Depression Guide

Reprinted from Barron’s, September 3, 2001

Depression Guide: You’re Not Alone
The brave art of fighting the deep blues

The Noonday Demon: An Atlas Of Depression
By Andrew Solomon
Scribner & Sons
571 pp., $28

Reviewed by David L. Nathan, MD

Who has failed to notice the overwhelming number of books in the Self-Help and Psychology sections of bookstores these days? Though few close the gap between good science and good reading, Andrew Solomon’s The Noonday Demon succeeds brilliantly. This is a multidimensional, complex work, and may be the best lay guide ever written for understanding and surviving depression.

The book consists of self-contained sections on different aspects of depression. People personally touched by depression, either as sufferers or as friends or family of the afflicted, will find the book front-loaded with countless pearls of wisdom on depression and its many modalities of treatment.

The author, himself afflicted with severe depression, has done his homework, drawing extensively from the most respected sources in the field. He provides dozens of first-hand accounts of people who have experienced depression, although the heterogeneity of his and others’ personal experiences shows that depression is a final, common pathway of many different psychological and physiological processes.

Solomon, in choosing not to limit his discussion to the most common depressive illness, known among psychiatrists as “major depression,” allows more people to see their own situations in the stories he

However, this approach could also lead the reader to confusion. Bipolar disorder, thyroid imbalance and childhood trauma can all lead a person to depression, but the causes are obviously very different. Likewise, different people need different treatments. Antidepressants can often be lifesaving, although they can make some with bipolar disorder worse. He outlines proven courses of treatment, putting heavy emphasis on the combination of medications and psychotherapy. And he stresses the potentially lethal dangers of undertreating depression.

There is an informed discussion about alternative treatments, which includes a look at the studies of their safety and efficacy. Solomon avoids the pitfall of elevating alternative approaches over conventional ones. “That God put a certain configuration of molecule into a plant and left another configuration of molecule to be developed by human science hardly recommends the first arrangement over the ”

Solomon’s personal experiences loom large throughout the first part of the book, which is understandable given that he continued to suffer recurrences even as he did his research and writing. He looks at the stigma and shame that often drive the issue underground, although he suggests that his self-disclosure “… made it easier to bear the illness and easier to forestall its return. I’d ”

Solomon is honest, sometimes painfully so, when discussing his own story of self-destructiveness, suicidal thoughts and noncompliance with treatment. Somehow, the author even succeeds in injecting a wry sense of humor, for example when he notes the isolation he felt at what should have been a pleasant dinner party: “I’m afraid I can’t actually follow what you’re saying because I’ve been taking ”

In later chapters, the book waxes academic — for example in its discussion of how depression affects different populations, categorized by gender, age, sexual orientation, ethnicity, and degree of substance abuse.

In a chapter entitled “Evolution,” he pursues the elusive answer to the question of why humans suffer from depression, focusing on the proposition that depression is too common in humans to be

There is a concise chapter on approaches to depression in different times and cultures, a generally sad discussion of dark times that helps explain our current biases against psychiatric illness. The author also looks at depression among the poor, and how society might start to better serve this under-treated group.

In “Politics,” perhaps the most important chapter of the latter half of the book, Solomon focuses on how Americans as a society

He points out that, while federal and state governments struggle to pass mental-health parity legislation, depression costs the United States an estimated $43 billion annually. Insurance companies strongly oppose providing coverage for psychiatric conditions on a par with other medical conditions, even though both can lead to suffering, loss of work productivity, societal ills and death. The author critiques the accomplishments and shortcomings of all sectors of mental health-care provision.

While this book should become the standard layperson’s text on depression, it has some shortcomings. Although the chapter on suicide deals mainly with its connection to depression, there is a lengthy philosophical discussion of “rational” suicide, an inappropriate digression

As in other works of this genre, it seems as if the author romanticizes his and others’ experiences, though perhaps this is a necessary device to capture the reader’s attention and bring the illness to life.

Finally, Solomon’s writing style is highly intellectual, which may make the book inaccessible to some of its target audience: The acutely depressed tend to lack the ability to concentrate well enough to read at this level. Solomon’s wisdom will be very valuable to family and friends of depressives, inasmuch as it provides an indispensable and unique tool for helping and understanding loved ones. And it is probably even more valuable for those readers who have little personal experience with depression, because it provides a clear window into the illness.

At the outset of the book, Solomon invokes the theme of depression as a teacher, and in this finds the support of many writers throughout history.

The close of The Noonday Demon is a view of the future, drawing upon what Solomon has learned and gained from depression. He concludes, “The opposite of depression is not happiness but vitality, and my life, as I write this, is vital, even when sad.”

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