Those of us who work with dual diagnosis patients know that depression frequently is matched with addictive disorders. Conventional wisdom and practice has been to encourage the client to get clean and sober, then order an assessment for depression. The assessment may be followed by a prescription for an antidepressant medication, a recommendation attributed to the person’s flawed biological and genetic coding. Recovery from addiction becomes the province of the addiction professional, and treatment for depression is the responsibility of the prescribing physician.

Dr. Whitfield, who is both a physician and psychotherapist, suggests that the drugs-alone approach — which he describes as expensive, often toxic, and marginally effective — stems from the medical model theory about how depression happens and how to treat it.
Dr. Whitfield believes that the widespread use of antidepressants has been influenced by the high-spending drug industry and the rise of profit-driven managed care organizations. He doubts the usefulness of electroshock, or electroconvulsive, therapy, likening it to a closed head electrical injury that impairs memory, cognition, and motivation.

He also observes that there is no one single type of “depression,” but rather many kinds of experiences that are labeled with this catch-all diagnosis. There are other factors in his argument: that many depression researchers do not ask about childhood abuse, and that antidepressants do work to minimize depression but only by a few percentage points (2 to 10 percent) better than a placebo.

Dr. Whitfiled further points out that “depressed” people often have several comorbid disorders such as anxiety disorders, thought disorders, personality disorders, and posttraumatic stress disorder (PTSD).

For instance, Dr. Whitfield notes that the common symptoms for depression are remarkably similar to the symptoms of PTSD. Psychomotor agitation (depression) can be reframed as hyperarousal (PTSD) and hopelessness (depression) as a sense of foreshortened future (PTSD). Other typical signs that fit both diagnoses are decreased sleep, decreased concentration, and feeling isolated from other people.

For mild to moderate depression, Dr. Whitfield suggests first addressing addictions, co-addictions, or other disorders. Identifying and expressing feelings and working with a history of trauma, particularly with a therapist who is trained in trauma treatment, is also helpful. He also recommends non-drug aids, including exercise, morning light therapy, education about depression through bibliotherapy, and the “positive” company of others. Noting that tobacco can aggravate depression, he recommends stopping its use. If there is no improvement, it is only then that he suggests a trial of antidepressant medication.

For severe depression, Dr. Whitfield again suggests addressing addictions or co-addictions as well as exploring and addressing painful feelings with safe people. When antidepressants are given a trial, they should be used in conjunction with the regular exercise and psychotherapy. He points out that grief, if it is present, must be validated and worked though rather than labeling people who are mourning with an ongoing mental illness.

The book cites nearly 300 published articles that describe the associations and effects of trauma. The many charts and graphs document Dr. Whitfield’s observations and research while satisfying the statistician’s desire for hard evidence, rather than just opinion or preference.

Further, a timeline is presented that shows how views about treatment for depression have evolved since 1896 when Sigmund Freud and Pierre Janet began hearing their patients’ stories of trauma.

Dr. Whitfield, a pioneer in the burgeoning adult children of alcoholics movement in the 1980s with Healing The Child Within, has worked with survivors of trauma for years.
The artwork on the book’s cover, which shows a barely dressed woman crouching with her face hidden, is a curious, confusing, and unfortunate choice for a book that should be of good use to men and women.

Advanced treatment professionals who preach the interrelationships of addiction, depression, and trauma may find this material more of a review. However, new addictions counselors, students, and people who are depressed and their families will find this book informative and worth sharing.

Karen Carnabucci, MSS, LCSW, TEP, is a psychotherapist, trainer, and psychodramatist in Racine, WI, with special interests in addiction, trauma, domestic violence, creativity, and experiential treatment. She can be reached via her Web site, www.companionsinhealing.com.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2004, v.5, n.4, pp. 68-69.

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