Coping With Depression Depression could be, well, a depressing subject matter to deal with, over the course of an entire 158-page text. However, by emphasizing positive coping strategies that can be adopted by sufferers of depression and the friends and loved ones of those going through a depressed period in their lives, Coping with Depression by Sharon Carter and Lawrence Clayton. (Hazeldon, 1995), manages to avoid this potential stylistic pitfall. In fact, if anything, it errs on the side of excessive cheerfulness.

Part of the reason the book has such an upbeat tone is because this work is clearly intended for younger, rather than older adults. It attempts to explain the many causes of depression, the different potential courses of treatment for depression (from therapy to chemical remedies), how to personally manage the disease on a daily basis and how to cope if a family member or friend is clinically depressed. Like many youthfully oriented books, it includes the expected, albeit useful quizzes and diagrams. The latter are particularly helpful in delineating the differences between, for instance, major and minor depressive episodes, and manic depression, otherwise known as bipolar disorder, and unipolar depression. The former is characterized by manic high mood swings of great joy, with plummeting lows of great sorrow, while the second ailment, to which the bulk of the text is directed, is a more generalized and abiding sense of sorrow.

The case studies that are included, however, while meant to be interesting, and engaging are not helpful. They have a staged, unreal quality to them and seem to be extrapolated less from life and more from the authors' imaginations. But very often life can provide a more helpful and complex guide than any therapist's imagination of such textbook journeys through depression, however clever the pseudonyms of such supposed case studies and the supposed fact that they are extrapolated from cases in real life. Because of the many contradictions within depression as a mental disease, there are, in life, few true textbook studies of this confusing ailment.

The author Sharon Carter and co-author Lawrence Clayton aim for clarity in their selection of case studies and presentation. But a sense of psychological clarity can be reached with too much simplification, as many clinicians often experience depression as a mental illness that traverses experience, personality and character, and chemical and biological modalities of relation. Added to the confusion, even amongst clinicians, the term depression has been variably used to describe a symptom, a syndrome, as well a mental disease or illness. In other words, depression can be a symptom of a personality disorder, such as a borderline personality disorder, a way of coping with the world, like a syndrome or a reflexive negative way of thinking that is counterproductive to reaching one's life goals, or an illness itself that must be treated with medicine.

Carter and Clayton do a good job for younger or less informed readers in showing that being 'depressed' about getting a poor grade on a test is different from the sense of worthlessness and despair that is unrelenting, and often is expressed in ineffectual, vague and holistic terms like 'I am a bad person,' and 'I can't do anything right.' Everyone has felt "down" or discouraged at some point with their lives. That is simply part of being human -- but to feel so every day, and to feel as if those symptoms will never go away is not normal. In this sense, the book does perform an important teaching function for teens, without being overtly patronizing to individuals whom might not be fully fluent in the terminology of the mental health field.

But the authors still face a considerable challenge, when speaking about depression. First of all, teens are unusually vulnerable to depression, historically at this time in American history, and also chemically as a group. But Carter and Clayton must also tell potentially depressed teen readers they aren't 'normal' like most comforting manuals...

Depression, however common, is still not a normalized state of mental health. The authors must still tell these most hopeless of teens that there is hope for treatment, even when there is considerable controversy within the medical field of psychiatry itself to treat depression like a personality disorder, a chemical imbalance, a genetic deficit in the brain chemical seratonin, or a classical psychological disease of childhood trauma.
What are the facts that most therapists can agree upon? As listed in the current American Psychiatric Association Diagnostic and Statistical Manual (DSM- IIIR), criteria for the diagnosis of depression include: (1) changes in appetite and weight; (2) disturbed sleep; (3) motor agitation or retardation; (4) fatigue and loss of energy; (5) depressed or irritable mood; (6) loss of interest or pleasure in usual activities; (7) feelings of worthlessness, self-reproach, excessive guilt; (8) suicidal thinking or attempts; and (9) difficulty with thinking or concentration. While depression as a term is still used in the broad sense to describe a syndrome that includes a constellation of physiological, affective, and cognitive manifestations, this is how the term is clinically defined as an abnormality, by a consensus of psychiatrists.

Of course, a parent might exclaim -- "irritable mood? Then my kid must be depressed! I must have been depressed all through puberty but I'm fine now!" Actually, there is a substantial genetic component to depression. However, the DSM-IIIR requires the presence of at least five of the symptoms listed above for a diagnosis of major depressive episode, not simply irritable moods or mood swings. Also, major depressive episode, unlike general dysthymia, or a subclinical depression characterized by a general low mood, usually has a clear onset and, with counseling and proper treatment, a clear ending. Major depression has less of the characteristics of a stage of life or a personality flaw or coping mechanism, unlike dysthymia, which is a persistent life condition and may be more due to personality or past experiences.

In contrast, quite often teen's major depressive episodes are triggered by disruptive life episodes, like going away to college, a death, a divorce, or a loss of some kind, rather than a 'mood.' Rather ironically, or intentionally, given the title of the text, depressions often result when someone feels that one cannot cope with a significant loss. A loss of any kind, including a death or simply not being accepted to one's first choice of college can cause a vulnerable teen, with perhaps a more vulnerable and rejection-sensitive set of brain synapses, to feel a loss of control over his or her environment. The person feels that nothing can be done to change unfortunate events in life. Particularly when unrealistic expectations are shattered, such as the idea that 'I thought he or she would always be with me -- we were star-crossed lovers,' or that 'I was always the smartest person in my class, but I'm not, now I'm in college so I must be stupid,' disappointment and a sense of unalterable perceived failure leads to negative thinking which gradually becomes self-defeating.

Because teens are so subject to so many life changes, they are often subject to more life stresses, stresses that impinge upon an already fragile and developing brain chemistry experiencing the transition to adulthood from childhood. As well as identifying depression within one's self, the authors thus also counsel young people how to spot depression in their friends, and they include in laypersons layperson's observations of a potentially depressed individual, such as the emotional symptoms of sadness, anxiety, guilt, anger, mood swings, helplessness, and hopelessness. A depressed friend may angrily lash out at another teen, and this book is at least helpful in assuring teens that they must not take reactions to heart, and see such reactions as symptoms of an illness, rather than get depressed themselves, and take such attacks as personal affront, as a teen may…