The Noonday Demon (82 page)

25
The idea that somatic illness masks depression is a commonplace. Jeffrey De Wester, in his article “Recognizing and Treating the Patient with Somatic Manifestations of Depression,”
Journal of Family Practice
43, suppl. 6 (1996), writes that while “it has been estimated that 77 percent of all mental health visits in the United States occur in a primary care physician’s office . . . less than 20 percent of these patients complain of psychological symptoms or distress,” page S4. Elizabeth McCauley et al., in “The Role of Somatic Complaints in the Diagnosis of Depression in Children and Adolescents,”
Journal of the American Academy of Child and Adolescent Psychiatry
30, no. 4 (1991), write that “somatization has been well documented as one way in which depression presents itself, especially in those individuals and/or cultures in which acknowledgment and expression of affect states is not acceptable,” page 631. For more, see also Remi Cadoret et al., “Somatic Complaints,”
Journal of Affective Disorders
2 (1980).

25
The percentages given here may be found in D. A. Regier et al., “The de facto mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services,”
Archives of General Psychiatry
50, no. 2 (1993). The study states, “Those with Major Unipolar Depression had an intermediate rate of mental health service use, in which almost half (49%) had some professional care, with 27.8% using the [specialty mental health/addictive] sector and 25.3% [general medical] sector care,” page 91.

25
That over 95 percent of the general population suffering from depression are
treated by general practitioners is stated in Jogin Thakore and David John, “Prescriptions of Antidepressants by General Practitioners: Recommendations by FHSAs and Health Boards,”
British Journal of General Practice
46 (1996).

25
That depression is recognized only 40 percent of the time for adults, and only 20 percent of the time for children was set out by Steven Hyman, the director of the National Institute of Mental Health (NIMH), in an oral interview on January 29, 1997.

25
The estimated number of people on Prozac and on the other SSRIs is taken from Joseph Glenmullen’s
Prozac Backlash,
page 15.

25
The mortality rates for depression have been studied extensively and the results are not fully consistent. The figure of 15 percent was originally established by S. B. Guze and E. Robbins, “Suicide and affective disorders,”
British Journal of Psychiatry
117 (1970), and was confirmed by Frederick Goodwin and Kay Jamison in a comprehensive review of thirty studies included in their book
Manic-Depressive Illness
(see the chart on pages 152–53). The lower rates are based on the work of G. W. Blair-West, G. W. Mellsop, and M. L. Eyeson-Annan, “Down-rating lifetime suicide risk in major depression,”
Acta Psychiatrica Scandinavica
95 (1997). This study demonstrated that taking current estimates of depression levels and applying the 15 percent figure would give an overall number of suicides at least four times as high as is currently documented. Some recent researchers have proposed a figure of 6 percent, but this is based on a population sample that seems to contain a deceptively high number of people treated as inpatients (see H. M. Inskip, E. Clare Harris, and Brian Barraclough, “Lifetime risk of suicide for affective disorder, alcoholism, and schizophrenia,”
British Journal of Psychiatry
172 (1998). The most recent work is by J. M. Bostwick and S. Pancratz, “Affective disorders and suicide risk: a re-examination,”
American Journal of Psychiatry
(in press). This work establishes a rate of 6 percent for those who have been hospitalized for depression, 4.1 percent for those who have had inpatient treatment, and 2 percent for those who have had no inpatient treatment. It should be emphasized that the statistical problems involved in these calculations are extremely complicated, and that different methods of calculating proportionate mortality have given varying rates, mostly higher than those established by Bostwick and Pancratz.

25
The comparative rates of cumulative depression were taken from the Cross-National Collaborative Group, “The Changing Rate of Major Depression,”
Journal of the American Medical Association
268, no. 21 (1992); see Figure 1, page 3100.

26
The notion that depression is occurring in a younger population is taken from D. A. Regier et al., “Comparing age at onset of major depression and other psychiatric disorders by birth cohorts in five U.S. community populations,”
Archives of General Psychiatry
48, no. 9 (1991).

26
For a particularly eloquent exegesis on the supermodel’s negative effects on women, see
The Beauty Myth
by Naomi R. Wolf.

27
Herman Spitz’s
The Raising of Intelligence
states, “On the Wechsler Intelligence Scales mild retardation is encompassed by IQs of 55 to 69, and on the Stanford-Binet Intelligence Scale by IQs of 52–67,” page 4.

30
The pills I see in these colors are BuSpar and Zyprexa (white); Effexor immediate release (pink); Effexor sustained release (dark red); and Wellbutrin (turquoise).

31
That skin cancer rates are rising is indicated by numerous studies. H. Irene Ball et al., “Update on the incidence and mortality from melanoma in the United States,” published in the
Journal of the American Academy of Dermatology
40 (1999), states,
“Over the past few decades, melanoma has become much more common; its increase in both incidence and mortality rates have been among the largest of any cancer,” page 35.

31
Hippocrates’ views on depression are discussed at length in chapter 8.

33
The horrors of the Khmer Rouge are extensively documented. For a vivid reenaction of the atrocities, I would commend the film
The Killing Fields.

38
The quotation from Ovid I have taken from Kay Jamison’s
Night Falls Fast,
page 66.

44
The story of my life with the Russians is told in my first book,
The Irony Tower,
and in these subsequent articles for
The New York Times Magazine:
“Three Days in August,” published September 29, 1991; “Artist of the Soviet Wreckage,” published September 20, 1992; and “Young Russia’s Defiant Decadence,” published July 18, 1993.

44
The rock band in question was Middle Russian Elevation.

45
The quotation from Gerhard Richter may be found in his poetical diary, published as
The Daily Practice of Painting,
on page 122.

47
The article I was closing during my kidney stones was published in the August 28, 1994, edition of
The New York Times Magazine
as “Defiantly Deaf.”

48
The idea of hypothalamic and cortical function coinciding has been put forward on many occasions and is explicated in Peter Whybrow’s
A Mood Apart,
pages 153–65.

48
The percentages are based, in my view, on difficult and still uncertain science and therefore show wide discrepancies. I have, nonetheless, taken these statistics, which reflect the general consensus, from Eric Fombonne’s essay “Depressive Disorders: Time Trends and Possible Explanatory Mechanisms,” published in Michael Rutter and David J. Smith’s
Psychosocial Disorders in Young People,
page 576.

48
I have not treated manic-depressive illness at great length; it is a topic that warrants books of its own. For a scholarly examination of the specifics of the disease, see Fred Goodwin and Kay Jamison’s
Manic-Depressive Illness.

52
The remarks by Julia Kristeva are from
Black Sun
and occur on page 53.

52
The Emily Dickinson poem, which is among my favorite poems ever in the whole history of the world, is in
The Complete Poems of Emily Dickinson,
pages 128–29.

53
The quotation from Daphne Merkin appeared in
The New Yorker,
January 8, 2001, page 37.

54
The Elizabeth Prince poem is unpublished.

55
The quotation from Leonard Woolf may be found in his book
Beginning Again,
on pages 163–64.

55
The catalog of what is going on during depression is drawn from multiple sources too numerous to list, as well as from countless interviews with doctors, clinicians, and specialists. For superb and vivid descriptions of the basics of the majority of these processes see Peter Whybrow’s
A Mood Apart,
pages 150–67. The April 1999 edition of
Psychology Today
offers another summary of the biologies of depression. Charles Nemeroff’s summary of the neurobiology of depression, found in the June 1998
Scientific American,
also provides a more detailed, nonacademic discussion of many of the complex issues brought up here.

56
The idea that raising levels of TRH can be a useful treatment in depression, at least temporarily, is spelled out in Fred Goodwin and Kay Jamison’s
Manic-Depressive Illness,
page 465.

56
There is now a large body of work to support the idea that depressions become more severe during a lifetime. I have discussed the matter in particular detail with Robert Post of the NIMH and John Greden of the University of Michigan.

56
The quotation from Kay Jamison is taken from
Night Falls Fast,
page 198.

56
The insight about seizures in the animal brain comes largely from the work of Suzanne Weiss and Robert Post. For information on the “kindling” phenomenon and its use as a model for affective disorders, see their coauthored article “Kindling: Separate vs. shared mechanisms in affective disorder and epilepsy,”
Neuropsychology
38, no. 3 (1998).

57
The information on the lesioning of monoamine systems in animal brains comes from Juan López et al., “Regulation of 5-HT Receptors and the Hypothalamic-Pituitary-Adrenal Axis: Implications for the neurobiology of suicide,”
Annals of the New York Academy of Sciences
836 (1997). On depression and the monoamine system and cortisol, see Juan López et al., “Neural circuits mediating stress,”
Biological Psychiatry
46 (1999).

57
This explanation of stress responses in depression is based on the work of Juan López and Elizabeth Young at the University of Michigan, and Ken Kendler at the Medical College of Virginia in Richmond. There are as many explanations of depression as there are stars in the night sky, but I think the Michigan scientists’ stress-based model is particularly convincing.

58
For the study using ketoconazole on an experimental basis, see O. M. Wolkowitz et al., “Antiglucocorticoid treatment of depression: double-blind ketoconazole,”
Biological Psychiatry
45, no. 8 (1999).

58
The studies on baboons were done by Robert Sapolsky and described to me in an oral interview with Elizabeth Young. The work on air traffic controllers may be found in R. M. Rose et al., “Endocrine Activity in Air Traffic Controllers at Work. II. Biological, Psychological and Work Correlates,”
Psychoneuroendocrinology
7 (1982).

58
That the heart is weakened after a myocardial infarction is a well-established idea. However, the severity of damage done to the heart depends upon the size of the area of dead tissue within the heart. While the data indicate that isolation lesions don’t necessarily put one at a higher rate of relapse than controls, diffuse coronary disease almost certainly does. Nonetheless, close attention must be paid to the heart condition of anyone who has experienced a heart attack, and therapies to prevent relapse are in order for such a person. I thank Dr. Joseph Hayes of Cornell for his assistance with this matter.

59
Juan López’s work with the stress systems of rats may be found in Juan López et al., “Regulation of 5-HT1A Receptor, Glucocorticoid and Mineralocorticoid Receptor in Rat and Human Hippocampus: Implications for the Neurobiology of Depression,”
Biological Psychiatry
43 (1998). The work on cortisol levels and adrenal enlargement postsuicide is found in Juan López et al., “Regulation of 5-HT Receptors and the Hypothalamic-Pituitary-Adrenal Axis: Implications for the Neurobiology of Suicide,”
Annals of the New York Academy of Sciences
836 (1997).