Raising an Optimistic Child: A Proven Plan for Depresion-Proofing Young Children--for Life
(McGraw-Hill, 2006) by Bob Murray and Alicia Fortinberry

Creating Optimism:
A Proven Seven-Step Program for Overcoming Depression
(McGraw-Hill, 2004) by Bob Murray and Alicia Fortinberry

By Bob Murray, PhD and Alicia Fortinberry, MS

Updated January 15, 2005

Depression is one of the greatest problems and killers of our time. Here we list the latest depression statistics, reveal surprising facts about underlying depression causes, the failure of standard treatments, and what works for depression in the long-term.

• Depression Statistics
• Why Standard Treatments are Inadequate
• Depression Causes
• Depression and Illness
• Effective Depression Recovery
• References and Further Reading

Depression Statistics

• Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. This includes major depressive disorder, dysthymic disorder, and bipolar disorder. [1]

• Everyone, will at some time in their life be affected by depression -- their own or someone else's, according to Australian Government statistics. (Depression statistics in Australia are comparable to those of the US and UK.) [2]

• Pre-schoolers are the fastest-growing market for antidepressants. At least four percent of preschoolers -- over a million -- are clinically depressed. [3]
  
  [Pill-Popping Pre-Schoolers | Even Toddlers Get the Blues]

• The rate of increase of depression among children is an astounding 23% p.a. [4]

• 15% of the population of most developed countries suffers severe depression. [5]

• 30% of women are depressed. Men's figures were previously thought to be half that of women, but new estimates are higher. [6]

• 54% of people believe depression is a personal weakness. [7]

• 41% of depressed women are too embarrassed to seek help. [8]

• 80% of depressed people are not currently having any treatment. [9]

• 92% of depressed African-American males do not seek treatment. [10]

• 15% of depressed people will commit suicide. [11]

• Depression will be the second largest killer after heart disease by 2020 -- and studies show depression is a contributory factor to fatal coronary disease. [12]
  
  [Depression Link to Heart Disease | Hostility, Depression May Boost Heart Disease]

• Depression results in more absenteeism than almost any other physical disorder and costs employers more than US$51 billion per year in absenteeism and lost productivity, not including high medical and pharmaceutical bills. [13]

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Standard Treatments Inadequate

• Antidepressants work for 35 to 45% of the depressed population, while more recent figures suggest as low as 30%. [14]

• Standard antipressants, SSRIs such as Prozac, Paxil (Aropax) and Zoloft, have recently been revealed to have serious risks, and are linked to suicide, violence, psychosis, abnormal bleeding and brain tumors. [15]
  
  [The Antidepressant Storm Rages On: Ely Lily Knew of Prozac Risk | Antidepressants May Increase Risk of Abnormal Bleeding]

• Government (FDA) warnings highlight concerns over the efficacy and use of antidepressants in children. Antidepressants with the exception of Prozac have been banned in Britain for children. The BMJ recently reported they found no scientific evidence whatsoever that SSRIs work for preschoolers (or for anyone under eighteen). [16]

• Antidepressants (particularly SSRIs) work only as well (or less) than placebos. [17]
  
  [Antidepressants Versus Placebos: Meaningful Advantages Are Lacking | Placebos as Good as Antidepressants]

• Cognitive behavioral therapy (CBT) has an 80% relapse rate in the long term. [18]

• Most doctors advise a combination of therapy and antidepressants.

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Causes of Depression

• Short-term (exogenous) depression can be caused by loss or extreme trauma.

• Chronic or life-long (endogenous) depression is caused by trauma in childhood which includes: emotional, physical or sexual abuse; yelling or threats of abuse; neglect (even two parents working); criticism; inappropriate or unclear expectations; maternal separation; conflict in the family; divorce; family addiction; violence in the family, neighborhood or TV; racism and poverty. [19]
  
  [Stress and Trauma Increase Risk of Depressive Disorders]

• There may be a genetic basis to some depression, but even if there is that genetic propensity must be triggered by some traumatic or stressful event.
  
  [Depression and Genetics Shortens Life-span | Maternal Deprivation Triggers Manic Depression]

• The problem is structural more than chemical, although the latter is affected.

• Trauma prevents certain parts of the brain (hippocampus and frontal lobe, where decisions are made) from developing properly. [20]
  
  [Smaller Hippocampal Volume Predicts Vulnerability to Psychological Trauma]

• Certain neurochemicals are also involved, such as a surplus of noradrenaline, perhaps as a result of the structural problem. Recent studies indicate that serotonin, which is targeted by most antidepressants (SSRIs), is not as much a factor in depression as the long-term presence of stress hormone cortisol. [21]
  
  [Myths of Depression Challenged]

• Physiological problems, plus learned beliefs and behaviors, make functional decisions difficult, and the results reinforce the depression in a vicious cycle.
  
  [Abused Kids See Emotion Differently]

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Depression and Illness

• Depression can “somatize,” or become expressed in the body. [22]

• 80% of people who see physicians are depressed. [23]
  
  [Depression Lowers Immunity | Depression and Illness]

• Studies are increasingly linking more illnesses to depression, including: osteoporosis, diabetes, heart disease, some forms of cancer, eye disease and back pain. [24]
  
  [Pain Common Side Effect of Depression | Back Pain and Depression Link Confirms Mind-Body Connection | Obesity, Depression Team up to Increase Heart-endangering Inflammation | Depression May Cause Diabetes | Breast Cancer, Depression and PTSD]

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Effective Depression Recovery

We believe that long-term recovery from depression ultimately requires addressing the underlying relationship causes of depression, not simply symptoms such as chemical imbalance and depressive thoughts. This is why healing both the relationship environment and the whole person is vital in preventing relapse. (The Uplift Program has a 94% success rate, according to follow-up questionnaires up to 2 years later.)

• Good relationships: studies show that relationships with partners, carers, teachers, co-workers and a supportive social network results in physical and emotional healing, happiness and life satisfaction, and prevents isolation and loneliness, major factors in depressive illness. [25]
  
  [Caring Relationships Crucial to Healing | If Richer Isn't Happier, What Is? | Happiness Is...]

• Understanding the real causes of depression so that people don't feel inadequate for not having been cured. [26]

• Learning how to create relationships that meet needs not met in childhood. [27]

• Identifying emotional, cognitive, relationship and neuromuscular patterns and learning concrete tools to change these, including many CBT techniques.

• A safe, supportive and non-judgemental group environment.

• A good relationship with a therapist or physician.
  
  [Therapy Can Change Brain Neurobiology | Couples Therapy Beats Antidepressants]

• Techniques to boost self-esteem and a sense of competence.

• Feldenkrais or Repatterning Movements (RPMs) that promote immediate improvements in wellbeing and effective movement while stimulating the brain to learn to form new connections on the basis of function instead of habit. [28]

• Moderate and even gentle exercise such as a brief walk. [29] Feldenkrais-type movements also help ease chronic pain often associated with depression and enable people to learn more functional, efficient and pleasurable ways of walking.
  
  [Better Mood a Short Walk Away | Why Exercise Cheers You Up]

• Meditation, prayer and relaxation exercises such as yoga or our own Meditations in Movement. [30]
  
  [Buddhists are Happier | Saying the Rosary is Good for Health]

• Fostering spiritual beliefs and a sense of purpose and sharing them with others. [31]
  
  [Faith, Social Ties "Protective" | Spiritual Belief Helps Grieving Process | Spiritual Beliefs Ward Off Depression]

• Spending time in nature and with pets. Even a potted plant or view from your office will help. [32]
  
  [Natural Scenes Calm Drivers | Dr Rex to the Rescue]

• Experiencing an ongoing environment that is free from trauma and very supportive so that the body and the brain can heal and develop.

Note that it is important to consult a healthcare practitioner or physican and never come off antidepressants without their advice.

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RELATED LINKS

• Article: Depression, a Social Problem with a Relationship Solution
• Article: Healing Depression Safely Without Antidepressants
• Self Help Tips: How to Survive Depression One Day at a Time
• Self Help Tips: 9 Rules for Living with a Depressed Person
• Self Help Program: Beat Depression CD Set
• Book: Creating Optimism: A Proven, 7-Step Program for Overcoming Depression

Check our event schedule for workshops and seminars.

References and Further Reading

[1] NIMH. “The Numbers Count: Mental Illness in America,” Science on Our Minds Fact Sheet Series.

[2] Australian Institute of Health and Welfare, 1998. “National Health Priority Areas Mental Health: A Report Focusing on Depression.” Depression statistics in Australia are comparable to those of the US and UK.

[3] Study published in Psychiatric Services, April 2004. Reported in our health news archive: Pill-Popping Pre-Schoolers, Even Toddlers Get the Blues

[4] Harvard University study reported in Harvard Mental Health Newsletter, February 2002.

[5] World Health Organization (WHO) report quoted in BBC-Online January 9, 2001.

[6] National Institute of Mental Health (NIMH). “The Numbers Count: Mental Illness in America,” Science on Our Minds Fact Sheet Series.

[7] National Mental Health Association (NMHA) study reported in MSNBC Health Today, March 10, 2004.

[8] NMHA Survey, 1996. NMHA factsheet on women and depression.

[9] “National Healthcare Quality Report”, 2003.

[10] D F Bailey, and J L Moore, III. “Emotional Isolation, Depression, and Suicide Among African American Men: Reasons for Concern.” In C Rubin (Ed), Linking Lives Across Borders: Gender-Sensitive Practice in International Perspective, (Pacific Grove, CA Books/Cole).

[11] Agency for Healthcare Research and Quality, 2003. “National Healthcare Quality Report.” This is a widely quoted statistic, though some experts such as Dr Christopher L Summerville, Executive Director of the Manitoba Schizophrenia Society, member of the Board of Directors of Mood Disorders of Canada, have cited higher figures.

[12] WHO report on mental illness released October 4, 2001. Health news stories: Depression Link to Heart Disease, Hostility, Depression May Boost Heart Disease

[13] According to a 2004 Rand Corporation report.

[14] Newer figures are lower but this figure was reported in the NY Times article Antidepressants Lift Clouds, But Lose 'Miracle Drug' Label, June 30, 2002. Also C Bruce Baker, MD, “Quantitative Analysis of Sponsorship Bias in Economic Studies of Antidepressants,” The British Journal of Psychiatry 2003, 183: 498-506.

[15] S. Vedantam. “FDA Links Antidepressants, Youth Suicide Risk.” Washington Post, 23 February, 2004, page A01. W. Meijer, et al. “Association of Risk of Abnormal Bleeding with Degree of Serotonin Reuptake Inhibition by Antidepressants,” Archives of Internal Medicine 2004, 164:2367-2370. Health news story: Antidepressants May Increase Risk of Abnormal Bleeding.

[16] J. Jureidini, et al. “Efficacy and Safety of Antidepressants for Children and Adolescents,” British Medical Journal 2004, 328:879-883. Health news story: The Antidepressant Storm Rages On: Ely Lily Knew of Prozac Risk.

[17] B Timothy Walsh, et al., “Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing,” JAMA, Apr 2002, 287:1840-1847. Irving Kirsch, Ph.D., and David Antonuccio, Ph.D. “Antidepressants Versus Placebos: Meaningful Advantages Are Lacking,” Psychiatric Times 2004, 19:9. Also see Burns et al., “Rumble in Reno: The Psychosocial Perspective on Depression,”. Health news stories: Antidepressants Versus Placebos: Meaningful Advantages Are Lacking, Placebos as Good as Antidepressants.

[18] Jackie Gollan, University of Washington, report presented to the Association For the Advancement of Behavior Therapy, December 1999.

[19] Virtually every recent study has linked depression to childhood trauma and abuse including Deborah Lott, “Childhood Trauma, CRF Hypersecretion and Depression,” Psychiatric Times, October 1999, 16:(10); Danya Glaser, “Child Abuse and Neglect and the Brain,” J Child Psychol. & Psychiat. 2000, 41:1:97-116; L Rowell Huesmann, et al., University of Michigan, “Longitudinal Relations Between Children's Exposure to TV Violence and Their Aggressive and Violent Behavior in Young Adulthood: 1977 - 1992,” Developmental Psychology, 39:2. An up-to-date definition of what constitutes childhood abuse can be found in the American Academy of Pediatrics report, “The Psychological Maltreatment of Children,” April 2, 2002. Health news stories: Stress and Trauma Increase Risk of Depressive and Anxiety Disorders, Maternal Deprivation Triggers Manic Depression.

[20] Studies include Meena Vythilingam, “Childhood Trauma Associated With Smaller Hippocampal Volume in Women With Major Depression,” American Journal of Psychiatry, 2002, 159:2072-2080, see Smaller Hippocampal Volume Predicts Vulnerability to Psychological Trauma. J D Connolly et al., “Human fMRI Evidence for the Neural Correlates of Preparatory Set,” Nature Neuroscience, 2002, 5:1345-1352. Also Daniel Amen, MD, “Why Don't Psychiatrists Look at the Brain,” Neuropsychiatry Review, February 2001, 2:1.

[21] David Burns et al., “Rumble in Reno: The Psychosocial Perspective on Depression,” Psychiatric Times, 2000, 17(8). Health news story: Myths of Depression Challenged.

[22] Widely known, but see Prof Steven Dubovsky, Mind Body Deceptions (New York, Norton & Co, 1997).

[23] J I Escobar et al, “Somatization in the Community,” Archives of General Psychiatry (1987) 44:713-718; and Z J Lipowski, “Somatization: Medicine's Unsolved Problem,” Psychosomatics, 1987, 28:294-297. More recent studies have come to the same broad conclusions. See A J Barsky, “Somatization and Medicalization in the Era of Managed Care,” Journal of the American Medical Association (JAMA), 1995, 274:1931-1934. Health news stories: Depression Lowers Immunity, Depression and Illness

[24] For diabetes: “Depression in Adults With Diabetes” by Patrick J Lustman, PhD, and Ryan Anderson, Psychiatric Times, January 2002, 19:1, see Depression May Cause Diabetes; for vision loss: see article in Ophthalmology by Stuart I Brown MD, chairman of UCSD's Department of Ophthalmology; for heart disease: many, including “Treating the Patient as a Whole Person” by Elizabeth Fried Ellen, LICSW, Psychiatric Times, June 2001, 17:6; Julia Hippisley Cox et al, “Depression as a Risk Factor for Ischaemic Heart Disease in Men,” British Medical Journal (BMJ), 1998, 316:1714-1719, also Prof Michael Frenneaux, University of Wales College of Medicine study for the British Heart Foundation, see Depression Link to Heart Disease and Hostility, Depression May Boost Heart Disease; for breast & prostate cancer: study by Joseph Gallo, Johns Hopkins School of Public Health, “Major Depression and Cancer,” Cancer Causes and Control, September 2000, 11:8, see Breast Cancer, Depression and PTSD.

[25] Numerous studies support our assertion that good relationships are the most important healing mechanism in mood disorders. See Roy F Baumeister, and Mark R Leary, “The Need to Belong: Desire for Interpersonal Attachments as a Fundamental Human Motivation,” Psychological Bulletin, 1995, 117(3)497-529. Press release: Caring Relationships Crucial to Healing. For relationships as factors in happiness and life satisfaction see our health news stories If Richer Isn't Happier, What Is?, Happiness Is....

[26] See T Stompe et al., “Guilt and Depression: A Cross-Cultural Comparative Study,” Psychopathology, 2001, 34(6):289-98.

[27] For a thorough overview of our theory of “needs-based” relationships see our book Creating Optimism: A Proven, 7-Step Program for Overcoming Depression, (New York, McGraw-Hill, 2004). See Abraham Maslow for other theories of need.

[28] Alicia Fortinberry has applied the work of Moshe Feldenkrais to develop Repatterning Movements (RPMs), which address emotional patterns and help heal depression.

[29] For example J Blumenthal et al., "Effects of Exercise Training on Older Patients With Major Depression," Archives of Internal Medicine 1999, 159:2349-2356. In a follow-up study carried out 6 months later the team found that walkers relapsed far less than those only on antidepressants. Health news stories: Better Mood a Short Walk Away, Why Exercise Cheers You Up.

[30] For example Owen Flanagan, “The Colour of Happiness,” New Scientist May 2003, 178(2396):44. See Buddhists are Happier, Saying the Rosary is Good for Health.

[31] For example Bridget Murray, “Getting to the Essential 'We' in Wellness,” Monitor on Psychology, November 2002, 33(10). More specifically H G Koenig, et al., “Modeling the Cross-Sectional Relationships Between Religion, Physical Health, Social Support, and Depressive Symptoms,” American Journal of Geriatric Psychiatry, (1997) 5:131-143. Health news stories: Faith, Social Ties "Protective", Spiritual Belief Helps Grieving Process, Spiritual Beliefs Ward Off Depression.

[32] For example Rebecca Clay, “Green is Good for You,” Monitor on Psychology, 2001, 32(4). And Sandra B Barker, “Therapeutic Aspects of the Human-Companion Animal Interaction,” Psychiatric Times, 1999, 16(2). Health news stories: Natural Scenes Calm Drivers, Dr Rex to the Rescue.

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About the Authors

Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Alicia Fortinberry is a psychotherapist, health writer and executive coach. Together they are the founders of the highly successful Uplift Program, and authors of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).

Disclaimer: The diagnosis and treatment of medical or psychiatric disorders requires trained professionals. The information provided in this article is for educational purposes only. It should NOT be used as a substitute for seeking professional help.