Depression For Dummies®
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Laura L. Smith, PhD, is a clinical psychologist at Presbyterian Medical Group at the Behavioral Medicine Outpatient Clinic, Albuquerque, New Mexico. At Presbyterian, she specializes in the assessment and treatment of both adults and children with depression and other emotional disorders. In addition, she has presented on new developments in cognitive therapy to both national and international audiences. Dr. Smith is coauthor of Overcoming Anxiety For Dummies (Wiley Publishing), Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth (Prima, 2001), and Why Can’t I Be the Parent I Want to Be? (New Harbinger Publications, 1999).
Charles H. Elliott, PhD, is a clinical psychologist and a member of the faculty at the Fielding Graduate Institute. He is a Founding Fellow in the Academy of Cognitive Therapy, an internationally recognized organization that certifies cognitive therapists for treating depression, anxiety, and other emotional disorders. In addition, he has written many articles and book chapters in the area of cognitive-behavior therapies. He has made numerous presentations nationally and internationally on new developments in assessment and therapy of emotional disorders. He is coauthor of Overcoming Anxiety For Dummies (Wiley Publishing), Why Can’t I Get What I Want? (Davies-Black, 1998; A Behavioral Science Book Club Selection), Why Can’t I Be the Parent I Want to Be? (New Harbinger Publications, 1999), and Hollow Kids (Prima, 2001).
Drs. Elliott and Smith are available for speaking engagements and workshops. You can visit their Web site at www.PsychAuthors.com. Interested readers also can find a list of background literature relevant to Depression For Dummies at the site.
We dedicate this book to our family: Alli, Brian, Nathan, Sara, and Trevor. And to our parents: William Thomas Smith (1914–1999), Edna Louise Smith, Joe Bond Elliott, and Suzanne Wieder Elliott.
Okay, we broke our promise and wrote another book. We may have to join Authors Anonymous! We thank our family and friends for putting up with our moans and complaints. We send our heartfelt appreciation to the Rodriquez family, especially Melodie and Adriana, who shared their home and table on holidays so we could write until the last second.
Thanks also to our agents, Ed and Elizabeth Knappman, who have supported our writing. We applaud and appreciate the professionalism of our editors at Wiley Publishing; special thanks to Mike Baker, Norm Crampton, Greg Pearson, Jennifer Bingham, Chrissy Guthrie, Esmeralda St. Clair, and Natasha Graf. Thanks to our technical editors, Cory Newman, PhD, and Howard Berger, MD.
We also appreciate Audrey Hite for taking good care of us. And thanks to Scott Love, computer geek extraordinaire, for designing our Web site and keeping our computers up and running. In addition, we thank Diana Montoya-Boyer for keeping us organized, Tracie Antonuk for her optimistic support of our writing, and Karen Villanueva, our personal publicist.
Finally, we’re especially grateful to have been invited into the lives of our many clients over the years. We have profited from what they have taught us about the problems they face. They have provided us with a greater understanding of depression as well as their brave struggle.
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/
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I’m very pleased that Drs. Charles Elliott and Laura Smith have reviewed and distilled the scientific literature on the treatment of depression for the general public. This book is uniquely comprehensive in that it thoroughly covers the scientifically validated treatments for depression, including behavior therapy, medications, interpersonal therapy, and cognitive therapy. The authors have also included promising ideas based on mindfulness and positive psychology. However, they have chosen to emphasize the importance of cognitive therapy because no other therapy has received as much support as cognitive therapy for the treatment of depression.
Thus, Drs. Elliott and Smith have woven important cognitive-therapy principles into their presentation of the other validated approaches to depression. This decision is appropriate, because research has suggested that some of these other therapies may in fact work due in part to the cognitive-therapy strategies embedded within them.
I believe a word about cognitive therapy is in order. In the late 1950s, I began developing cognitive therapy. At the time, I was dissatisfied with the lack of evidence supporting the value of the prevailing psychotherapy — Freudian psychoanalysis — in treating depression. Cognitive therapy quickly became established as a highly effective treatment for depression, a finding that has been verified in numerous subsequent clinical trials. Over the ensuing decades, cognitive therapy has also demonstrated excellent outcomes in the treatment of problems with anger, anxiety, panic disorder, stress, relationship problems, substance abuse, eating disorders, and, most recently, even schizophrenia. To date, no other psychotherapy has demonstrated such consistent effectiveness across a broad swath of problems. Depression For Dummies does a marvelous job of providing readers with the core techniques and principles of cognitive therapy as applied to depression.
I feel it’s important to note that Depression For Dummies isn’t a book for dummies! Rather, this book lays out the principles of cognitive therapy, as well as other validated psychotherapies, in exceptionally clear terms. Drs. Elliott and Smith include fascinating clinical examples and effective exercises within the most reader-friendly, even entertaining, format I’ve seen in a book of this genre. I have no doubt it will prove to be a powerful self-help resource as well as an adjunct to psychotherapy.
I have known Dr. Elliott since the early 1980s, when he was a highly skillful cognitive therapist serving in a major psychotherapy outcome study. I recall last encountering Drs. Elliott and Smith just a few years ago at an international conference on cognitive therapy in Catania, Italy. They presented at this conference as part of their honeymoon. Such dedication to cognitive therapy!
If you struggle with depression, I strongly recommend Depression For Dummies. These authors convey considerable compassion, empathy, and insight in addition to unusual clarity.
Aaron T. Beck, MD
President, The Beck Institute for Cognitive Therapy and Research
Title
Introduction
A Note to Our Depressed Readers
Conventions Used in This Book
About This Book
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Discovering Depression and Preparing a Plan
Chapter 1: Demystifying and Defeating Depression
Just Singing the Blues or Depressed?
The Varying Faces of Depression
Adding Up the Costs of Depression
Feeling Good Again
Feeling Better than Good
Celebrating Sadness
Chapter 2: Detecting Depression
Recognizing the Ravages of Depression
The Six Plagues of Depression
Connecting Drugs, Diseases, and Depression
Good Grief! Is Depression Ever Normal?
Digging Out the Causes of Depression
Monitoring Mood
Chapter 3: Breaking Barriers to Change
Rummaging Through the Reasons for Avoidance
Saving Yourself from Self-Limitations
Chapter 4: Finding Help for Depression
Stumbling onto a Solution
Exploring the Self-Help Option
Pursuing the Psychotherapy Option
Talking to a Professional about Antidepressant Medication
Part II : Untwisting Your Thinking: Thought Therapy
Chapter 5: Discovering Depression- Driven Thinking
Thinking about Cognitive Therapy
Tracking Thoughts, Feelings, and the Related Events in Your Life
Digging Up Distortions in Thinking
Chapter 6: Breaking Up the Dark Clouds of Depressive Thinking
Thought Court Is Now in Session
Opening a Thought-Repair Toolkit
Chapter 7: Discovering the Cracked Lenses Behind Depression
Looking Closely at the Mechanics of Life-Lenses
Searching for Your Mind’s Life-Lenses
Breaking Problematic Life-Lenses
Writing New Prescriptions for Clear Lenses
Chapter 8: Mending Your Memory
Making Sense of Memory
Depressing Disruptions
Worrying About Forgetting
Boosting Broken Memory
Part III : Taking Action Against Depression: Behavior Therapy
Chapter 9: Getting Out of Bed
Taking Action
Putting One Foot in Front of the Other: Activity Logs
Conquering Can’ts
Charting Your Course through Negative Predictions
Giving Yourself Credit
Chapter 10: Working Out to Lift Depression
Introducing Endorphins into Your Life
Conquering Couch Potato-itis
Easing into Exercise
Weighing Your Exercise Options
Chapter 11: Rediscovering Healthy Pleasures
Taking Fun Seriously
Making a List and Checking It Twice
Fighting the Pleasure Busters
Chapter 12: Solving Life’s Headaches
Drawing Up the Problem-Solving Game Plan — S.O.C.C.E.R.
Assessing Your Problem Situation (S)
Foraging for Options (O)
Contemplating Consequences (C)
Choosing Your Poison (C)
Handling Your Emotions (E)
Running and Reviewing (R)
Part IV : Rebuilding Connections: Relationship Therapy
Chapter 13: Working Through Loss, Grief, and Mourning
Losing What You Care About
Working Through Grief
Chapter 14: Relationship Enhancement
The Depression-Rejection Connection
Pursuing Positives
Defeating Defensiveness
Getting Your Message Across
Part V : Fighting the Physical Foe: Biological Therapies
Chapter 15: Prescribing Pleasure
Hammering Depression: Choosing the Right Tool for You
Exploring the Medication Option
Working with Your Doctor to Find the Correct Medication
Brushing Up on Biology
Deciphering Drugs for Depression
Looking Beyond Antidepressants
Chapter 16: Hype, Help, or Hope? Alternative Treatments for Depression
Keeping Your Doc in the Loop
Swallowing Supplements and Herbs
Vibrancy from Vitamins and Minerals
Happy Foods
Lighting Up the Darkness
Treating Severe Depression
Searching Further
Part VI : Looking Beyond Depression
Chapter 17: Reducing the Risk of Relapse
Risking Relapse with Depression
Preparing a Prevention Plan
Reining in Relapse When It Occurs
Chapter 18: Confronting Depression with Mindfulness
Drawing the Line Between You and Your Mind
Losing Your Mind
Living Mindfully
Chapter 19: Pursuing Happiness Through Positive Psychology
Hunting Down Happiness
Getting on the Right Path to Real Happiness
Part VII : The Part of Tens
Chapter 20: Ten Ways Out of a Bad Mood
Chomping on Chocolate
Doing Something Nice
Getting a Lift from Exercise
Singing Yourself into a Better Mood
Calling a Long-Lost Friend
Dancing to a Different Beat
Soaking the Blues Away
Petting Your Way to a Better Mood
Taking a Hike
Mellowing Through Mindfulness
Chapter 21: Ten Ways to Help Kids With Depression
Finding Fun
Doling Out Discipline
Giving Feedback
Climbing Every Mountain
Revving Up Responsibilities
Talking and Listening
Recognizing Depression
Looking Under Rocks
Getting Help
Loving No Matter What
Chapter 22: Ten Ways to Help a Friend or Lover with Depression
Recognizing Depression
Referring for Help
Listening Without Solving
Taking Care of Yourself
Holding Criticism at Bay
Depersonalizing Depression
Finding Patience
Remembering to Care
Providing Encouragement and Remaining Hopeful
Exhorting Exercise
Appendix: Resources for You
Self-Help Books
Resources to Help Children
Helpful Web Sites
D ecadent luxuries, dazzling technology, and startling new knowledge flood the senses and excite the imagination. What was the domain of science fiction less than a generation ago is now commonplace in many living rooms. Today, cable companies beam recently released movies to inches-thick televisions that hang on walls. All you have to do is press a few buttons on your remote control and your home is a cinema. And, with a couple of mouse clicks, you can order a pizza online that arrives in time for the start of the movie.
In the field of healthcare, advancing knowledge of the immune system promises new cancer treatments that go to the source of the disease. Nanotechnology eventually will allow inconceivably small machines to clean out congested arteries like a plumber’s snake. And the human genome project begins to solve the mysteries behind countless inherited diseases.
Truly, life has never been so good and bountiful. What a wonderful time to be alive. Sure, the world still has plenty of problems, but solutions for many of them lie on the horizon.
Yet the World Health Organization paints a less optimistic picture. It estimates that on any given day, 121 million people worldwide suffer from depression. Over the course of a year, almost 6 percent of the world’s men and fewer than 10 percent of the women suffer an episode of depression. Depression rates continue to increase. And most experts believe that the increase is real — not just a result of more people seeking help. Today, kids exhibit depression at nearly ten times the rate of previous generations.
Theories abound concerning the alarming increase in depression today. But regardless of the cause, this scourge robs its victims of happiness, joy, and the capacity to give and receive love.
The good news is that more weapons exist for defeating depression than ever before. Clinicians have devised new psychotherapies that have been verified as effective in treating depression and preventing relapse. Furthermore, science is beginning to understand the delicate relationship between mood and brain chemistry. Medications that target specific chemicals provide important additional tools for the alleviation of depression. The vast majority of people no longer need to suffer with long-standing, intractable depression.
We’re keenly aware of the pain and profound despair you may be experiencing. Likely, your sense of humor is depleted. With this book, we attempt to lighten an exquisitely somber subject with tidbits of humor. Some of you may take offense with our attempts or even feel diminished or discounted by this decision. We can understand that reaction. At the same time, your long-term goals need to include rediscovering laughter. Thus, we hope you can try to take our occasional use of wit in the manner we intend it — as another way to help you lift yourself out of the fog of depression.
In addition, we realize that the title Depression For Dummies may seem offensive to some, especially because when people are depressed, they’re prone to make negative, personalized interpretations (see Part II for more information on this topic). However, we assure you that the content of this book is as serious and in-depth as any book on depression. The For Dummies format simply enables us to present important material in easily digestible segments. We leave it up to you to determine if we succeed in doing so.
In this book, we avoid the use of professional jargon as much as possible. When we occasionally find it necessary to use a technical term, we clearly define that term.
We also include numerous stories to illustrate the information and techniques we present. The people you read about aren’t real; however, they represent composites of the many wonderful people we’ve known and worked with over the years. We bold the name of each character the first time it appears to alert you to the fact that we’re telling a story.
Finally, if you’re reading this book because you want help in defeating your own depression, we recommend that you purchase a spiral notebook. Use that notebook to write out the exercises we present throughout the book. We call these exercises Antidepression Tools and highlight them with an icon. Use your notebook often and reread what you’ve written from time to time.
We have two primary goals in writing this book. First, we want you to understand the nature of depression. Understanding depression makes the idea of dealing with it less frightening. Second, we present what you’re probably most interested in discovering — how to overcome your depression or help someone you love who has depression.
We leave no stone unturned in our quest to bring you every possible means for battling depression. We draw strategies for defeating depression from the fields of medicine and psychotherapy. We tell you about the newest arsenal of medications that can combat depression. We show you how focusing on your overall health with exercise and nutrition can pay off. Plus, we extract elements from the psychotherapeutic approaches that have stood up to the tests of rigorous research and been verified as highly effective treatments for depression. These approaches include
Cognitive therapy
Behavior therapy
Interpersonal and relationship therapy
Then we go one step further. We turn to the new field of positive psychology for ideas on navigating your way from feeling good again to feeling even better. We want you to make your life more joyful and more meaningful.
Depression For Dummies offers you the best advice available based on scientific research. We believe that, if you practice the techniques and strategies we provide in this book, you’ll very likely feel better. For many people, this book may be a complete guide for defeating mild to moderate depression. Numerous studies show that self-help often works.
However, depression frequently needs more care and attention than you can receive through self-help. If your depression significantly hinders your ability to work or play, you need to get professional help. No book can completely replace therapy. Start by seeing your family doctor. If you’re seeing a therapist or counselor, you may find that Depression For Dummies can help augment your therapy. Be sure to discuss that possibility with your therapist. Depression can be conquered; please don’t give up.
Who would want to read this book? We assume, perhaps foolishly, that you or someone you love suffers from depression. We also figure that you want to banish depression from your life. Finally, we imagine that you’re curious about a variety of helpful strategies that can fit your lifestyle and personality. If these descriptions strike a chord, this book is for you.
We organize Depression For Dummies into 7 parts and 22 chapters. Right now, we’re going to tell you a little about each part.
Chapter 1 explores the costs of depression in economic, social, and emotional terms. We describe what depression looks like in various people. Finally, we provide an overview of the best means for treating depression. In Chapter 2, we cover the difference between the various forms of depression. Further-more, we explain the difference between grief and depression. Chapter 3 shows you how to find the motivation for taking charge of your own depression. And Chapter 4 tells you how to find and get professional help.
More studies support the value of thought therapy (cognitive therapy) for the treatment of depression than any other psychotherapy. Part II shows you how certain habitual ways of thinking can be a major contributor to depression. A number of chapters combine to give you a large toolbox of techniques for changing these dark, distorted thoughts into realistic appraisals of yourself, your world, and your future. You can see that this transformation isn’t based on rationalization, chicanery, or self-deception. Rather, you discover how to subject your thoughts to reasoned scrutiny based on logic and evidence.
When you feel overwhelmed by depression, you likely find yourself disengaging from everyday life. You start doing less and less as you put off tackling even slightly disagreeable tasks. Of greater concern, previously enjoyable activities seem dull, bland, and devoid of pleasure. Part III shows you how to short-circuit “do-nothingism” and slowly regain confidence and joy. We give you a mental boost to get moving again through exercise and rediscovering healthy pleasures.
Clinical trials of interpersonal therapy demonstrate the value of addressing the relationship side of depression. Depression has a way of disrupting relationships with friends, family, partners, and other loved ones. And relationship problems can worsen depression. Part IV extracts crucial elements from interpersonal therapy and provides additional ideas for handling relationship difficulties that can increase depression. We cover issues such as communicating in healthy ways and coping with loss and grief.
Pharmaceutical companies have invested billions of dollars into developing a wide range of antidepressant medications. We review these medications, from the earliest to the most recent, and give you important information regarding their effectiveness and side effects. We also give you some tools for helping make the decision as to whether or not medications make sense for you and your depression. We also explore the role of herbs, supplements, and nutrition in alleviating depression and review a few alternative physiologically based treatments for depression, such as light therapy.
We have every reason to believe that the information in the first five parts, perhaps in conjunction with professional help, will lift you out of your depression. But what do you do next? Part VI tells you how to deal with possible relapses in the future. This part tells you how to reduce the likelihood of such slips and how to deal with them if they do occur. Next, we discuss a new approach, called mindful acceptance that has recently been found to be very helpful for reducing depression relapse.
Part VI then turns to the field of positive psychology for ideas on how to further enhance your life. We want you to feel better than good again, so we lay out strategies for enhancing your sense of well-being through a sense of purpose and connectedness.
If you want quick ideas on how to deal with a bad mood, you can find them here. Then we show you ten ways to help your kids if they get depressed. We conclude with ten ways to help a friend or lover over- come depression.
Throughout this book, we use icons in the margins to quickly point out different types of information. Here are the icons you’ll see and a few words about what they mean.
Most books are written so that you have to start on page one and read straight through. But we wrote Depression For Dummies so that you can use the detailed Table of Contents to pick and choose what you want to read based on your individual interests. Don’t worry too much about reading chapters and parts in any particular order. Read whatever chapters apply to your situation. However, we suggest that you at least skim Part I, because it contains a variety of fascinating facts as well as important ideas for getting started.
In addition, the more severe your depression, the more we urge you to start with Chapter 3 and continue with Part III. These chapters contain a variety of ways for overcoming the powerful inertia that keeps severely depressed people from taking actions. After you read those chapters, feel free to continue picking and choosing what you want to read.
In this part . . .
Discover the symptoms of depression and sort out whether you or someone you care about may be depressed. We tell you about the worldwide depression epidemic. And we explain the different forms of depression.
The task of defeating depression presents numerous obstacles. We show you what these roadblocks are and how to deal with them. In this part, we also give you an overview of the various treatments for depression and how to obtain the best possible help.