Down in the Dumps (or When Feeling Down Seems Normal):
New Approaches to Overcoming the Dysthymia and other forms of Low-Grade Depression
(book was later published as: Beating the Blues: New Approaches to Overcoming Dysthymia and Chronic Mild Depression)
By
Michael Thase, MD
and
Susan S. Lang
A Book Proposal
Rationale
Some 17 million Americans suffer from depression each year; at least eight million more have dysthymia, chronic low-grade depression. Striking two to three times as many women as men, dysthymia is a lingering gloominess that never quite lifts. In addition, millions more of us suffer from many of the criteria of dysthymia; though not severe enough to be diagnosed as having dysthymic disorder, the periods of living “in the dumps” make millions miserable.
Many Americans are also suffering from the lingering effects of the trauma of September 11, 2001. Over these many months, the anxieties have subsided and are no longer acute but many of us are left with a deep sense of sadness, mourning some loss of controls, feeling less hopeful, pessimistic and negative.
The tragedy here is that far too many people don’t recognize there’s anything actually wrong, Over time they come to think that their feelings of apathy, passivity, and glumness are their personalities. If chronic, they become dysthymic, which some call the disorder of discontent.
Low grade chronic depression, however, is highly treatable, with many strategies are self-directed. Yet this negative way of approaching life often is ignored and more often than not, undertreated. People with periods of apathy and passivity or dysthymia typically hold jobs, have families, and get through the day just as most people do. But life for them has become a joyless, grim grind. Some describe it as a monotone of bleakness that pervades their life; many don’t realize they can help themselves and if need be, seek very effective psychotherapies and/or medications to live a brighter life. Unfortunately, most people with dysthymia believe that their glumness is just their personality, their usual self. They accept their view of life as normal, unaware that they have a disorder that can clearly be helped.
Not only can dysthymia be treated with remarkable success but many of the strategies also can be adopted by the average person to short circuit the pessimism that feeds their persistent depressive response to live.
Concept and Approach
This book would be a practical, slim handbook with as many lists, charts and boxes as possible, written for the lay pubic. It would include the self-help strategies generated from the behavioral and psychological approaches adapted from, for example, Aaron Beck, Albert Ellis, David Burns, Martin Seligman and Daniel Goleman; detailed discussions of non-drug strategies; and complete sections on medications and the “trial and error” strategy doctors use. The book would be comprehensive, practical, self-help oriented to benefit not only those with dysthymia but also those with milder forms of negative or pessimistic approaches to life. With the wealth of medications and information available, doctors and therapists do not have time to fully inform their patients about dysthymia and the strategies to treat it. This book also would fulfill their need to fully inform clients of a multi-disciplinary approach to low grade depression.
The Market
With no competitors, the book could become the gold standard reference on dysthymia for the lay public. Dysthymia afflicts more women than men for a variety of reasons, and since women tend to buy self-help books, the book would be purchased widely. It would not only be marketed to those with dysthymic disorder but to individuals who want to shake off days of gloom, negativity or low energy. It would also be relevant to the year following the events of September 11, 2001.
The Competition
Although there are 500 books on clinical depression at Amazon.com, only one book has dysthymia in its title and that book is academic in nature: Dysthymia and the Spectrum of Chronic Depressions by Hagop S. Akiskal and Giovanni B. Cassano (editors). There is no competition.
AUTHORS
Michael Thase, MD
Professor, Department of Psychiatry
Medical Director of the Mood Disorders Module
University of Pittsburgh School of Medicine
Chief, Division of Adult Academic Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
Made Headlines with story: New Study Led By University of Pittsburgh Researcher Shows Mirtazapine (Remeron) Cuts Risk of Depression Relapse by More Than 50 Percent
Biography
Michael E. Thase, M.D. is Professor of Psychiatry at the University of Pittsburgh School of Medicine and the Western Psychiatric Institute and Clinic. His research interests pertain to the assessment and treatment of mood disorders, including the short-term and prophylactic efficacy of pharmacotherapy and cognitive therapy in relationship to the psychobiological correlates of depression. A 1979 graduate of the Ohio State University College of Medicine, Dr. Thase has directed the Depression Treatment and Research Center at the University of Pittsburgh since its inception in 1987. In 1988, he became Director, Division of Mood, Anxiety, and Related Disorders, and Associate Director of the Mental Health Clinical Research Center at Western Psychiatric Institute and Clinic. Dr. Thase has authored or coauthored over 200 scientific articles and book chapters. He is coeditor of the books entitled Handbook of Outpatient Treatment, published in 1990 by Plenum Press, and Cognitive Therapy with Inpatients: Developing a Cognitive Milieu, which was published in 1992 by Guilford Press.
Susan S. Lang
Susan S. Lang is the author or co-author of ten books. She is also a senior science writer at Cornell University where for 17 years, she has been translating social and biological sciences research for the popular media. Her news releases have been used by newspapers and magazines across the country and around the world. At Cornell, Lang also worked as a researcher and senior manuscript editor for Dr. Carl Sagan for three years. As a freelance writer, Lang has published more than 125 articles on health and psychology in national magazines, including Vogue, Ladies’ Home Journal, Woman's Day, Family Circle, Good Housekeeping, McCall's, Parade, American Health, Organic Gardening, Cosmopolitan, and New Woman. Her article on dysthymia, “When Feeling Down Feels Normal,” (on low-grade, chronic depression), published in Good Housekeeping, January 1994 won the 1995 Honorable Mention, Robert T. Morse Award, American Psychiatric Assn.
Lang’s books include:
You Don't Have to Suffer: A Complete Guide to Treating Cancer Pain for Patients and Their Families, with Richard B. Patt, M.D., (Oxford University Press, 1994; hard and paper; second edition in preparation) Translated into Japanese and Italian; went into a second printing within two months of publication. #10, University Presses Bestseller List, as reported in Library Journal, July 9, 1994. Chosen by Science News for their Science News Book list.
Positive reviews in Science News, Oncology Times” Booklist m Library Journal, Publishers Weekly, 12/20/93. The Washington Post, May 31, 1994. New York Times 3/16/94 The Clinical Journal of Pain
Headache Help with Lawrence Robbins, M.D. (Houghton Mifflin, 1995; second edition 2000).
Selection with Rodale Book Club, Doubleday Health Book Club. and Literary
Guild of America, Publisher’s Clearinghouse.
Excerpted in Good Housekeeping, June 1995.
Positive reviews in Headache Quarterly, Vol. XI, 2000, National Headache Foundation, Neuropractice, Fall 1996, Science News, July 8, 1995.
Women Without Children: Reasons, Rewards, Regrets (Pharos, 1991).
boxed review in Booklist
Editor’s Choice, Booklist, as one of top 150 books in 1991
translated into German and Japanese
Seven nonfiction books for children and young adults.
With a B.S. from Cornell University and a Masters of Library Science (which gives her unique research skills) from the University of Michigan, Lang is well qualified to write this kind of book for the layperson.
Down in the Dumps
New Approaches to Overcoming the Dysthymia and other forms of Low-Grade Depression
Contents:
Part I: Understanding Dysthymia and its Milder Forms
- What is Dysthymia or Dysthymic Disorder?
- How Does it Differ from Clinical Depression or Major Depression?
- What Causes Dysthymia? (including long term effects of grief or anxiety, biochemical causes, sociocultural re September 11, 2001, and style of approaching life
- Who Gets Dysthymia?
- How is Dysthymia Diagnosed?
- Signs and Symptoms: Identifying Typical Patterns
- Self-Monitoring Tests
Part II: Treatments
- Psychosocial Treatments
- Medical Treatments
- Current Research on New Treatments
Part II: Other Day-to-Day Strategies For Feeling Better
- Diet and Nutrition
- Herbal Supplements
- Biofeedback , Relaxation, and Stress Management
- Support Groups
- Combating Negative Thought Patterns
- Focusing on Positive Actions
Part III: Different Populations with Dysthymia
- Women Facing Dysthymia
- Men Facing Dysthymia
- Early Onset: Children and Adolescents with Dysthymia
- Dysthymia and Aging
- Conclusion
Appendix:
Set of Handouts (at least a dozen handout sheets of handy tips, lists and pitfalls that distill many of the concepts from cognitive therapy.
Where to Find Help
Glossary
References
Index
Dysthymia: Down in the Dumps
New Approaches to Overcoming the Blues and Low-Grade Depression
By
To Come, M.D.
And
Susan S. Lang
CHAPTER ONE: When Most Days Feel Cloudy and Overcast
What is dysthymia? (a mood disorder in which a person chronically feels unhappy and dissatisfied despite success; a low-grade depression, present for at least two years; it can be as disabling as major depression and congestive heart failure.) A startling 35 to 40 per cent of people with dysthymia never marry. Most dysthymics are pessimists and have difficulty coping with stress, which can influence their openness to new challenges. Such a life view has tremendous implications for high blood pressure, heart disease and other health concerns.
Symptoms include a poor appetite or overeating, difficulty sleeping or sleeping too much, low energy, fatigue and feelings of hopelessness. But people with dysthymic disorder may have periods of normal mood that last up to 2 months. Family members and friends may not even know that their loved one is depressed. Even though this type of depression is mild, it may make it difficult for a person to function at home, school or work.
Its roots are in circumstances, psychology and genetic predisposition
Many experience temporary blues as a normal response to major life stressors, such as loss, sorrow, chronic illness, job-related concerns and emotional trauma. But when a pervasive negative and pessimistic explanatory style persists, it sets the stage for dysthymia. Unchecked, the cloudy grey mood of the blues can become chronic. Many people don’t even notice the change, as the onset of dysthymia is often subtle. Unrecognized, the mild depression becomes a way of life; untreated, it can lead to depressive disorders. It often takes hindsight after the cloud has lifted to even realize one was living in its shadow for so long.
How to Identify Dysthymic Features
What Puts You at Risk for Dysthymic Tendencies?
Self-Monitoring Tests (Beck’s Depression Index as well as charts to monitor your mood, energy, reactions to uplifting events and stressful events and to track feelings; also to track activities and rate them pleasurable, personal or physical activities as well as obligatory, automatic, choice)
How does it differ from clinical depression?
What if you have a milder form of the blues but still want to improve your outlook
CHAPTER TWO: How You Can Fall Into the Dumps
Some typical patterns
When Bad Things Happen and the Law of Inertia
When Good People Think Bad Thoughts
Unproductive Thinking – By changing how you think and your style of self-speak, you change your mood (adapted from Ellis, Beck, Seligman, etc.)
When People Don’t Do Things that Would Make Them Better
By changing what you do, you change how you feel (adapted from Morita psychotherapy, among others)
When Relationships Darken Your World
CHAPTER THREE: The Psychology of Feeling Good
Thought Therapy
Pessimism, Negativity and distorted thinking, rigidity, fear perfectionism, jumping to conclusions, overreactions, generalizing, overexpectations
Strategy: Analyze your style and content of self-speak, Stop unwanted thoughts, Make affirmations, Disprove negativity, Seek pleasurable activities, finding support
Getting Organized, gaining control
Boosting Your Energy Levels
Sleep, relaxation
CHAPTER FOUR: Other Ways To Help Yourself: What You Can Do Today
Herbal/nutritional supplements: do they work? (St. John’s Wort, inocitol, kava, and others
Diet (?)
Relaxation/Biofeedback
Stress Management
Group support: how to organize one if you can’t find one
CHAPTER FIVE: Psychotherapy
Although treatment is usually successful, why do only one in five people actually seek help? Yet nearly everyone, if treated, could experience significant relief in several weeks.
Role of psychotherapy
Types of Professionals
Types of psychotherapists
Types of psychotherapies
Cognitive, supportive behavioral, interpersonal, psychoanalytical, cultural analysis
Group methods
What to Tell the Clinician
How does it feel? Onset? When do you feel worse?
Keeping a record
CHAPTER SIX: Medications
How your therapist/doctor chooses medication.
Medications: dysthymia has biological underpinnings and may need medication to compensate. Recent research shows some medications, especially the newer generation of drugs such as Prozac, Zoloft, Paxil, Effexor and Serzone, very effective for dysthymia. Charts to include dose range, side effects, etc.
CHAPTER SEVEN: Dysthymia and The Blues in Women
How hormones (menstruation, pregnancy, menopause, birth control pills) affect mood.
Other special concerns of women.
CHAPTER EIGHT: Dysthymia and The Blues in Men
CHAPTER NINE: Dysthymia and The Blues in Children
CHAPTER TEN: Dysthymia and The Blues in Teens
CHAPTER ELEVEN: Dysthymia and The Blues in Older Adults
CHAPTER TWELVE: Putting It All Together
GLOSSARY
Further explanation of medical terms used in the books that might be confusing for the general reader.
APPENDIX
DSM-IV Definition of Dysthymia and Depression
Summary of Other Mood Disorders
Dysthymia Drug Identification Guide
Dysthymia Calendar / Diary
Resources (organizations, web sites, discussion groups, etc.)
REFERENCES
INDEX
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