Provided by the National Institute of Mental Health
Life is full of emotional ups and downs. But when
the "down" times are long lasting or interfere with your ability to function,
you may be suffering from a common, serious illness—depression. Clinical
depression affects mood, mind, body, and behavior. Research has shown that in
the United States about 19 million people—one in ten adults—experience
depression each year, and nearly two-thirds do not get the help they need.9
Treatment can alleviate the symptoms in over 80 percent of the cases. Yet,
because it often goes unrecognized, depression continues to cause unnecessary
suffering.
Depression is a pervasive and impairing illness that affects both women and men,
but women experience depression at roughly twice the rate of men.1 Researchers
continue to explore how special issues unique to women—biological, life cycle,
and psycho-social-may be associated with women's higher rate of depression.
No two people become depressed in exactly the same way. Many people have only
some of the symptoms, varying in severity and duration. For some, symptoms occur
in time-limited episodes; for others, symptoms can be present for long periods
if no treatment is sought. Having some depressive symptoms does not mean a
person is clinically depressed. For example, it is not unusual for those who
have lost a loved one to feel sad, helpless, and disinterested in regular
activities. Only when these symptoms persist for an unusually long time is there
reason to suspect that grief has become depressive illness. Similarly, living
with the stress of potential layoffs, heavy workloads, or financial or family
problems may cause irritability and "the blues." Up to a point, such feelings
are simply a part of human experience. But when these feelings increase in
duration and intensity and an individual is unable to function as usual, what
seemed a temporary mood may have become a clinical illness.
--------------------------------------------------------------------------------
THE TYPES OF DEPRESSIVE ILLNESS
In major depression, sometimes referred to as unipolar or clinical depression,
people have some or all of the symptoms listed below for at least 2 weeks but
frequently for several months or longer. Episodes of the illness can occur once,
twice, or several times in a lifetime.
In dysthymia, the same symptoms are present though milder and last at least 2
years. People with dysthymia are frequently lacking in zest and enthusiasm for
life, living a joyless and fatigued existence that seems almost a natural
outgrowth of their personalities. They also can experience major depressive
episodes.
Manic-depression, or bipolar disorder, is not nearly as common as other forms of
depressive illness and involves disruptive cycles of depressive symptoms that
alternate with mania. During manic episodes, people may become overly active,
talkative, euphoric, irritable, spend money irresponsibly, and get involved in
sexual misadventures. In some people, a milder form of mania, called hypomania,
alternates with depressive episodes. Unlike other mood disorders, women and men
are equally vulnerable to bipolar disorder; however, women with bipolar disorder
tend to have more episodes of depression and fewer episodes of mania or
hypomania.5
SYMPTOMS OF DEPRESSION AND MANIA
A thorough diagnostic evaluation is needed if three to five or more of the
following symptoms persist for more than 2 weeks (1 week in the case of mania),
or if they interfere with work or family life. An evaluation involves a complete
physical checkup and information gathering on family health history. Not
everyone with depression experiences each of these symptoms. The severity of the
symptoms also varies from person to person.
Depression
Persistent sad, anxious, or "empty" mood
Loss of interest or pleasure in activities, including sex
Restlessness, irritability, or excessive crying
Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
Sleeping too much or too little, early-morning awakening
Appetite and/or weight loss or overeating and weight gain
Decreased energy, fatigue, feeling "slowed down"
Thoughts of death or suicide, or suicide attempts
Difficulty concentrating, remembering, or making decisions
Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
Mania
Abnormally elevated mood
Irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased activity, including sexual activity
Markedly increased energy
Poor judgment that leads to risk-taking behavior
Inappropriate social behavior
CAUSES OF DEPRESSION
Genetic Factors
There is a risk for developing depression when there is a family history of the
illness, indicating that a biological vulnerability may be inherited. The risk
is somewhat higher for those with bipolar disorder. However, not everybody with
a family history develops the illness. In addition, major depression can occur
in people who have had no family members with the illness. This suggests that
additional factors, possibly biochemistry, environmental stressors, and other
psychosocial factors, are involved in the onset of depression.
Biochemical Factors
Evidence indicates that brain biochemistry is a significant factor in depressive
disorders. It is known, for example, that individuals with major depressive
illness typically have dysregulation of certain brain chemicals, called
neurotransmitters. Additionally, sleep patterns, which are biochemically
influenced, are typically different in people with depressive disorders.
Depression can be induced or alleviated with certain medications, and some
hormones have mood-altering properties. What is not yet known is whether the
"biochemical disturbances" of depression are of genetic origin, or are secondary
to stress, trauma, physical illness, or some other environmental condition.
Environmental and Other Stressors
Significant loss, a difficult relationship, financial problems, or a major
change in life pattern have all been cited as contributors to depressive
illness. Sometimes the onset of depression is associated with acute or chronic
physical illness. In addition, some form of substance abuse disorder occurs in
about one-third of people with any type of depressive disorder.7
Other Psychological and Social Factors
Persons with certain characteristics—pessimistic thinking, low self-esteem, a
sense of having little control over life events, and a tendency to worry
excessively—are more likely to develop depression. These attributes may heighten
the effect of stressful events or interfere with taking action to cope with them
or with getting well. Upbringing or sex role expectations may contribute to the
development of these traits. It appears that negative thinking patterns
typically develop in childhood or adolescence. Some experts have suggested that
the traditional upbringing of girls might foster these traits and may be a
factor in women's higher rate of depression.
WOMEN ARE AT GREATER RISK FOR DEPRESSION THAN MEN
Major depression and dysthymia affect twice as many women as men. This
two-to-one ratio exists regardless of racial and ethnic background or economic
status. The same ratio has been reported in 10 other countries all over the
world.12 Men and women have about the same rate of bipolar disorder
(manic-depression), though its course in women typically has more depressive and
fewer manic episodes. Also, a greater number of women have the rapid cycling
form of bipolar disorder, which may be more resistant to standard treatments.5
A variety of factors unique to women's lives are suspected to play a role in
developing depression. Research is focused on understanding these, including:
reproductive, hormonal, genetic or other biological factors; abuse and
oppression; interpersonal factors; and certain psychological and personality
characteristics. And yet, the specific causes of depression in women remain
unclear; many women exposed to these factors do not develop depression. What is
clear is that regardless of the contributing factors, depression is a highly
treatable illness.
THE MANY DIMENSIONS OF DEPRESSION IN WOMEN
Investigators are focusing on the following areas in their study of depression
in women:
The Issues of Adolescence
Before adolescence, there is little difference in the rate of depression in boys
and girls. But between the ages of 11 and 13 there is a precipitous rise in
depression rates for girls. By the age of 15, females are twice as likely to
have experienced a major depressive episode as males.2 This comes at a time in
adolescence when roles and expectations change dramatically. The stresses of
adolescence include forming an identity, emerging sexuality, separating from
parents, and making decisions for the first time, along with other physical,
intellectual, and hormonal changes. These stresses are generally different for
boys and girls, and may be associated more often with depression in females.
Studies show that female high school students have significantly higher rates of
depression, anxiety disorders, eating disorders, and adjustment disorders than
male students, who have higher rates of disruptive behavior disorders.6
Adulthood: Relationships and Work Roles
Stress in general can contribute to depression in persons biologically
vulnerable to the illness. Some have theorized that higher incidence of
depression in women is not due to greater vulnerability, but to the particular
stresses that many women face. These stresses include major responsibilities at
home and work, single parenthood, and caring for children and aging parents. How
these factors may uniquely affect women is not yet fully understood.
For both women and men, rates of major depression are highest among the
separated and divorced, and lowest among the married, while remaining always
higher for women than for men. The quality of a marriage, however, may
contribute significantly to depression. Lack of an intimate, confiding
relationship, as well as overt marital disputes, have been shown to be related
to depression in women. In fact, rates of depression were shown to be highest
among unhappily married women.
Reproductive Events
Women's reproductive events include the menstrual cycle, pregnancy, the
postpregnancy period, infertility, menopause, and sometimes, the decision not to
have children. These events bring fluctuations in mood that for some women
include depression. Researchers have confirmed that hormones have an effect on
the brain chemistry that controls emotions and mood; a specific biological
mechanism explaining hormonal involvement is not known, however.
Many women experience certain behavioral and physical changes associated with
phases of their menstrual cycles. In some women, these changes are severe, occur
regularly, and include depressed feelings, irritability, and other emotional and
physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric
disorder (PMDD), the changes typically begin after ovulation and become
gradually worse until menstruation starts. Scientists are exploring how the
cyclical rise and fall of estrogen and other hormones may affect the brain
chemistry that is associated with depressive illness.10
Postpartum mood changes can range from transient "blues" immediately following
childbirth to an episode of major depression to severe, incapacitating,
psychotic depression. Studies suggest that women who experience major depression
after childbirth very often have had prior depressive episodes even though they
may not have been diagnosed and treated.
Pregnancy (if it is desired) seldom contributes to depression, and having an
abortion does not appear to lead to a higher incidence of depression. Women with
infertility problems may be subject to extreme anxiety or sadness, though it is
unclear if this contributes to a higher rate of depressive illness. In addition,
motherhood may be a time of heightened risk for depression because of the stress
and demands it imposes.
Menopause, in general, is not asssociated with an increased risk of depression.
In fact, while once considered a unique disorder, research has shown that
depressive illness at menopause is no different than at other ages. The women
more vulnerable to change-of-life depression are those with a history of past
depressive episodes.
Specific Cultural Considerations
As for depression in general, the prevalence rate of depression in African
American and Hispanic women remains about twice that of men. There is some
indication, however, that major depression and dysthymia may be diagnosed less
frequently in African American and slightly more frequently in Hispanic than in
Caucasian women. Prevalence information for other racial and ethnic groups is
not definitive.
Possible differences in symptom presentation may affect the way depression is
recognized and diagnosed among minorities. For example, African Americans are
more likely to report somatic symptoms, such as appetite change and body aches
and pains. In addition, people from various cultural backgrounds may view
depressive symptoms in different ways. Such factors should be considered when
working with women from special populations.
Victimization
Studies show that women molested as children are more likely to have clinical
depression at some time in their lives than those with no such history. In
addition, several studies show a higher incidence of depression among women who
have been raped as adolescents or adults. Since far more women than men were
sexually abused as children, these findings are relevant. Women who experience
other commonly occurring forms of abuse, such as physical abuse and sexual
harassment on the job, also may experience higher rates of depression. Abuse may
lead to depression by fostering low self-esteem, a sense of helplessness,
self-blame, and social isolation. There may be biological and environmental risk
factors for depression resulting from growing up in a dysfunctional family. At
present, more research is needed to understand whether victimization is
connected specifically to depression.
Poverty
Women and children represent 75 percent of the U.S. population considered poor.
Low economic status brings with it many stresses, including isolation,
uncertainty, frequent negative events, and poor access to helpful resources.
Sadness and low morale are more common among persons with low incomes and those
lacking social supports. But research has not yet established whether depressive
illnesses are more prevalent among those facing environmental stressors such as
these.
Depression in Later Adulthood
At one time, it was commonly thought that women were particularly vulnerable to
depression when their children left home and they were confronted with "empty
nest syndrome" and experienced a profound loss of purpose and identity. However,
studies show no increase in depressive illness among women at this stage of
life.
As with younger age groups, more elderly women than men suffer from depressive
illness. Similarly, for all age groups, being unmarried (which includes
widowhood) is also a risk factor for depression. Most important, depression
should not be dismissed as a normal consequence of the physical, social, and
economic problems of later life. In fact, studies show that most older people
feel satisfied with their lives.
About 800,000 persons are widowed each year. Most of them are older, female, and
experience varying degrees of depressive symptomatology. Most do not need formal
treatment, but those who are moderately or severely sad appear to benefit from
self-help groups or various psychosocial treatments. However, a third of
widows/widowers do meet criteria for major depressive episode in the first month
after the death, and half of these remain clinically depressed 1 year later.
These depressions respond to standard antidepressant treatments, although
research on when to start treatment or how medications should be combined with
psychosocial treatments is still in its early stages.4,8
DEPRESSION IS A TREATABLE ILLNESS
Even severe depression can be highly responsive to treatment. Indeed, believing
one's condition is "incurable" is often part of the hopelessness that
accompanies serious depression. Such individuals should be provided with the
information about the effectiveness of modern treatments for depression in a way
that acknowledges their likely skepticism about whether treatment will work for
them. As with many illnesses, the earlier treatment begins, the more effective
and the greater the likelihood of preventing serious recurrences. Of course,
treatment will not eliminate life's inevitable stresses and ups and downs. But
it can greatly enhance the ability to manage such challenges and lead to greater
enjoyment of life.
The first step in treatment for depression should be a thorough examination to
rule out any physical illnesses that may cause depressive symptoms. Since
certain medications can cause the same symptoms as depression, the examining
physician should be made aware of any medications being used. If a physical
cause for the depression is not found, a psychological evaluation should be
conducted by the physician or a referral made to a mental health professional.
Types of Treatment for Depression
The most commonly used treatments for depression are antidepressant medication,
psychotherapy, or a combination of the two. Which of these is the right
treatment for any one individual depends on the nature and severity of the
depression and, to some extent, on individual preference. In mild or moderate
depression, one or both of these treatments may be useful, while in severe or
incapacitating depression, medication is generally recommended as a first step
in the treatment.3 In combined treatment, medication can relieve physical
symptoms quickly, while psychotherapy allows the opportunity to learn more
effective ways of handling problems.
Medications
There are several types of antidepressant medications used to treat depressive
disorders. These include newer medications—chiefly the selective serotonin
reuptake inhibitors (SSRIs)—and the tricyclics and monoamine oxidase inhibitors
(MAOIs). The SSRIs—and other newer medications that affect neurotransmitters
such as dopamine or norepinephrine—generally have fewer side effects than
tricyclics. Each acts on different chemical pathways of the human brain related
to moods. Antidepressant medications are not habit-forming. Although some
individuals notice improvement in the first couple of weeks, usually
antidepressant medications must be taken regularly for at least 4 weeks and, in
some cases, as many as 8 weeks, before the full therapeutic effect occurs. To be
effective and to prevent a relapse of the depression, medications must be taken
for about 6 to 12 months, carefully following the doctor's instructions.
Medications must be monitored to ensure the most effective dosage and to
minimize side effects. For those who have had several bouts of depression,
long-term treatment with medication is the most effective means of preventing
recurring episodes.
The prescribing doctor will provide information about possible side effects and,
in the case of MAOIs, dietary and medication restrictions. In addition, other
prescribed and over-the-counter medications or dietary supplements being used
should be reviewed because some can interact negatively with antidepressant
medication. There may be restrictions during pregnancy.
For bipolar disorder, the treatment of choice for many years has been lithium,
as it can be effective in smoothing out the mood swings common to this disorder.
Its use must be carefully monitored, as the range between an effective dose and
a toxic one can be relatively small. However, lithium may not be recommended if
a person has pre-existing thyroid, kidney, or heart disorders or epilepsy.
Fortunately, other medications have been found helpful in controlling mood
swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol®)
and valproate (Depakote®). Both of these medications have gained wide acceptance
in clinical practice, and valproate has been approved by the Food and Drug
Administration for first-line treatment of acute mania. Studies conducted in
Finland in patients with epilepsy indicate that valproate may increase
testosterone levels in teenage girls and produce polycystic ovary syndrome in
women who began taking the medication before age 20.11 Therefore, young female
patients should be monitored carefully by a physician. Other anticonvulsants
that are being used now include lamotrigine (Lamictal®) and gabapentin (Neurontin®);
their role in the treatment hierarchy of bipolar disorder remains under study.
Most people who have bipolar disorder take more than one medication. Along with
lithium and/or an anticonvulsant, they often take a medication for accompanying
agitation, anxiety, insomnia, or depression. Some research indicates that an
antidepressant, when taken without a mood stabilizing medication, can increase
the risk of switching into mania or hypomania, or of developing rapid cycling,
in people with bipolar disorder. Finding the best possible combination of these
medications is of utmost importance to the patient and requires close monitoring
by the physician.
Herbal Therapy
In the past few years, much interest has risen in the use of herbs in the
treatment of both depression and anxiety. St. John's wort (Hypericum perforatum),
an herb used extensively in the treatment of mild to moderate depression in
Europe, has recently aroused interest in the United States. St. John's wort, an
attractive bushy, low-growing plant covered with yellow flowers in summer, has
been used for centuries in many folk and herbal remedies. Today in Germany,
Hypericum is used in the treatment of depression more than any other
antidepressant. However, the scientific studies that have been conducted on its
use have been short-term and have used several different doses.
Because of the widespread interest in St. John's wort, the National Institutes
of Health (NIH) is conducting a 3-year study, sponsored by three NIH
components—the National Institute of Mental Health, the National Institute for
Complementary and Alternative Medicine, and the Office of Dietary Supplements.
The study is designed to include 336 patients with major depression, randomly
assigned to an 8-week trial with one-third of patients receiving a uniform dose
of St. John's wort, another third an SSRI commonly prescribed for depression,
and the final third a placebo (a pill that looks exactly like the SSRI and the
St. John's wort, but has no active ingredients). The study participants who
respond positively will be followed for an additional 18 weeks. After the 3-year
study has been completed, results will be analyzed and published.
The Food and Drug Administration issued a Public Health Advisory on February 10,
2000. It stated that St. John's wort appears to affect an important metabolic
pathway that is used by many drugs prescribed to treat conditions such as heart
disease, depression, seizures, certain cancers, and rejection of transplants.
Therefore, health care providers should alert their patients about these
potential drug interactions. Any herbal supplement should be taken only after
consultation with the doctor or other health care provider.
Psychotherapy
In mild to moderate cases of depression, psychotherapy is also a treatment
option. Some short-term (10 to 20 week) therapies have been very effective in
several types of depression. "Talking" therapies help patients gain insight into
and resolve their problems through verbal give-and-take with the therapist.
"Behavioral" therapies help patients learn new behaviors that lead to more
satisfaction in life and "unlearn" counter-productive behaviors. Research has
shown that two short-term psychotherapies, interpersonal and
cognitive-behavioral, are helpful for some forms of depression. Interpersonal
therapy works to change interpersonal relationships that cause or exacerbate
depression. Cognitive-behavioral therapy helps change negative styles of
thinking and behaving that may contribute to the depression.
Electroconvulsive Therapy
For individuals whose depression is severe or life threatening or for those who
cannot take antidepressant medication, electroconvulsive therapy (ECT) is
useful.3 This is particularly true for those with extreme suicide risk, severe
agitation, psychotic thinking, severe weight loss or physical debilitation as a
result of physical illness. Over the years, ECT has been much improved. A muscle
relaxant is given before treatment, which is done under brief anesthesia.
Electrodes are placed at precise locations on the head to deliver electrical
impulses. The stimulation causes a brief (about 30 seconds) seizure within the
brain. The person receiving ECT does not consciously experience the electrical
stimulus. At least several sessions of ECT, usually given at the rate of three
per week, are required for full therapeutic benefit.
Treating Recurrent Depression
Even when treatment is successful, depression may recur. Studies indicate that
certain treatment strategies are very useful in this instance. Continuation of
antidepressant medication at the same dose that successfully treated the acute
episode can often prevent recurrence. Monthly interpersonal psychotherapy can
lengthen the time between episodes in patients not taking medication.
THE PATH TO HEALING
Reaping the benefits of treatment begins by recognizing the signs of depression.
The next step is to be evaluated by a qualified professional. Although
depression can be diagnosed and treated by primary care physicians, often the
physician will refer the patient to a psychiatrist, psychologist, clinical
social worker, or other mental health professional. Treatment is a partnership
between the patient and the health care provider. An informed consumer knows her
treatment options and discusses concerns with her provider as they arise.
If there are no positive results after 2 to 3 months of treatment, or if
symptoms worsen, discuss another treatment approach with the provider. Getting a
second opinion from another health or mental health professional may also be in
order.
Here, again, are the steps to healing:
Check your symptoms against the list on page 3.
Talk to a health or mental health professional.
Choose a treatment professional and a treatment approach with which you feel
comfortable.
Consider yourself a partner in treatment and be an informed consumer.
If you are not comfortable or satisfied after 2 to 3 months, discuss this with
your provider. Different or additional treatment may be recommended.
If you experience a recurrence, remember what you know about coping with
depression and don't shy away from seeking help again. In fact, the sooner a
recurrence is treated, the shorter its duration will be.
Depressive illnesses make you feel exhausted, worthless, helpless, and hopeless.
Such feelings make some people want to give up. It is important to realize that
these negative feelings are part of the depression and will fade as treatment
begins to take effect.
Along with professional treatment, there are other things you can do to help
yourself get better. Some people find participating in support groups very
helpful. It may also help to spend some time with other people and to
participate in activities that make you feel better, such as mild exercise or
yoga. Just don't expect too much from yourself right away. Feeling better takes
time.
WHERE TO GET HELP
If unsure where to go for help, ask your family doctor, OB/GYN physician, or
health clinic for assistance. You can also check the Yellow Pages under "mental
health," "health," "social services," "suicide prevention," "crisis intervention
services," "hotlines," "hospitals," or "physicians" for phone numbers and
addresses. In times of crisis, the emergency room doctor at a hospital may be
able to provide temporary help for an emotional problem and will be able to tell
you where and how to get further help.
Listed below are the types of people and places that will make a referral to, or
provide, diagnostic and treatment services.
Family doctors
Mental health specialists such as psychiatrists, psychologists, social workers,
or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Family service/social agencies
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies
FURTHER INFORMATION
National Institute of Mental Health
Information Resources and Inquiries Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Telephone: 1-301-443-4513
FAX: 1-301-443-4279
TTY: 1-301-443-8431
FAX4U: 1-301-443-5158
Website: http://www.nimh.nih.gov
E-mail: nimhinfo@nih.gov
Visit the following links for information on organizations that focus on
depression, women's mental health, and mental disorders in general.
REFERENCES
1 Blehar MC, Oren DA. Gender differences in depression. Medscape Women's Health,
1997;2:3. Revised from: Women's increased vulnerability to mood disorders:
Integrating psychobiology and epidemiology. Depression, 1995;3:3-12.
2 Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of the gender
difference in lifetime rates of major depression. Archives of General
Psychiatry, 2000; 57:21-27.
3 Frank E, Karp JF, and Rush AJ. Efficacy of treatments for major depression.
Psychopharmacology Bulletin, 1993;29:457-75.
4 Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce ML,
Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, and Parmelee
P. Diagnosis and treatment of depression in late life: Consensus statement
update. Journal of the American Medical Association, 1997;278:1186-90.
5 Leibenluft E. Issues in the treatment of women with bipolar illness. Journal
of Clinical Psychiatry (supplement 15), 1997;58:5-11.
6 Lewisohn PM, Hyman H, Roberts RE, Seeley JR, and Andrews JA. Adolescent
psychopathology: 1. Prevalence and incidence of depression and other DSM-III-R
disorders in high school students. Journal of Abnormal Psychology,
1993;102:133-44.
7 Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, and Goodwin FK.
Comorbidity of mental disorders with alcohol and other drug abuse: Results from
the epidemiologic catchment area (ECA) study. Journal of the American Medical
Association, 1993;264:2511-8.
8 Reynolds CF, Miller MD, Pasternak RE, Frank E, Perel JM, Cornes C, Houck PR,
Mazumdar S, Dew MA, and Kupfer DJ. Treatment of bereavement-related major
depressive episodes in later life: A controlled study of acute and continuation
treatment with nortriptyline and interpersonal psychotherapy. American Journal
of Psychiatry, 1999;156:202-8.
9 Robins LN and Regier DA (Eds). Psychiatric Disorders in America, The
Epidemiologic Catchment Area Study. New York: The Free Press, 1990.
10 Rubinow DR, Schmidt PJ, and Roca CA. Estrogen-serotonin interactions:
Implications for affective regulation. Biological Psychiatry, 1998;44(9):839-50.
11 Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P,
Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced hyperandrogenism during
pubertal maturation in girls with epilepsy. Annals of Neurology,
1999;45(4):444-50.
12 Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR,
Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubin-Stiper M, Wells JE,
Wickramaratne PJ, Wittchen H, and Yeh EK. Cross-national epidemiology of major
depression and bipolar disorder. Journal of the American Medical Association,
1996;276:293-9.
HELPFUL BOOKS
Many books have been written on major depression and bipolar disorder. The
following are a few that may help you understand these illnesses better.
Andreasen, Nancy. The Broken Brain: The Biological Revolution in Psychiatry. New
York: Harper & Row, 1984.
Carter, Rosalyn. Helping Someone With Mental Illness: A Compassionate Guide for
Family, Friends and Caregivers. New York: Times Books, 1998.
Duke, Patty and Turan, Kenneth. Call Me Anna, The Autobiography of Patty Duke.
New York: Bantam Books, 1987.
Dumquah, Meri Nana-Ama. Willow Weep for Me, A Black Woman's Journey Through
Depression: A Memoir. New York: W.W. Norton & Co., Inc., 1998.
Fieve, Ronald R. Moodswing. New York: Bantam Books, 1997.
Jamison, Kay Redfield. An Unquiet Mind, A Memoir of Moods and Madness. New York:
Random House, 1996.
The following three booklets are available from the Madison Institute of
Medicine, 7617 Mineral Point Road, Suite 300, Madison, WI 53717, telephone
1-608-827-2470:
Tunali D, Jefferson JW, and Greist JH, Depression & Antidepressants: A Guide,
rev. ed. 1997.
Jefferson JW and Greist JH. Divalproex and Manic Depression: A Guide, 1996
(formerly Valproate guide).
Bohn J and Jefferson JW. Lithium and Manic Depression: A Guide, rev. ed. 1996.
--------------------------------------------------------------------------------
Depression: What Every Woman Should Know was originally developed for the
Depression Awareness, Recognition, and Treatment (D/ART) program. The brochure
has been revised by Margaret Strock, staff member in the Information Resources
and Inquiries Branch, Office of Communications and Public Liaison, National
Institute of Mental Health (NIMH). Expert assistance was provided by Mary Blehar,
Ph.D., Matthew Rudorfer, M.D., Melissa Spearing, and Clarissa Wittenberg, NIMH
staff members, and by Ellen Frank, M.D., Western Psychiatric Institute,
University of Pittsburgh Medical Center. Their help in assuring the accuracy of
this brochure is gratefully acknowledged. Editorial assistance was provided by
Lisa Alberts, NIMH staff member.
All material in this publication is free of copyright restrictions and may be
copied, reproduced, or duplicated without permission from NIMH; citation of the
source is appreciated.
For more information on research into the brain, behavior, and mental disorders
contact:
National Institute of Mental Health
Information Resources and Inquiries Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, Maryland 20892-9663
Telephone: 1-301-443-4513
TTY: 1-301-443-8431
FAX: 1-301-443-4279
Mental Health FAX 4U 1-301-443-5158
E-mail: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov
NIH Publication No. 00-4779
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