175 Myrna Weissman’s evolutionary theories about depression and women I have taken from an oral interview.
176 The information about depression among adult survivors of childhood sexual abuse is in Gemma Gladstone et al., “Characteristics of depressed patients who report childhood sexual abuse,” American Journal of Psychiatry 156, no. 3 (1999): 431–37.
176 For information about anorexia and depression, see Christine Pollice et al., “Relationship of Depression, Anxiety, and Obsessionality to State of Illness in Anorexia Nervosa,” International Journal of Eating Disorders 21 (1997), and Kenneth Altshuler et al., “Anorexia Nervosa and Depression: A Dissenting View,” American Journal of Psychiatry 142, no. 3 (1985).
176 Freud’s description of Dora occurs in his essay “Fragment of an Analysis of a Case of Hysteria,” in volume 7 of The Standard Edition of the Complete Psychological Works of Sigmund Freud. For a feminist discussion of Dora, see Jill Astbury’s Crazy for You, pages 109–32.
176 For a discussion of ideas of femininity and depression, see Susan Nolen-Hoeksema’s Sex Differences in Depression. For a discussion of the expectations of motherhood and postpartum depression, see Verta Taylor’s Rock-A-By Baby, pages 35–58.
176 The quotations from Dana Crowley Jack may be found in her book Silencing the Self, pages 32–48.
177 Jill Astbury’s analysis is in her book Crazy for You. The quotation comes from pages 2–3.
178 The comparative rate of male-to-female suicide is in Eric Marcus’s Why Suicide?, in which he states, “Of the approximately thirty thousand people a year who take their lives, twenty-four thousand are men and six thousand are women,” page 15.
178 The discussion of the rates of depression in single, divorced, or widowed men may be found in Myrna Weissman et al., “Cross-National Epidemiology of Major Depression and Bipolar Disorder,” Journal of the American Medical Association 276, no. 4 (1996).
180 The statistics on depression among Jewish men may be found in Bruce Bower, “Depression: Rates in women, men . . . and stress effects across the sexes,” Science News, June 3, 1995, page 346.
180 The qualities of children with a depressed mother are spelled out in Marian Radke-Yarrow et al., “Affective Interactions of Depressed and Nondepressed Mothers and Their Children,” Journal of Abnormal Child Psychology 21, no. 6 (1993). Also see Anne Riley’s NIMH grant proposal entitled “Effects on children of treating maternal depression,” page 32.
181 Bruce Bower’s “Depressive aftermath for new mothers,” Science News, August 25, 1990, reports on a variety of studies that have found infant depression as early as three months of age.
181 The effects of a mother’s depression upon her young appear immediate and grave. Tiffany Field, an expert in the field who has been publishing for over two decades, writes concerning an almost “neonatal” depression: “Infants show ‘dysregulation’ in their behavior, physiology, and biochemistry, which probably derives from prenatal exposure to a biochemical imbalance in their mothers,” page 200. See Tiffany Field, “Maternal Depression: Effects on Infants and Early Interventions,” Preventive Medicine 27 (1998). Unfortunately, these malignant effects also seem to endure. Nancy Aaron Jones et al., “EEG Stability in Infants/Children of Depressed Mothers,” Child Psychiatry and Human Development 28, no. 2 (1997), describes a study in which the children of depressed mothers were followed from three months to three years of age. Seven of the eight children who had shown EEG asymmetry as infants still showed this pattern of dysregulation at three years of age. However, studies have also shown that even the most basic of maternal attention and interaction can alleviate much of the problem. Martha Peláez-Nogueras et al., “Depressed Mothers’ Touching Increases Infants’ Positive Affect and Attention in Still-Face Interaction,” Child Development 67 (1996), claims that the calm and intimate interaction of a mother touching her infant can have drastically positive effects on the infant’s mood and sociability. Other studies, such as Sybil Hart et al., “Depressed Mothers’ Neonates Improve Following the MABI and Brazelton Demonstration,” Journal of Pediatric Psychology 23, no. 6 (1998), and Tiffany Field et al., “Effects of Parent Training on Teenage Mothers and Their Infants,” Pediatrics 69, no. 6 (1982), demonstrate that parent education can ameliorate much of the damage done by maternal depression.
181 The study of children of depressed mothers nearly one year after maternal improvement is Catherine Lee and Ian Gotlib’s “Adjustment of Children of Depressed Mothers: A 10-Month Follow-Up,” Journal of Abnormal Psychology 100, no. 4 (1991).
181 The information on a ten-year follow-up of social impairment, depression, panic disorders, and alcohol dependence is in Myrna Weissman et al., “Offspring of Depressed Parents,” Archives of General Psychiatry 54 (1997).
181 The comparison of children with a depressed mother and children with a schizophrenic mother is in Anne Riley’s NIMH grant proposal entitled “Effects on children of treating maternal depression,” page 32.
181 The problems of attention deficit disorder, separation anxiety, conduct disorder, and increased somatic complaints are described in Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children” in Walker and Roberts’s Handbook of Clinical Child Psychology, pages 319–39. Also see Dr. David Fassler and Lynne Dumas’s monograph on childhood depression entitled Help Me, I’m Sad: Recognizing, Treating, and Preventing Childhood Depression.
182 Sameroff’s work on two-to-four-year-old children of depressed mothers is in Sameroff et al., “Early development of children at risk for emotional disorder,” Monographs of the Society for Research in Child Development 47, no. 7 (1982).
182 The study on high blood pressure is in A. C. Guyton et al., “Circulation: Overall regulation,” Annual Review of Physiology 34 (1972), edited by J. M. Luck and V. E. Hall. The information cited here is in the table on page 12.
183 Anaclitic depression is outlined by René Spitz, “Anaclitic Depression,” Psychoanalytic Study of the Child 2 (1946). For a case example, see René Spitz et al., “Anaclitic Depression in an Infant Raised in an Institution,” Journal of the American Academy of Child Psychiatry 4, no. 4 (1965).
183 My description of “failure to thrive” is taken from oral interviews with Paramjit T. Joshi at Johns Hopkins and Deborah Christie at the Adolescent Medical Unit at University College London and Middlesex Hospital.
184 The study that came up with the 1 percent statistic is E. Poznanski et al.’s “Childhood depression: Clinical characteristics of overtly depressed children,” Archives of General Psychiatry 23 (1970). The study that came up with the 60 percent statistic is T. A. Petti’s “Depression in hospitalized child psychiatry patients: Approaches to measuring depression,” Journal of the American Academy of Child Psychiatry 22 (1978).
184 The figures on child suicide are taken from Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children” in Walker and Roberts’s Handbook of Clinical Child Psychology, page 328. According to statistics for 1997, from the NIMH’s Web site, suicide was the third leading cause of death for children aged ten to fourteen.
185 That tricyclics are not effective in children and adolescents is reported in N. D. Ryan et al., “Imipramine in adolescent major depression: Plasma level and clinical response,” Acta Psychiatrica Scandinavica 73 (1986). There are fewer studies concerning MAOIs and child and adolescent depression, largely because, as Christopher Kye and Neal Ryan write in “Pharmacologic Treatment of Child and Adolescent Depression,” Child and Adolescent Psychiatric Clinics of North America 4, no. 2 (1995), these drugs “require an especially high sensitivity for the impulsivity, compliance, and maturity of the depressed adolescent,” page 276. The general idea held by most clinicians today is nicely summed up in Paul Ambrosini, “A review of the pharmacotherapy of major depression in children and adolescents,” Psychiatric Services 51, no. 5 (2000). He writes that the studies to date “could suggest that affective disorders amo
ng children and adolescents represent a distinct biological entity that has a differing response pattern to pharmacotherapy,” page 632.
187 The course of life depression for those who have been depressed as children is described in Myrna Weissman et al., “Depressed Adolescents Grown Up,” Journal of the American Medical Association 281, no. 18 (1999), pages 1707–13.
187 Only in the post-Freudian world have many of the questions surrounding childhood depression finally been asked. While childhood depression is now well documented as a clinical reality, the numbers seem to surge during adolescence. Myrna Weissman et al. write in their article “Depressed Adolescents Grown Up,” Journal of the American Medical Association 281, no. 18 (1999), “It is now clear that major depressive disorder often has an onset in adolescence.” That approximately 5 percent of teens suffer from depression is an oft-cited statistic; I have taken it from Patricia Meisol’s “The Dark Cloud,” published in the May 1, 1999, edition of The Sun.
187 I recommend strongly the video Day for Night: Recognizing Teenage Depression, produced by the Depression and Related Affective Disorders Association (DRADA) working in cooperation with the Johns Hopkins University School of Medicine. It is an eloquent and inspiring record of the kinds of depression that afflict young people today.
187 That parents underestimate the depression of their children can be adduced from a number of studies and statistics. One such statistic, from Howard Chua-Eoan, “How to Spot a Troubled Kid,” Time 153, no. 21 (1999), is that “57% of teens who had attempted suicide were found to be suffering from major depression. But only 13% of the parents of suicides believed their child was depressed.” Pages 46–47.
187 The statistic for suicidal thoughts among high school students is from George Colt’s The Enigma of Suicide, page 39.
187 Pioneering work done by Myrna Weissman and others has begun to shed light on the clinical reality of childhood and adolescent depression. Many researchers are beginning to look at the long-term effects of early diagnosis. The article “Depressed Adolescents Grown Up,” coauthored by Weissman and published in The Journal of the American Medical Association 281, no. 18 (1999), notes: “The major findings are a poor outcome of adolescent-onset Major Depressive Disorder and the continuity and specificity of MDD arising in and continuing into adulthood.” Page 1171.
188 The multiplicand for the correlation between early depression and adult depression is in Eric Fombonne’s essay “Depressive Disorders: Time Trends and Possible Explanatory Mechanisms,” in Michael Rutter and David J. Smith’s Psychosocial Disorders in Young People, page 573.
188 The figure of 70 percent is from Leonard Milling and Barbara Martin’s essay “Depression and Suicidal Behavior in Preadolescent Children,” in Walker and Roberts’s Handbook of Clinical Child Psychology, page 325.
188 The idea that sexual abuse causes depression is discussed in Jill Astbury’s Crazy for You, pages 159–91. Gemma Gladstone et al., “Characteristics of depressed patients who report childhood sexual abuse,” American Journal of Psychiatry 156, no. 3 (1999), discusses sexual abuse as an indirect cause of depression, pages 431–37.
188 The Russian orphanage adoption story was recounted in Margaret Talbot, “Attachment Theory: The Ultimate Experiment,” New York Times Magazine, May 24, 1998.
189 That the elderly depressed are undertreated is indicated by a number of articles and studies, both academic and popular. Sara Rimer explores the various causes and consequences in “Gaps Seen in Treatment of Depression in Elderly,” New York Times, September 5, 1999. In the article, Dr. Ira Katz, director of geriatric psychiatry at the University of Pennsylvania School of Medicine, is quoted as saying, “More than one in six older patients who go to a primary-care doctor’s office have a clinically significant degree of depression, but only one in six of those get adequate treatment.” George Zubenko et al.’s “Impact of Acute Psychiatric Inpatient Treatment on Major Depression in Late Life and Prediction of Response,” American Journal of Psychiatry 151, no. 7 (1994), explains, “It has been observed that recognition of major depression in the elderly is hampered because depressed mood seems less prominent in older patients than among younger adults. Moreover, the increasing burden of physical disorders with increasing age complicates the differential diagnosis of major depression in the elderly, especially when a cross-sectional assessment is made.”
189 Emil Kraepelin’s comments on the elderly depressed are in C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,” International Clinical Psychopharmacology, suppl. 6, no. 5 (1992).
189 On the idea that older people in nursing homes are twice as likely to be depressed as those living in their own communities, see Ibid.
189 On the suggestion that one-third of nursing-home residents are depressed, see Ibid.
189 On the social dimensions of elderly depression and the importance of having a good friend, see Judith Hays et al., “Social Correlates of the Dimensions of Depression in the Elderly,” Journal of Gerontology 53B, no. 1 (1998).
189 That levels of neurotransmitters are low in the elderly is confirmed in C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,” International Clinical Psychopharmacology, suppl. 6, no. 5 (1992).
189 On the comparative levels of serotonin in the very elderly, see Ibid.
189 That the diminution of serotonin through natural aging does not necessarily have immediate dire consequences is proposed by a number of studies. B. A. Lawlor et al.’s “Evidence for a decline with age in behavioral responsivity to the serotonin agonist, m-chlorophenylpiperazine, in healthy human subjects,” Psychiatry Research 29, no. 1 (1989), eloquently states: “The functional significance of alterations in brain serotonin (5HT) associated with normal aging in both animals and humans is largely unknown.”
189 The information on the delayed response to antidepressants among the elderly is in George Zubenko et al., “Impact of Acute Psychiatric Inpatient Treatment on Major Depression in Late Life and Prediction of Response,” American Journal of Psychiatry 151, no. 7 (1994).
190 On the success rate for treatment of depression among the elderly, see Ibid.
190 On prescription of short-term hospitalization for the elderly depressed, see Ibid.
190 The symptoms of depression among the elderly are described in Diego de Leo and René F. W. Diekstra’s Depression and Suicide in Late Life, pages 21–38.
190 The term “emotional incontinence” is used in Nathan Herrmann et al., “Behavioral Disorders in Demented Elderly Patients,” CNS Drugs 6, no. 4 (1996).
192 The role of depression in predicting Alzheimer’s and senility is discussed in Myron Weiner et al., “Prevalence and Incidence of Major Depression in Alzheimer’s Disease,” American Journal of Psychiatry 151, no. 7 (1994).
192 On serotonin levels in Alzheimer’s patients, see Ibid.
193 Work on whether lowered levels of serotonin may cause dementia is to be found in Alan Cross et al., “Serotonin Receptor Changes in Dementia of the Alzheimer Type,” Journal of Neurochemistry 43 (1984), and Alan Cross, “Serotonin in Alzheimer-Type Dementia and Other Dementing Illnesses,” Annals of the New York Academy of Sciences 600 (1990).
193 On the effect of SSRIs on intellectual and motor skills, see C. G. Gottfries et al., “Treatment of Depression in Elderly Patients with and without Dementia Disorders,” International Clinical Psychopharmacology, suppl. 6, no. 5 (1992).
193 M. Jackuelyn Harris et al.’s “Recognition and treatment of depression in Alzheimer’s disease,” Geriatrics 44, no. 12 (1989), is my source on long-term use of low dosages of SSRIs. They write, “Generally, Alzheimer’s patients require lower dosages of medication and longer drug treatment trials than younger patients treated for depression.” Page 26.
193 Use of trazodone and benzodiazepines for depression in the elderly is described in Nathan Herrmann et al., “Behavioral Disorders in Demented Elderly Patients,” CNS Dru
gs 6, no. 4 (1996).
193 On proposal of hormone therapies for sexual aggressivity in Alzheimer’s, see Ibid.
193 For a discussion of and statistics related to depression and stroke, see Allan House et al., “Depression Associated with Stroke,” Journal of Neuropsychiatry 8, no. 4 (1996).
193 For a review of the work on strokes in the left frontal lobe, see Ibid.
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