Depression: Getting the Help You Need

Donna Cohen, Ph.D.
Professor, Department of Aging and Mental Health and
Professor, Department of Psychiatry and Behavioral Sciences
University of South Florida
Tampa, Florida 33612

Living with a chronic illness, such as diabetes, arthritis, heart disease, asthma, or chronic obstructive pulmonary disease, changes every aspect of your personal, family and social life. Coping with the symptoms, lifestyle changes, and sometimes the possibility of life threatening complications becomes a daily challenge.

Your doctors, nurses, and other health professionals will set goals with you to manage your illness, but there are also many things you can do to take care of yourself. Research has shown that a good mental attitude makes a difference. Feeling good about yourself is essential to taking control of your illness instead of letting it control you!

There is a medical disorder, called depression, that occurs in 25-50% of people with chronic illnesses. When depression occurs it cannot be ignored. It interferes with your ability to feel good about yourself, the world you live in and your future. It affects your desire to take medications, follow health care regimens, relate to other people, and live a healthy lifestyle.

When you are depressed you feel bad. Michael Wallace, the news correspondent of "60 Minutes", described his depression as an "endless darkness." In testimony to Congress about depression Mr. Wallace said: "Sunshine means nothing to you. The seasons, friends, or good food mean nothing. All you focus on is yourself and how badly you feel."

Depression can happen to anyone. It is particularly common in people with heart disease, arthritis, chronic lung disease, stroke, cancer, Alzheimer's disease, and Parkinson's. In older people medical illnesses are a common trigger for depression, and untreated depression makes chronic illnesses worse.

It is also not easy to live with and love someone who is depressed. Stress, arguments and misunderstandings are common. When someone you love is depressed, you can feel angry, lost, frustrated or frail. You can feel shut out and drained.

This article on depression is meant to help you deal with depression, because depression is treatable! This article describes what you and your family need to know about depression. It discusses the different forms of depression, how to recognize depression, when and where to get help, what is involved in a medical work-up, what causes depression, the different forms of treatment, and many other important topics. Recognizing and dealing with depression is essential to control the course of your illness and enjoy a high quality of life.

The Many Faces of Depression

Depression has many faces, ranging from brief feelings of sadness to a serious medical condition. Most people feel sad and worried many times throughout life. Feelings of depression and sadness are normal reactions to hard times, disappointments, losses, illness or death. These events take the joy out of life, and it is natural to feel sad, lose interest in people and things, have sleep problems, and feel tired. These are all common expressions of what is called a normal reactive depression. The problems causing a reactive depression may or may not go away, but you find ways to accept or deal with your losses or problems. You bounce back and start to feel better in a short time.

When sadness persists or keeps returning, when the things you do everyday like eating, sleeping, working, and enjoying life continue to be difficult, you are dealing with something more than just "feeling down" or "feeling blue." You are dealing with a clinical depression, an illness that requires treatment. Many people wrongly believe that depression is normal in older adults. It is not! Most people also believe that depression in adults with chronic illness is normal. It is not! Clinical depression is a medical illness, and biological psychological, social, and existential factors may all interact to cause depression.

Fortunately, most depressive disorders are treatable. However, if undetected and untreated, clinical depression worsens your health problems and destroys the quality of life. It can lead to personal suffering, withdrawal from others, family disruption and conflict, and sometimes suicide. And because of the potential for suicide, depression is a life-threatening illness.

There are several types of clinical depression. The most common forms include major depressive disorders or unipolar disorders, dysthymia, and bipolar disorders also known as manic depressive disorders.

Major depressive disorder is characterized by a sadness, helplessness, and hopelessness that does not go away, as well as altered patterns of eating and sleeping, weight loss or weight gain, and loss of interest in sex and other pleasures. Major depressive disorders differ from a normal reactive depression in many ways, including the number of symptoms, how severe they are, and how long they last. Major depressive disorders are not just mood changes. They are truly incapacitating. Life feels overwhelming and miserable, and anything pleasurable, such as eating, being with friends, or having sex becomes unappealing. William Styron, the Pulitzer prize-winning author described his depression as feeling "condemned" to life, where "the entire body and spirit of a person is in a state of shipwreck."

In severe depression some people have hallucinations, where they believe they hear voices or music, see lights or images, taste or smell things, or have the sensation of being touched. Others may experience delusions, where beliefs about who they are or what is happening are not true.

Dysthymia is very similar to a major depressive disorder. Dysthymia is characterized by chronic mild depressive symptoms that last at least two years. This is in contrast to a major depressive disorder where there are one or more distinct episodes of depression. Some people have described living with dysthymia as seeing the world through dark glasses. They are able to function and get on with life but they do not feel happy. One woman described her dysthymia this way, "I do what I have to do but I feel like all my lights are out." Dysthymia may also occur together with major depression, and this condition is known as a double depression.

Bipolar disorder is the medical name for manic depressive disorder. The hallmark of bipolar depression is mania. Mania is the occurrence of symptoms at some point in a person's illness that are the opposite of depression, such as elation, pressured speech, hyperactivity, a belief in one's ability to do great and important things, reckless spending, and the inability to sleep. Bipolar depression is characterized by mood swings of both depressive and manic behavior. Although the shifts from one state to the other are usually gradual, they can occur suddenly. The rapid-cycling form of bipolar disorder involves four or more complete mood cycles in a year.

Since clinical depression may be associated with increased sensitivity to pain, feeling tired, and general malaise or "having the blahs", many people and even physicians, mistakenly attribute these symptoms to age or physical health problems. When depression occurs it will make anyone who already has health problems feel worse. Most depressed persons also lose interest in caring for themselves, ignore good health care, fail to take medications, and as a result may get sicker.

The Signs of Depression

Clinical depression affects the body and the mind. Depression causes changes in thinking, mood, behavior, and bodily functions. The key to detecting signs of depression is "change."

Thinking: Depressed individuals often feel inadequate or overwhelmed. Even easy tasks seem impossible. Concentration is difficult, disrupting activities from reading to driving. Making decisions is burdensome, from deciding what clothes to wear to making business decisions. The world appears bleak, and feelings of pessimism color perception of self-worth. Even successes are interpreted as failures. Thoughts of suicide may occur when the depression is severe.

People with bipolar depression are usually distracted very easily, and they think and talk very quickly, often without making much sense. Judgement is impaired such that they do not recognize the hurtful consequences of inappropriate sexual behaviors, poor financial investments or extravagant spending. They often have grandiose thoughts of being the world's best lover, authority, or business person.

Mood: Depressed individuals feel empty, helpless, hopeless, and worthless, or they may report overwhelming pain and despair. Individuals may cry a great deal, often for little or no reason. Many people with depression experience symptoms of anxiety such as agitation and excessive worry. It is also common to feel anger or even rage, irritation, frustration, and anxiety in addition to the sadness and despair. Depressed moods are pervasive and persistent and do not lift even when good things happen.

During manic episodes individuals may feel on top of the world, so much so that they believe there is nothing they cannot do. Excitability and irritability at the slightest change are common. Individuals may be paranoid and have delusions of being followed or persecuted for their religious beliefs. Hostility and violent behavior may also occur.

Behavior: Many behavioral changes are a signal of depression. These include restlessness, hand-wringing, pacing, and the inability to meet deadlines and complete projects, withdrawal from friends, staying in bed most of the day, and loss of interest in sex. Depressive behaviors can be destructive and hasten death. It is not uncommon for individuals to self-medicate, by drinking alcohol or taking sedatives, in an attempt to make the depression go away.

Many behavioral changes signal bipolar depression. These include restlessness, increased talkativeness, laughing inappropriately or inappropriate humor, increased sexuality and impulsive behaviors such as buying someone twenty pairs of red shoes, selling or buying a new business, or arranging to take friends or strangers on an expensive trip.

Bodily Functions: Depression is a disease affecting the entire body. Individuals report any number of physical pains such as headaches, backaches, joint pain, stomach problems, chest pain, and gastrointestinal distress. Individuals with bipolar depression usually sleep very little and lose a great deal of weight.

Test Your Depression

Do you want to know how depressed you are? The following test, developed by Dr. Leonora Radloff at the National Institute of Mental Health, and known as the Center for Epidemiological Studies-Depression Test, may help clarify what you are feeling. You can also take this test online and have your score calculated for you by clicking here.

To determine your score, add up the numbers you circled for each question or statement. Your total will be between 0 and 60. If you scored from 0 to 9, you are in a non-depressed range. You are also below the average score of adults in the United States. A score of 10 to 15 places you in the mildly depressed range, and a score of 16 to 24 in the moderately depressed range. If you scored over 24, you may be severely depressed.

A high score on this questionnaire is not the same as a diagnosis of depression. However, if you did score high, or, regardless of your score, if you have thoughts about suicide, reach out to someone as soon as possible. Call your doctor or a mental health professional. Check your telephone book for a crisis hotline or a community mental health center.

If your score fell in the moderately depressed range, take the test again in two weeks. If you still score in that range, please call your physician.

Testing for Mania

Impaired judgement is as much a part of mania as it is of depression. It is usually more obvious to friends and family. The following scale is designed to help you determine the severity of manic symptoms and decide whether you should get professional help. It was developed by Dr. Ivan Goldberg, and it is known as the Goldberg Mania Scale. The items below refer to how you have felt and behaved during the past week. For each item, circle the appropriate number. You can also take this test online and have your score calculated for you by clicking here.

To determine your score, add up the numbers you circled for each statement. A score of 20 or higher suggests that you should see a professional.

Getting Help

It is not a sign of weakness to see a doctor when you are depressed. The very nature of depressive symptoms is to drain you of the desire and energy to talk with family or seek professional help. The most courageous thing you can do is to get help. It is the first step to feeling better.

Both men and women get depression. There is a widespread myth that depression is a woman's disease. It is not "unmanly" or "wimpy" to admit feeling depressed. Unfortunately, men are reluctant to seek treatment and instead become irritable or angry, drink or use drugs, withdraw from loved ones, or act irresponsibly.

Because depressed people often feel like failures, many feel they are not worthy of help. They may also feel hopeless to the point of not wanting to get out of bed or to ask for help from a professional or the family. In the case of manic-depressive illness individuals may deny that they have a problem and feel that getting help is a preposterous idea.

It is not unusual to resist getting help, but telling someone how badly you feel is the first step to feeling better. A physician is the best person to contact because they need to know your medical history. If you are resistant to seeing a physician, ask a friend, member of the clergy, nurse or other confidant to make the appointment.

To be clinically depressed is to have a medical illness and need treatment. Depressive disorders are diseases of the brain, just as cardiovascular diseases are diseases of the heart and circulatory system. Depressive disorders are not the result of character flaws, bad parenting, divine punishment, or personal weaknesses. They are nothing to be ashamed of or embarrassed to have.

Indeed, you should feel just the opposite. Learning to spot the signs of depression is like learning to spot signs of cancer. It can save your life! Being proactive, learning to detect the signs of depression, and getting help are essential steps to good health!

The Diagnosis of Depressive Disorders

To be diagnosed with a major depressive disorder using current diagnostic criteria, you must display at least five of the following nine symptoms:

This list of symptoms is not intended as a way for you to diagnose yourself, but rather to educate you about the dimensions of depression. It also gives you a sense of the areas about which your physician may interview you.

Symptoms of major depression usually develop over days to weeks. In the months before these symptoms become serious you may have anxiety, or even panic attacks. It is also possible for a major depression to develop suddenly under severe stress, such as a major life crisis or change in your health.

The features of dysthymic disorders are similar to major depression. Dysthymic disorder usually begins in childhood or adolescence. To be diagnosed with a dysthymic disorder, you must have a depressed mood most of the day, more days than not, for at least two years and have at least two of the following symptoms:

To be diagnosed with bipolar disorder you must have at least one episode of mania. There are two types of mania, euphoric and dysphoric, and a person can experience both types when they have bipolar disorder. A person who is euphoric is on a high, in love with themselves and the world. They are full of energy, talk a mile a minute, and are full of grandiose thoughts. A person who is dysphoric is experiencing a different kind of high. They talk fast and have grandiose thoughts but they are agitated, angry, destructive, and often paranoid.

Some people may have had previous episodes of depression as well as subsequent cycles of mania and depression. To be diagnosed with a manic episode using current diagnostic criteria you must have a noticeable period of persistently elevated, expansive, or irritable mood lasting at least one week, and three or more of the following symptoms in the same period:

Bipolar disorder is a lifelong condition. It cannot be cured but it can be managed effectively. Bipolar illness usually causes substantial problems that affect marriage, work, and family. Individuals with bipolar disorder need to be protected from the possible negative consequences of poor judgement and excessive activity. Over time, even in periods of remission, the chronicity and unpredictability can lead not only to legal, marital, and job problems, but also medical complications of as well as suicide.

Tips for Coping with Mild Depression

There are a number of things you can do to cope with mild depression. The following tips are helpful for everyone who experiences a normal reactive depression.

Effective Treatments for Clinical Depression

Most individuals with depression respond to treatment. Available treatments include antidepressant medications, psychotherapy, and when necessary for seriously depressed individuals, electroconvulsive therapy.

Antidepressant medications correct chemical imbalances in the brain that cause depression. Depression is caused by changes in chemicals known as neurotransmitters. Depression involves changes in two major neurotransmitters, serotonin and noradrenalin, that play an important role regulating your mood, sleep, eating, sexual activity, thinking as well as motor activity.

Ask your doctor, nurse, or pharmacist to explain how the drug or drugs you are taking changes your neurotransmitters. Understanding the biochemical changes associated with depression will actually help you get better. Knowing the effect of the treatment plan should reinforce the sense that you are in control of changing the chemicals in your brain.

There are more than three dozen different kinds of antidepressants. Four major classes of antidepressants are used to treat major depressive disorder: selective serotonin reuptake inhibitors (SSRIs), and other new compounds, including venlafaxine, bupropion, and nefazodone, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).

All antidepressant drugs available in the U.S. have been demonstrated to be effective in treating major depression, but no single antidepressant medication has been demonstrated to be significantly more effective than another. Furthermore, no single drug results in success for all patients. The selection of a specific drug depends on many factors, such as side effects, whether the drug was effective for you in the past, other co-existing medical illnesses, other medications you are taking, the type of depression, and how much the drug could interfere with your life style. Ask your physician to explain why they have chosen a specific drug for you.

Side effects occur in a certain number of patients taking any medication, and they usually are dependent on the dose and the level of drug in your blood. Many side effects are more likely to occur at the beginning of treatment or for a short time after dosage increases. Many patients adapt to most side effects over time. However, if you experience significant side effects, let your doctor know. If you cannot tolerate a certain drug, there are others to try.

Most antidepressant drugs take several weeks, perhaps 3-5 weeks, before there is some improvement. Reach out to others to help you until the symptoms improve. Sleep is one of the first changes you will notice as the depression responds to treatment. Side effects need to be closely monitored and medications can be changed when side effects are intrusive.

The newer serotonin selective reuptake inhibitors (SSRIs) are usually prescribed as the first-line treatment of depression. There are three SSRIs approved for use in the United States: Fluoxetine (Prozac), Sertraline (Zoloft), and Paroxetine (Paxil). They are all equally effective in treating depression. The most common side effects are gastrointestinal, such as nausea or diarrhea and agitation or trouble sleeping. About half of people who take SSRIs do not have side effects, and those who do can usually tolerate them. There are subtle differences in side effects so it is important to ask your doctor to explain which is best for you.

Prior to the SSRIs, tricyclic antidepressants were considered the standard treatment for depressive illness. Common tricyclics include Norpramin (Desipramine), Amitriptyline, Nortriptyline, Sinequan, Elavil, Anafranil, and Doxepin. These drugs are equally effective but their side effects differ. They can cause dry mouth, blurred vision, sweating, urinary retention, a speeded heartrate, and a tendency for a drop in blood pressure when rising from a sitting or reclining position, known as orthostatic hypotension. Tricyclics are less expensive than the SSRIs, but their side effects and toxicity make them less desirable for many people.

Monoamine oxidase inhibitors are usually only used after other drugs have not worked. Common MAOIs include Nardil (Phenelzine), Parnate (Tranylcypromine), and Marplan (Isocarboxide). MAOIs are effective but they have bad effects if you eat foods that have a protein called tyramine. A partial list of foods to avoid include cheese, yogurt, smoked foods, soy sauce, bananas, caffeine and chocolate. Medications that contain norepinephrine can also be dangerous when used with MAOIs, causing a dangerous rise in blood pressure with the risk of stroke. Drugs to avoid include antihistamines, decongestants, any cold medication, codeine, narcotic pain relievers, and some forms of anesthesia. Talk with your physician and pharmacist.

Three psychotherapies can be especially useful, often in conjunction with drugs. These include cognitive-behavioral, behavioral, and interpersonal psychotherapies. If there are marital difficulties, couples behavioral therapy can be very effective. Cognitive therapy is a short term therapy. It is designed to change your negative views of yourself, the world, and the future. Behavioral therapy focusses largely on improving social skills and communication skills to change certain behaviors. You learn to monitor daily activities, schedule pleasurable activities to counter depression, review activities that are difficult for you and find ways to master them. Interpersonal psychotherapy is based on the notion that your interpersonal relationships play on a significant role in your depression. You learn how to resolve difficulties in interpersonal functioning, such as how not to isolate yourself, how to deal with grief, role changes and cope with your health problems.

No one of these therapies is more effective than the other. However, different people may get more benefit from one or another. When your doctor suggests psychotherapy without drugs for your depression make sure your doctor has experience. If there is no improvement in six weeks and no significant improvement in 12 weeks, ask your doctor about starting a drug as well. It is important that you consider yourself in a partnership with your doctor. Each of you bring special knowledge and skills to the table to treat the depression.

Electroconvulsive therapy (ECT) can be extremely effective when individuals have a psychotic depression, or are severely depressed and have not responded to antidepressant drugs. ECT works rapidly and can literally save a persons life allowing them to return to a productive life. It can be administered in a hospital or initiated in the hospital and continued on an outpatient basis. Most people tolerate ECT very well and recover from their depression.

Effective Treatments for Bipolar Disorder

Three types of drugs are commonly used to treat bipolar disorders: mood stabilizers, antidepressants, and antipsychotics. Mood stabilizers are the primary treatment for most people. Lithium is the oldest and most common mood stabilizer , and it is usually the first drug you will be given after the diagnosis of bipolar disorder. Lithium is marketed is Eskalith, Lithane, Lithobid, Lithonate, and Lithotabs. Most people tolerate Lithium well, and it is effective by itself in more than half of all patients.

Some people have side effects that may include nausea, fatigue, diarrhea, weight gain, tremors, or having to go to the bathroom frequently. If you have side effects with regular lithium, a time-released form such as Lithobid many work better for you.

Some people need two or three drugs to stabilize their mood. Antidepressants may be prescribed if you also have significant depression in addition to the mania. Antidepressants may actually induce cycling and cause you to show manic symptoms. Therefore, it is important to watch your moods carefully and stay in contact with your physician. Antipsychotic medications may be prescribed for bipolar illness to calm people down in an acute manic phase while waiting for the mood stabilizer to take effect. The major antipsychotic drugs include Thorazine (Chlorpromazine), Mellaril (Thioridazine), Stelazine, Haldol (Haloperidol), Risperdal (Risperidone), Clozaril (Clopazine), and Trilafon (Perphenezine). Again, as with all drugs, these medications need to be monitored for side effects. These may include slowed speech and thinking, sleepiness, restlessness, confusion, stiffness or twitching.

Finding the right combination of drugs and dosages may take a long time. If the first medication does not work, do not give up. It is very important to work with your physician to find out what works for you. If the drugs are causing side effects that make you uncomfortable, do not be afraid to complain to your doctor, ask them to lower the dosage or try something else. You may find that you will have to balance the complete elimination of symptoms with a level of side effects you can handle. It is essential that you and your doctor communicate, so you both understand how you are feeling.

Although drug therapy is the primary treatment forbipolar depression, psychosocial treatments are effective to increase compliance with drug regimens, decrease hospitalizations and relapses, improve quality of life, and help cope with stress. Bipolar patients and often families express frustration and resentment because they receive so little information about the disorder and their medications. Education about the complexities of bipolar illness and it's successful treatment have been shown to be highly effective.

Family Can Help

Depression affects the entire family. Depressed individuals can make other family members as well as friends feel angry, frustrated and guilty. These negative reactions may occur when family members do not understand that a relative is depressed. They also occur when the depressed person denies they have a problem and other family members become frustrated with the deepening depression as well as the helplessness of not being able to overcome the resistance to seeing a professional. More than half of depressed adults report that their family members do not understand them. A vicious cycle can evolve when the negative emotional reactions of family members aggravate the sadness or mania, hopelessness and low self-esteem of the depressed person.

It is not easy to live with and love someone who is depressed. Chronic depression makes life tough. Arguments and misunderstandings are common in close relationships. Sexual problems often lead to distancing, stress, conflict, and even divorce in spouses. Children and grandchildren will also be affected when a parent or grandparent is critical, easily irritated, angered, or emotionally distant.

There are many ways for family members to help and support a depressed relative. Knowledge about depression, patience, and persistence are key. It is important to learn as much as you can about depression, what causes it, how the disease affects a person's thinking, world view, ability to function, and ability to communicate. It is also essential to learn how to talk to the depressed person. Learn how to be an active listener and ask your depressed relative what he or she hears you saying to them. If you think they have misunderstood say "I don't think you are hearing me", and explain yourself in a different way. Try not to be angry and accuse them of not listening. This is not an easy task. The goal is to ask your relative to help you understand them.

Tips for constructive family coping include the following:

It is not uncommon for depressed people to resist or refuse going for treatment. They frequently deny having a problem. Feelings of fatigue, helplessness and hopelessness immobilize and paralyze the person from taking action. Some depressed people resist asking for help because they feel guilty for causing trouble. And if your physician is uncomfortable or embarrassed dealing with depression, this will reinforce the denial or make the patient dig their heels in to resist help. If you are concerned that your physician will not take the time to discuss depression matter-of-factly and sympathetically, find another one.

Reassure your relative that depression is not a sign of weakness. It is an illness like heart disease, arthritis, or the flu, and it can be treated. Ask your physician to explain in detail, even using pictures, what parts of the brain are involved. This reinforces that depression is a "real" disease and the brain is affected. Ask the doctor to link specific symptoms to chemical changes in the brain, and later continue to reinforce this in discussions. For example, sleep difficulties and appetite changes are caused by chemical imbalances in a part of the brain called the hypothalamus.

Education, understanding, patient persistence, and reaching out to allies such as clergy, significant kin or friends are the keys to success. Assure the depressed person that you are concerned and willing to be there. Take everything one day at a time. Remember that living with and caring for someone with depression is impossible, so just do the best you can. Focus on being there with them until you reach the "light at the end of the tunnel." The agony, torture and bleakness can be erased and a joy of living and togetherness restored.

Selected Sources

There are many resources about depression for both patients and family members. Books include:

Terrance Real, I Don't want to Talk About It: Overcoming the Secret Legacy of Male Depression. (New York, Scribner, 1997).

Laura Epstein and Xavier Francisco Amador, When Someone You Love Is Depressed. (New York, Free Press, 1996)

Donna Cohen and Carl Eisdorfer, Caring for Your Aging Parents. (New York, Tarcher/Putnam, 1993)

A free brochure on depression in older people is available from the Geriatric Psychiatry Alliance by calling the toll-free number 1-888-463-6472.

A number of organizations can help you find information as well as specialists in treating depressed children. They include:

The American Academy of Child and Adolescent Psychiatry 1-800-333-7636.

Children's Rights of America (707) 998-6698.
They operate a 24 hour youth crisis hot line 1-800-442-4673.

One of the most acclaimed personal descriptions of the experience of depression is William Styron's Book Darkness Visible, (Random House). It is a short book describing the onset of his depression in 1985 through his hospitalization and recovery.

A book by psychologist Kay Jamison describes her personal story of living with manic depression: An Unquiet Mind: A Memoir of Moods and Madness, (Alfred A. Knopf).

Patty Duke wrote about her personal difficulties in a popular book, A Brilliant Madness, Living with Manic-Depressive Illness, (Bantam Books).

Kathy Cronkite wrote about dozens of well-known people with depression in On the Edge of Darkness, (Doubleday).

The psychologist Martha Manning wrote about her severe depression in Undercurrents, (Harper San Francisco). It is filled with humor as well as her reflections on relationships with family and friends.

Two books give basic information about depression for a lay audience. One is How to Heal Depression, (Prelude Press) by Harold Bloomfield and Peter McWilliams.
The second is Understanding Depression, (Oxford University Press) by Donald Klein.

Here are numbers for national organizations that provide information and/or referrals about depression. They may also be able to make local referrals in your community.

National Depressive and Manic Depressive Association 1-800-826-3632, 1-800-222-1213 (Connexions Program for Families).

National Institute of Mental Health; The Depression/Awareness, Recognition, and Treatment Program 1-800-421-4211.

National Mental Health Association 1-800-228-1114.

National Foundation for Depressive Illness 1-800-248-4344.

National Alliance for the Mentally Ill Helpline 1-800-950-6264.

American Psychiatric Association (202) 682-6000.

American Psychological Association (202) 336-5500.