Hand-Me-Down Blues

With the increasing prevalence of depression in the United States, the greater availability of “cleaner” antidepressants, and the downward pressure on reimbursement for primary care office visits, many caregivers have adopted a simplified approach consisting of pharmacotherapy as the only treatment for depression. As a result, the multidimensional aspect of depression is often ignored. In his book directed at individuals and their family members affected by depression, Yapko first presents a complicated multifactorial basis for depression and then breaks down the treatment and prevention into skills for building family strengths. The first part describes the biopsychosocial model of depression. Depression is discussed with respect to its social context and its cognitive, behavioral, and cultural components, with much less emphasis placed on the supposed fundamental role of its biological component. Convincing arguments are presented showing that neurochemistry and life experiences are a “2-way street.” The second part discusses depression from a family perspective. Nurture as opposed to nature is emphasized. Attribution formation and styles, whether constructive or destructive, are shown to be learned skills. The interactions of marriage and depression are addressed from the perspective of the relationship of depression to marital discord, gender roles, and the effect on spouses and children. The author emphasizes the need for inclusion of family members in the treatment. The final part deals with prevention and treatment. Depression is described as a reflection of a problem in the family system or the result of adversity challenging a weak structure. Critical thinking and relationship skills are illustrated with examples. The teaching of emotional intelligence—the ability to tolerate ambiguity and have foresight—is shown to prevent depression. Throughout, Yapko utilizes personally acquired examples, along with good common sense, to effectively help the reader understand the concepts he teaches. The reading level of the book unfortunately seems to fall somewhere between being a resource for a primary care physician treating depression and a tool for an affected lay individual or family member. Although Yapko does admit to a role for pharmacotherapy in the treatment of depression, his book was clearly not sponsored by a drug company. It would be a good patient resource, but only after recovery from an acute episode of depression when concentration abilities are unaffected by the disease process.