Overview

Depression heads the list of reasons that people seek mental health services, and physicians report that depression is the underlying factor in the majority of visits to medical doctors. Depression: A Comprehensive Reference for Professionals is designed for mental health workers engaged in diagnosing and treating depressed clients.

Although the book will be comprehensible to those with associate degrees working as drug and alcohol counselors and in entry-level mental health positions, the material will be sufficiently comprehensive and technically accurate to meet the needs of

The book will also be of interest to sophisticated readers seeking information about the maze of available mainstream and alternative treatments.

The National Institute of Mental Health estimates that 10% of the population is depressed at any given time and that 25% will be stricken at some point during their lifetime. Depression is often a factor in a range of other medical and psychiatric problems, from failure-to-thrive to alcoholism. Despite the fact that at least a million professionals provide services to depressed clients, colleges courses on the subject are virtually unheard of. Where they exist, Beck's books, which describe a single treatment approach, are commonly used as texts. Despite the wealth of technical information available in technical journals and the hundreds of pop self-help books designed for lay audiences, no comprehensive reference exists. Service providers have difficulty locating reliable information.

Only M.D.'s with specialties in psychiatry or neurology are adequately trained to prescribe medications for depression. Yet even these professionals find that keeping up with developments in the field is as pressing as it is difficult given the proliferation of psychotropic medications, herbal remedies, and other treatments. They may not know, for instance, that decreasing the dosage of some third generation antidepressants often increases therapeutic effect.

Family practitioners, gynecologists, and doctors of internal medicine are usually the first professionals to whom patients turn for assistance with mental health issues. Primary care providers write most of the prescriptions for antidepressant medications despite their limited training in psychiatry. They often fail to recommend counseling and psychotherapy due to their uncertainty as to how to handle patient resistance. Meanwhile, in emergency rooms across the countries, emergency medicine physicians write prescriptions and formulate recommendations for patients suffering from acute depressive episodes although their formal psychiatric training is often minimal.

The widespread lack of physician knowledge about antidepressants is reflected in the printed instructions that appear on the bottles and boxes patients pick up at the pharmacy. It is common for labels on Prozac prescriptions to say "Take 1 pill as needed for depression," even though Prozac must be taken daily for several weeks to achieve therapeutic levels.

When M.D.'s prescribe medication and make counseling referrals, it is typical for patients to address medication questions and concerns to the counselor they see weekly rather than to the prescribing M.D., whom they may not see again for many months. Whether the individual therapist is a Ph.D. psychologist, a master's level social worker, or one of the half million practitioners with associate's and bachelor's degrees working in outpatient, day treatment, residential treatment, rehabilitation, and inpatient facilities, the practitioner is likely to have less relevant academic background and training than needed to provide optimal care. Mental health workers are expected to overcome their deficiencies through on-going supervision and staff development, but in most public health settings supervision and education is minimal or non-existent.

Still, mental health providers find themselves in the position of having to render opinions on the efficacy of their clients' prescriptions, assess the correctness of dosages, and explain side effects. Often these caregivers have important information to which the prescribing physician is not privy, such as the fact that the patient is abusing alcohol, is anorexic, or is taking medications prescribed for other conditions. They must determine whether such information needs to be communicated to the prescribing physician and when to alert clients to potential problems.

In fact, counselors often end up determining what medication physicians prescribe in the first place. When they refer clients to an M.D. for a medication evaluation, they influence the process by the kind of background information they provide. During the referral discussion, it is common for physicians to ask counselors what to prescribe. And since patients direct most medication-related questions to the therapists they see regularly rather than to the prescribing physicians they see every few months, mental health workers feel pressured to be knowledgeable about psychotropic medications.

But acquiring that knowledge isn't easy. Few master's and doctoral level practitioners take courses in psychopharmacology. Those who do find that no sooner have they graduated and begun working with "real" people than the information they acquired in college is out of date.

Negotiating the maze of medications is only the tip of the iceberg when it comes to the information about depression professional mental health workers need to be effective with clients, many of whom cannot take them or reject them on principle. Counselors must know how to

They must be cognizant of theories of depression, including

They need to grasp

Treatment providers must be aware of the many treatment approaches available to their clients, including

They need to know what books to recommend to clients and what on-line resources are available for clients as well as for themselves.

The good news is that controlled research studies show that 80% of cases of clinical depression can be effectively treated with medication, psychotherapy, or a combination of the two. Once mental health providers have an effective tool to assist them as they strive to help clients heal, perhaps they can attain similar success.

The length will be about that of an introductory college psychology text. To enhance readability, the text will contain a liberal sprinkling of

Quotes from famous sufferers to help readers comprehend clients' subjective experience of depression and the helping process;.

Sidebars that present case studies and provide excerpts from clinical assessments and treatment sessions to illustrate points and introduce readers to situations commonly encountered when diagnosing and treating depressed populations;

Charts and graphs to summarize technical information about medications, results of research studies, etc.; and

Graphic art to present diagrams of the brain, EEG's of depressives and controls, Rorschach and TAT plates, drawings produced by depressed clients at various stages of treatment, etc.