Dr. Weissman is director of the Clinical and Genetic Epidemiology at the NY State Psychiatric Institute, which conducts many studies on depression in families, and co-author with late Gerald Klerman of the Comprehensive Guide to Interpersonal Psychotherapy.
In the age of managed care, medications are the emphasis in the treatment of depression. However, studies show that the combination of psychotherapy and medication are more effective in the treatment of major depression than either alone. Dr. Weissman discusses the various types of psychotherapy, what you should ask your therapist, and how family members or caregivers can be involved. She also discusses the results of her research into generational depression and her current large-scale sibling study.
How would you define psychotherapy?
There are many kinds of psychotherapy. In general, it is a talk between the patient and the therapist. But it is not just random talk. There is a theoretical basis and a protocol that the therapist follows. During therapy, patients should have a trusting relationship with their therapists so that they can discuss anything that they want. Patients need to know that the talks are confidential and they won't be chastised. That way, they can honestly evaluate what is going on without blame.
What is interpersonal psychotherapy?
In the 1970s my late husband, Gerald Klerman, developed various studies to test out the best maintenance treatment for major depression. He set out to develop a psychotherapy that would be time limited, specified in a manual, and could be tested the same way drugs are tested. The result is interpersonal psychotherapy.
The idea behind interpersonal psychotherapy is not to cure major depression, but to understand the relationship between the onset of depression and what is going on in the patient's life at the time the symptoms emerged. This analysis provides an understanding of the environmental triggers so that the patient can better deal with those factors.
There are other structured psychotherapies that have been tested that are good, especially cognitive behavioral therapy. Both interpersonal psychotherapy and cognitive therapy have been tested in clinical trials and specified in a manual.
How effective is psychotherapy in comparison to medication?
There was a study published by Chuck Reynolds that showed that the combination of medication and psychotherapy is better than either alone for major depression. One of our studies showed that the combination is better than either treatment alone. Psychotherapy and medication have different outcomes. Medications more rapidly affect the symptoms. Patients sleep and eat better quickly on medication. Psychotherapy usually takes longer.
What types of questions should one ask about psychotherapy?
You should ask your therapist what type of psychotherapy is being used, how long will it last, and what you can expect (what will your therapist cover). What will your therapist do if the psychotherapy doesn't work and how will your therapist know it is not working? For example, if by the end of ten to twelve weeks, you don't have some reduction in your symptoms (e.g., eating or sleeping better), what will your therapist recommend?
How should family members be involved in psychotherapy?
We encourage family involvement and meeting with families, but only with patients' approval. We have done studies involving martial partners. We found that often the marital partner was also depressed. For adolescents, we always have the parent involved in the initial phase and may bring in the parent later.
What research are you conducting on depression in families?
We are studying three generations of depression in families. We have grandparents, parents, and children that we have followed for over 15 years. We also have studied depressed children, now grown up, that we followed into adulthood to study the likelihood that childhood depression leads to adult depression.
We are currently looking for siblings for our Genetics of Major Depression Study, the largest study involving at least two siblings that have major depression. This is a study of depression that starts before the age of 30, which is considered to be the most severe with the most familialty. We compare the genetic material of siblings (blood samples) to help us discover the gene location for major depression.
What results have you found about families from your studies?
We have confirmed that depression runs in families. It is not inevitable and you are not doomed if you have depression in your family, but your risk is increased. If the general population risk for depression is 10%, your risk may be 30%. Also, depression runs in generations, so grandchildren can develop depression. Usually the first signs are not depression, but anxiety disorders, which occur before puberty.