DEPRESSIONthe effectiveness of such alternative medicine. For
example, a group of researchers in Texas, in col-
laboration with German scientists, surveyed stud-
ies including a total of 1,757 outpatients with
mainly mild or moderately severe depressive dis-
orders, and found that extracts of St. John’s wort
were more effective than placebos (i.e., inactive
pills) and as effective as standard antidepressant
medication in the treatment of depression. They
also had fewer side effects than standard antide-
pressant drugs (Linde et al. 1996).
In extreme cases of depression when drugs
have been tried and found to not have an effect,
and when the patient does not have the time to
wait for drugs to take an effect (sometimes up to
two or three weeks), electroconvulsive therapy
(ECT) is recommended. ECT involves passing a
current of between 70 and 130 volts through the
patient’s head after the administration of an anes-
thetic and muscle relaxant (to prevent injury from
the convulsion caused by the charge). ECT is
effective in treating severe depression although
the exact mechanisms by which it works have not
been determined.
Cognitive treatments. Cognitive therapists fo-
cus on the thoughts of the depressed person and
attempt to break the cycle of negative automatic
thoughts and negative self-views. Therapy sessions
are well structured and begin with a discussion of
an agenda for the session, where a list of items is
drawn up and then discussed one by one. The
therapist then tries to identify, understand, and
clarify the misinterpretations and unrealistic ex-
pectations held by the client. Therapists use sever-
al techniques to identify these thoughts including
asking direct questions, asking the client to use
imagery to evoke the thoughts, or role-playing.
Identifying these thoughts is a critical part of
cognitive therapy and clients are also asked to
keep daily diaries to list automatic thoughts when
they occur as they are often unnoticed by de-
pressed individuals. The client is then asked to
provide a written summary of the major conclu-
sions from the session to solidify what has been
achieved and finally, the therapist prescribes a
‘‘homework assignment’’ designed to help the cli-
ent practice skills and behaviors worked on during
the session. Behavioral therapy is closely related to
cognitive therapy and involves training the client
to have better social skills and behaviors that en-
able them to develop better relationships with others.
Which are more effective treatments: cogni-
tive or biological? A large National Institute of
Mental Health study suggests that there is little
difference in the effectiveness of the two therapies
although the two treatments seem to produce
different effects over time. Patients who received
cognitive therapy were less likely to have a return
of depression over time as compared to patients
with biological therapy, although the small sample
size used in this study precludes a definite answer
to this question. Both therapies have been found
to be effective, and it is likely that one is better with
some forms of depression than the other, depend-
ing on how long the person has been depressed
and the exact nature of his or her symptoms. In
general both treatments, whether cognitive or bio-
logical, are recommended to be continued for a
short time after the depressed episode has ended
in order to prevent relapse.CONCOMITANTSA wide body of research has documented the links
between depression and a wide variety of other
factors. It is both a component of many other
psychological disorders as well as something that
follows many other disorders. In fact, some studies
have shown that out of all the people at a given
time with depression, only 44 percent of them
display what can be called ‘‘pure’’ depression,
whereas the others have depression and at least
one other disorder or problem. The most com-
mon of these associated problems are anxiety,
substance abuse, alcoholism, and eating disorders
(see Hammen 1997 for more details). Given the
symptoms of depression, individuals with the dis-
order also experience associated social problems
including strained relationships with spouses, fami-
ly, and friends, and in the workplace. Most alarm-
ing perhaps is that the children of depressed par-
ents (especially mothers) are especially at risk for
developing problems of their own.Depression has also been linked to positive
factors although not always with good results. For
example, there is some evidence that depression is
linked to creativity. Artists tend to suffer more
than their share of depression according to psy-
chiatrists at Harvard medical school, who charted
the psychological histories of fifteen mid-twenti-
eth-century artists. They found that at least half of