Outcome for Medical Disorders,” Medicine 73 (1994).
174 This figure on postpartum depression reflects an extremely varied set of statistics on this issue. There are two problems in arriving at an accurate figure. First, how stringently one defines postpartum depression radically affects its apparent frequency. Second, many symptoms resembling those found in depression can in fact occur as physiological repercussions of childbirth. Susan Nolen-Hoeksema writes about one study in which “the seemingly high rates of depression in new mothers resulted from their acknowledgment of the aches and pains and problems in sleeping that come with pregnancy and having a new baby, rather than the presence of the full range of depressive symptoms.” She continues, “Estimates of the prevalence of nonpsychotic depression in women during the postpartum period range from 3 to 33 percent.” She provides an average of 8.2 percent. These quotations come from her book Sex Differences in Depression, pages 62–65. Verta Taylor, in her book on postpartum depression entitled Rock-A-By Baby, reports that 10 to 26 percent of new mothers experience this malady.
174 The statistics concerning severe postpartum and mild postpartum depression are taken from Susan Nolen-Hoeksema’s Sex Differences in Depression, pages 62–64. Menopausal depression is described on pages 70–71.
174 The statistic on rate of serotonin synthesis is to be found in Simeon Margolis and Karen L. Swartz, “Sex Differences in Brain Serotonin Production,” The Johns Hopkins White Papers (1998): 14.
174 The question of disenfranchisement as the source of women’s depression is amply discussed in a number of books and publications, including Susan Nolen-Hoeksema’s Sex Differences in Depression, Jill Astbury’s Crazy for You, and Dana Crowley Jack’s Silencing the Self.
174 The statistics on postpartum depression in stressed women are in Susan Nolen-Hoeksema’s Sex Differences in Depression, page 68. Her quote is from pages 60–61.
175 On the parity of male and female rates of depression among college students, as well as proposed explanations, see Ibid., 26–28.
175 The overall statistics on male-to-female depression rates are in Myrna Weissman’s “Cross-National Epidemiology of Major Depression and Bipolar Disorder,” Journal of the American Medical Association 276, no. 4 (1996), working on the basis of her epidemiological studies (see the first note for chapter five, page 173, above). That women have higher rates of panic disorders and eating disorders while men have higher incidences of autism, attention deficit hyperactivity disorder, and alcoholism was discussed in a personal correspondence with Steven Hyman.
175 The information on the nature of female disenfranchisement is not taken verbatim from any one source. Numerous authors have described and explained these various phenomena in different ways. My list is not meant to be either definitive or exhaustive. For the reader who would like more in-depth explanations of these ideas, I recommend Susan Nolen-Hoeksema’s Sex Differences in Depression, Jill Astbury’s Crazy for You, and Dana Crowley Jack’s Silencing the Self. Professor George
175 The two feminist explanations of depression, as well as various summaries concerning the connection between depression and marital status, may be found in Susan Nolen-Hoeksema’s Sex Differences in Depression, pages 96–101.
175 Brown has also done much interesting work regarding “the role of life events in the onset of depressive disorders.” Various studies by him and his colleagues have found humiliation and entrapment to be key descriptive factors of depressogenic events for women. See “Loss, humiliation and entrapment among women developing depression: A patient and non-patient comparison,” Psychological Medicine 25 (1995). Other scientists’ findings on the importance of roles in defining depression are reported in numerous articles. That a woman’s concern for her offspring should be a typical depressogenic event for her is consistent with traditional gender roles. However, one article states: “When in practice the man also had significant involvement in domestic roles this gender difference in onset did not occur.” For more on this topic, see J. Y. Nazroo et al., “Gender differences in the onset of depression following a shared life event:
A study of couples,” Psychological Medicine 27 (1997): 9.
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