A Battle Plan Against Depression
by Rachel Mittelman

In one “Cathy” comic, the heroine crossly describes men as “all solution, no sympathy.” For depressed teenagers and their parents, as Dr. Miriam Kaufman has learned over 18 years of work with teens, this attitude can be as misguided as the oft derided “all sympathy, no solution” approach. She conveys both sympathy and solution in Overcoming Teen Depression: A Guide for Parents, maintaining a scientific, matter-of-fact tone throughout.

Kaufman makes no attempt to gloss over the complexity of depression’s causes and manifestations; she believes that people need to understand their problems in order to deal with them honestly. Thus, she avoids over-simplification and distinguishes between everyday unhappiness and clinical depression as well as between depression and illnesses with similar effects. A diagnosis of major depression requires loss of interest or pleasure in previously enjoyed activities, sometimes experienced as sadness and sometimes as apathy. This feeling must be continuously present for two weeks, accompanied by four of the following: sleep problems; changes in eating patterns; difficulty concentrating; listlessness; feelings of worthlessness, hopelessness or guilt; suicidal thoughts.

Of course, all except the last symptom are part of normal teenage experience, so parents should not automatically ascribe them to illness. To make matters more complicated, some depressed teens eat more than usual and some less, some feel lethargic while others become restless, and sleep patterns can be affected in every way imaginable. Many symptoms are also characteristic of various medical conditions that parents should rule out before their children are diagnosed as depressive.

Faced with these facts, depressed teenagers and their parents could easily despair of overcoming the complicated disease. As such an outlook obviously feeds directly into any existing depression, Kaufman convincingly reassures her readers that there is hope for a cure. First and foremost, she constantly reminds parents and teenagers that “it isn’t your fault.” Depression arises from a combination of physical, mental and sociological factors. It is by no means a sign of personal weakness or poor upbringing, and people can defeat it by treating it as a comprehensible problem to be solved over time, not by sinking into a debilitating morass of unwarranted guilt.

Treatment, Kaufman feels, is essential, although some teenagers eventually overcome depression on their own. She generally recommends a combination of antidepressant medication and psychotherapy, but firmly asserts that the course of treatment should be tailored to each patient. To help parents and teenagers understand the possible treatments she lists commonly prescribed medications with their mode of action and important potential side effects. In addition to chapters on medication and psychotherapy, Kaufman includes a comprehensive section about conventional and herbal alternative treatments, discussing their reliability in coping with various aspects of depression as well as their potential dangers and fringe benefits. As for psychotherapy, she warns parents and teenagers against using a therapist with whom they are not comfortable, and especially to distrust anyone who makes blanket statements like “I never prescribe medication” or “this method always works.”

Her primary guideline is to be realistic rather than believing in cure-alls and quick fixes. And indeed, her advice is consistently moderate and reasonable. Her only categorical statement is that any suicidal mention or attempt, however casual or ineffectual, should receive an aggressive response. She makes clear when particular research supports the efficacy of a certain treatment, when she recommends it despite the absence of specific research, and when she does not put much faith in the treatment. Nevertheless, she does not neglect to explain even approaches she doesn’t agree with, which should make readers more comfortable using her book as a sole reference guide.

Its final qualification as a guidebook is Kaufman’s clear, accessible style. The reader can easily look up a specific topic in her well-organized book and find all the main facts listed. While Kaufman at times is redundent, her goal may be to reassure and encourage. Parents and readers have the comforting sense that they understand the nature of their child’s illness and have the tools needed to fight against it.

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