In every way, depression is a growing problem. Rates of depression have steadily climbed over the last 50 years and are significantly higher in those born after 1945 than in those born before. In addition, the average age of onset of a first depressive episode is steadily decreasing—it is now mid-20s whereas it once was mid-30s. Cross-cultural data show that the United States has a higher rate of depression than almost any other country, and that as Asian countries Westernize their rates of depression increase correspondingly.

The data make it abundantly clear that these changes are not the product of individual biochemistry or of family genetics but of pathology within our culture. There are many depressogenic factors operating in our culture. Information overload is one. Since 1945 we have accumulated at least as much information as we had throughout history until then.

The more information there is, the more we end up essentially skimming the surface. This leads to a style of thinking in which we see only the big picture and miss the depth of detail. As a result, when we are faced with difficult problems, we do not recognize the many small steps that solutions typically require; things feel overwhelming and insurmountable, leading us to give up before we even start.

Our growing reliance on technology also contributes to depression. One of technology's main values is speed. But speed has warped our perspective of time so that we expect things to happen at ever-faster rates. Embracing speed as a cultural value has advantages when you're dealing with things that can actually be done quickly, such as e-mail, but it is a profound disadvantage when applied to other domains of life, like building a relationship.

You can't instantly learn to be a good judge of other people's character or instantly build good relationships with your colleagues at your new job. But people want a good relationship, and they want it now, without having a clue what the steps are and how long it takes to achieve each one. They expect instant intimacy and fool themselves into thinking they've achieved it by sleeping with somebody before they know who the person is.

Depending on whose data you believe, Americans watch between four and seven hours of television per day. This has insidious effects on our culture, such as reducing our tolerance for frustration. Watching major problems occur and get resolved in 30 minutes, with two commercial breaks really does lead us to underestimate the complexity of things.

It has became fashionable to call depression a disease, to medicalize it. And certainly neurotransmitters like serotonin and norepinephrine are involved in depression. But if you ask the more critical question—is biology the cause of depression?—the best data suggest that genes account for about one in five cases. The idea that a chemical imbalance causes depression, rather than reflects it, ignores the fact that the brain's biochemistry responds to our ways of thinking—in short, to life experience.

When therapists go looking for the cause of depression, they are wasting valuable time. Depression, scientists have learned, is an organized, patterned way of responding to events and experiences. For example, some people develop the tendency to take things personally, even when things are not personal. Or they tend to engage in all-or-nothing thinking. Either way, the result is that they draw wrong conclusions about events and make the mistake of believing those conclusions rather than testing them. A person whose relationship has broken up tells himself, "No person will ever love me, I'll never fall in love again." And he doesn't, unless somebody comes along and challenges that false belief.

It has long been assumed that when depression runs in families the cause is defective genes. But parents also transmit their general patterns of perception and thinking to their children. Some children are programmed early in life to make grossly negative interpretations about themselves. They bring home an A-minus grade and their father says, "You're a lazy kid. You're grounded until you get an A." Just like that they learn that they're nothing without the A, that it's all or nothing.

Depression is helped most when we encourage people to be active on their own behalf, to challenge their own thinking, to find out whether the thoughts that hurt them are true or not. That's why psychotherapy outperforms medication in the long run. In studies comparing drug therapy to psychotherapy for depression, after about a month medications are ahead; they provide a reduction of symptoms more quickly and more reliably than therapy does. After a couple of months, antidepressants and psychotherapy are running neck and neck; at 12 weeks, therapy is actually slightly ahead. Clients feel better about themselves when they're taking action on their own behalf and learning the principles that will help insulate them from later episodes of depression. As a result, relapse occurs 50 percent more often among patients receiving medication alone than among those receiving both drugs and therapy.

Cognitive therapy, behavioral therapy, interpersonal therapy, and medication all work. But, no matter what, you do need a variety of skills in order to avoid depression. Here are some of them:

Perhaps the most important skill is the ability to recognize and tolerate ambiguity. In many situations in there is no single correct answer but a variety of possibilities. Life is inherently ambiguous; an experiential Rorschach. It is in response to ambiguity that we're most likely to make the negative interpretations that can lead to depression.

Critical thinking is crucial for overcoming depression. By this I mean the ability to examine the evidence and correctly assess the truth of your beliefs, to discriminate between things that you're responsible for and things that you're not. People tend to underestimate or overestimate the amount of control they actually have over situations. If they assume they're helpless when they're not, they don't even try. The ability to recognize what you are and are not responsible for is directly related to how much guilt you experience.

You need to discriminate between ways in which you are defined by your achievements and ways that you are not. Times when it's okay to get in touch with your feelings, and those when you'd better get out of touch with them. When it's okay to focus on the present, and when it's better to concentrate on the future.

Another crucial skill is the ability to clearly articulate goals. Wanting to be happy is not an unreasonable goal. But what exactly do you mean by happy? Whatever else therapists do, they must create learnable sequences for people to follow in achieving their goals. When someone tells me, "I want to be happy." I respond, "Great, let's create a flowchart for how to do that."

A highly important skill for warding off depression is learning to discriminate between what you feel versus what is objectively true. Good mental health requires you to juggle the interplay between what's going on within you and what is going on out there.

Finally, relationship skills are important for preventing depression. We've known for decades that relationships serve as buffers against illness and emotional disorders. The people who are at the greatest risk for depression are those who are most lonely. Demographically, single women face the highest risk; married men, the lowest. So it's crucial to know how to meet people, assess them, communicate with them, let them know you're interested in them. And once you're in a relationship, you need to take steps to keep it healthy, such as asserting personal boundaries and setting up the rules by which the relationship will operate.

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A Whopper of a Tale,  Omega-3s, found mainly in fish, are great for the brain and more.

Hara Estroff Marano

It's hailed as the most important finding in psychiatry in the last 40 years. Yet the information is as old as mankind.

Compelling evidence is amassing that regularly eating a class of fats widely found in fish and seafood is effective in preventing and even treating depression. The fats, so-called omega-3 fatty acids, turn out to be critical components of nerve cells and are available solely from what we eat.

Omega-3 fats also appear to have been integral parts of the diets of our prehistoric ancestors. Although the amount of omega-3s in the food supply has radically dropped in the past hundred years, eons of evolution have custom-crafted our brains and bodies to depend on them for basic biochemical maneuvers.

It's taking some very sophisticated science to highlight just what functions omega-3s serve for modern man. Ongoing research indicates that they are key to the smooth operation of arteries and hearts, and abet blood flow. A lack of omega-3s may help explain why depression and heart disease tend to occur together. Omega-3s also keep the immune system from overreacting.

But their most significant role may be in the brain. There are two principal omega-3s, DHA, or docosahexaenoic acid, and EPA, or eicosapentaenoic acid, and scientists now know that DHA spurs the development of the infant brain and visual system. In fact, the Food and Drug Administration has approved DHA for incorporation into infant formulas in the U.S.

Joseph R. Hibbeln, M.D., a psychiatrist at the National Institute of Alcohol Abuse and Alcoholism, almost single-handedly opened the most exciting frontier in medicine in the mid-1990s when he reported that prevalence rates of major depression around the world vary as much as 50-fold, and the differences can be predicted by a single factor--a country's rate of seafood consumption. Since then, researchers have shown that:

* In a double-blind pilot study of 30 patients with manic-depression who had not responded well to standard medications, omega-3s (given as fish-oil capsules) stabilized mood so effectively the trial was halted after four months so that more patients could be treated with the supplements, alone or in combination with drugs. A larger study is now underway,

* One gram a day of EPA given to patients with major depression improved their clinical course by 50 percent over and above that achieved by the antidepressants they were already taking.

* Blood tests of depressed patients show a marked depletion of omega-3s in red blood cells.

* Prevalence rates of seasonal affective disorder follow latitude--except for Iceland and Japan, two northerly countries where fish is consumed regularly.

* In a survey of 3,000 people of northern Finland, eating fish two times a week reduced by 47 percent the risk of being depressed, and similarly reduced suicidal thinking.

* In a stringently controlled study of 22 countries, prevalence rates of postpartum depression were found to vary according to rates of seafood consumption. "Pregnancy depletes mothers of omega-3s," explains Hibbeln. "The placenta selectively binds DHA and delivers it to baby's brain." The U.S. fared poorly in the survey, particularly the inner cities.

* In a strictly controlled 16-country analysis of prevalence rates for several psychiatric disorders, schizophrenia and anxiety disorders showed no relationship to seafood consumption; but a 30-fold variation in rates of bipolar disorder could be predicted by amount of seafood consumed.

* In newborn animals fed DHA-supplemented formula, levels of the neurotransmitter serotonin doubled in the frontal cortex, an area of the brain implicated in mood disorders.

No one is sure yet whether the effective antidepressive agent in adults is EPA or DHA or both. Or how much of either, in what proportion, is needed. And it's not clear when the most important effect of omega-3s against depression is established.

"In the cross-national surveys, the people have been exposed to differing intake of omega-3s virtually their entire life. The data don't say whether the protective effect was established primarily in early development and carried into adulthood, or whether there's a direct treatment effect in adulthood. Data suggest the latter, but that does not rule out an impact also in infancy."

The story of omega-3s in medicine, says Hibbeln, "is just getting underway." He and others believe that across the board, Americans should increase their intake of omega-3s. But given the unknowns, he is content to recommend getting the fatty acids from real food rather than supplements.

Both EPA and DHA are found in algae and seaweed and travel up the food chain to all seafood. It is a myth, says Hibbeln, that they exist only in cold-water fish. The highest concentrations of DHA are found in caviar and mackerel. Sardines are close to the top. Omega-3s are also found in flaxseed, walnuts, and in wild plants and game.

Hibbeln's recommendation for preventing psychiatric disorders is exactly what the American Heart Association now believes fights cardiovascular disease--eating seafood two to three times a week. That includes crabs and shrimp and oysters. "They're all better than hamburger," he says.

But adding seafood is only half the story. It's essential to cut out sources of corn oil and soy oil--almost ubiquitous in margarine, fried foods and commercial salad dressings. They contain a predominance of omega-6 fatty acids, which compete in the body with omega-3s and displace them.

"If you cut out soy oil and corn oil, and use olive oil instead, you will double the effect of any fish that you eat," Hibbeln contends. "You get closer to a Mediterranean diet. And that's closer to the diet on which mankind evolved."

Nevertheless, high concentrations of fish oils in supplements are available in health-food stores. But anyone who takes fish oil supplements has to also take antioxidant vitamins to prevent the conversion of omega-3s into substances that actually damage cell membranes. Andrew L. Stoll, M.D, head of psychopharmacology at Harvard's McLean Hospital and a key omega-3 researcher, recommends 500 mg of vitamin C and 400 units of E.

"I don't want patients to stop their medications and start these. It's best to work with your doctor. Educate your doctor," says Stoll.

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Vitamin B: A Key to Energy, To fight fatigue, irritability, and poor concentration power up with B vitamins.

B vitamins are often called the energy vitamins, but they are more like keys that unlock it.

Fatigue, irritability, poor concentration, anxiety and depression—all can be signs of a B vitamin deficiency. That's because compounds in the B complex are needed for everything from the healthy maintenance of brain cells to the metabolism of carbohydrates, the brain's source of fuel. Bs are also necessary for production of neurotransmitters, which regulate mood and conduct messages through the brain.

The B complex includes B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, pantothenic acid, biotin, B12 and folate, also known as folic acid on vitamin bottles. It also includes choline, a nutrient found in eggs that is needed to produce cell membranes and may slow age-related memory loss.

Which B is most important? It's impossible to say.

"They all have important roles," says Roxanne Moore, a registered dietitian at the Maryland Department of Education and a spokeswoman for the American Dietetic Association. A varied, healthy diet of lean meats, colorful vegetables and whole grains will usually cover the bases.

The subgroup of B6, B12 and folate is the subject of much research. Sufficient intake lowers rates of birth defects, cardiovascular disease, depression, dementia and Alzheimer's disease. The three work together and even marginal deficiencies have large effects.

B6 and B12 contribute to the myelin sheath around nerve cells, which speeds signals through the brain. B12 and folic acid together are needed for making normal cells, including blood cells. Inadequate B12 or folic acid can yield blood cells unable to carry vital oxygen to the brain.

These three Bs aid in the manufacture of the excitatory neurotransmitter GABA, as well as serotonin and dopamine, neurotransmitters that regulate mood. All three neurotransmitters interregulate each other, but the ways they work in concert or against each other are only beginning to be understood.

Only rarely are the effects of a B vitamin deficiency clear-cut. The Centers for Disease Control reported that two children had severe motor and language skill delays because of a deficiency in vitamin B12. They had both been breastfed by vegan mothers who were also deficient in B12.

The vitamin occurs naturally only in animal products, although many cereal and soy products are fortified with B12, among others. Both children quickly improved after eating a new diet, but both also had lingering language and motor problems a year after treatment.

"The problem doesn't affect just vegetarians," says Maria Elena Jefferds, Ph.D., a CDC epidemiologist. "There are plenty of non-vegan Americans who don't pay enough attention to what they eat and lack basic nutrients."

The key is a varied diet. The importance of some nutrients is only now emerging.

Choline is one that shows promise. Found in protein-rich food such as eggs, it is needed by everyone for the production of cell membranes and for making the neurotransmitter acetylcholine, which affects memory. Pregnant women must also consume choline to support the rapid production of fetal brain cells.

Pregnancy may prove to be the most decisive period for many nutrients. Animal studies by Duke University neuroscientist Christina Williams, Ph.D., have shown that a diet with four times the normal amount of choline during pregnancy can actually prevent memory decline in offspring as they reach old age. Supplemented animals also have superior memory throughout their own lives.

"Early choline supplementation actually changes the brain, altering the structure and the functioning," says Williams. "We were astounded by such a big affect."

Choline was added to the government list of essential nutrients in 1998. Data from the Human Genome Project may show that we all have a "nutrient genotype." "It may all come down to sluggish enzymes," says Williams. "It may be that most people eat enough choline, but some people can't use it."

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Natural Help for Antidepressants
Augmenting antidepressants with folic acid. Help for treatment-resistant depression Vitamin B folate, or folic acid, is now in the psychiatrist's arsenal of antidepressants.

Hara Estroff Marano