Rates, Risks, and Treatment of Depression: My Scientific Journey

Highlights from the Presentation

On Her First Experience with Psychotherapy at Yale University Early in Her Career

It was an exciting research job. It was the first maintenance treatment trial of medication to prevent relapse and major depression. But the study needed to include psychotherapy, as the hypothesis was that psychotherapy, as commonly used, would interfere with the medication effects.

In other words, if you got the combination, you would do worse.

Since I was the social worker on the team, I was asked to help design the psychotherapy. That was a challenge. There were no psychotherapy manuals to describe what you did, and there were no clinical trials.

In other words, I was the perfect person, because I had no prejudices.

On Challenging the Status Quo in Studying Psychiatric Disorders

My research is in three broad areas, with meandering for curiosity along the way. There's no time to present all this meandering.

The findings I present will seem simple, obvious, and well known. When I began in all these areas, the conventional wisdom for evaluating psychotherapy was that you couldn't measure it or evaluate it. Every situation was unique for doing epidemiologic surveys of psychiatric disorders of people in the community. I was told people wouldn't tell you about their disorders

And for studying familial depression in children, we were told the children did not get depressed because they had insufficient ego development.

Well, these ideas seem silly right now. While my research may seem obvious to you, in the 1970s and 1980s, when I started, it was not obvious, and instead, it was considered undoable.

It's hard to believe that, isn't it?

On the Origins of Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy (IPT) assumes that there is a relationship between the disruptions of close attachments to death of a loved one, disagreements, life changes, loneliness, isolation, and the onset of recurrence of symptoms such as distress or depression. And these triggers are observed across cultures.

It does not get into the biological causes of depression, but says that when a person becomes depressed or has an exacerbation of symptoms, there's something going on in their interpersonal life.

IPT set out to categorize or simplify what these problem areas are.

On IPT’s Findings Around the World

We started to hear about all these studies in the different countries, and were very interested in how a common thread would work in countries that seem to have such different social structure.

And having a lot of time in our hands, because we couldn't go anyplace during the pandemic, I collaborated with one of our very brilliant junior faculty, Jennifer Mose, and we put together a letter and rules for getting information and chapters from these different countries.

The underlying idea was that human attachments are critical to well-being. In every country. In every country their severance through death disputes, life changes, or their absences are associated with distress.

This simple truth holds across different cultures and situations, and is a reflection of our common humanity.

On Genetic and Generational Ties to Depression and Other Disorders

Anxiety is the first presentation in childhood. That's tough because children get anxious. But a child who has a family history of depression and start to show anxiety when they're before puberty is a child that may be at risk for more problems.

Substance abuse is increased in adulthood in everybody but particularly in the High Risk group (group with parents or grandparents who are depressed).

Forty percent of grandchildren with a depressed parent and a grandparent have depression by adolescence.

The parents, now in their fifties, the high risk parents have an increased risk of cardiovascular disease, and we have been showing a much more increased risk of various kinds of medical problems.

On Where Interpersonal Psychotherapy is Today

Psychotherapy, like medication, can be tested in controlled clinical trials.

As far as epidemiology, the rates, the age of onset, the risks of psychiatric disorders and community samples are now available worldwide—and not just in developed countries, but in developing countries [as well].

We now know that depression is highly familial and the first onsets are in youth.

It isn't a disorder, as we were told, of menopausal women. In fact, around menopause the rates of first onset of depression really go down. It is a disorder of youth.

A psychosocial and a biological understanding of transmission is emerging and the successful treatment of a depressed parent can have a positive effect on their depressed offspring. So it's well worth putting a lot of effort into that treatment.