Brooders. They also get plenty of time surrounded by the "clan," in the form of frequent social gatherings with family members, Starbucks dates with friends, and volunteer work. "Hunter-gatherers almost never had time alone," says Ilardi; even a generation or two ago, people grew up supported by extended family and much more engaged with their community. Too much time in isolation, he says, means "opportunities to ruminate," the modern scourge. Studies indicate that brooders are far more likely than nonbrooders to develop depression. "I feel terrific now, but I'm really well plugged in with my old friends," says Russo, who regularly calls and E-mails former colleagues, occasionally traveling 70 miles to Philadelphia to meet them for lunch.
Obsessive thinkers can learn to redirect themselves. Cognitive behavioral therapy, for example, teaches people to recognize when irrational negative thoughts are triggering a mood plunge and to reframe those thoughts in a rational way. Was that coworker really laughing at my outfit? Or just trying to be witty in front of the boss? A 2006 study published in the American Journal of Psychiatry found that people whose symptoms disappeared after cognitive behavioral therapy showed significant changes on MRI scans in two brain regions associated with depression. What's more, the therapy appears to be as effective as medication when used for resistant depression, according to findings from the Star*D trial.
"Drugs are quicker acting and take less work in the short run, but they only suppress the problem," says Michael Thase, a professor of psychiatry at the University of Pennsylvania School of Medicine who led the comparative study for Star*D. The therapy, he says, allows people to take action when their mood is dipping to prevent a full-blown relapse.
After learning anti-rumination strategies in weekly group therapy sessions, TLC participant Becky Foerschler of Lawrence, Kan., now puts a 15-minute limit on her mental rehashings of tense conversations with friends and family. Foerschler, who first developed depression two years ago at age 47, then uses techniques to distract herself, like calling a friend or getting out of bed to read. She says that she's been symptom free for the past 15 months.
Data on all of Ilardi's 73 graduates haven't yet been published. But he reports that 59 percent achieved complete remission, compared with just 10 percent of a control group that continued on antidepressants or therapy. And most of the patients have stayed depression free after one year of follow-up. Ilardi allows that he made things convenient: He provided free fish oil supplements and light boxes; a local fitness club donated gym memberships; and his graduate students volunteered as informal personal trainers. In the real world, people in the throes of depression often have a hard time just getting out of the house to have a prescription filled. "If I had depression, I would probably undertake many of the elements he's talking about," says psychiatrist John Rush, who led the Star*D study at UT Southwestern, "but whether they're sufficient for those with chronic depression remains to be demonstrated."
Better care. Clearly, what most doctors offer is a far cry from the extent of care Ilardi provides. A September study by the Rand Corp. found that most do a poor job of monitoring medications and addressing alcohol abuse and suicide risk; fully one quarter of patients given prescriptions for antidepressants never completed treatment, and many whose symptoms got worse weren't given a higher dose or a different medication. "Doctors shouldn't just ask, 'How are things?' " says Rush, whose symptom assessment questionnaire, available at ids-qids.org, is used widely by researchers to measure treatment effects. "Symptoms should be assessed before treatment and again after six to eight weeks. If the score on the questionnaire doesn't improve, treatment needs to be altered." The Star*D study suggests that genetic differences could explain why some folks feel completely better on a particular drug, while others get some benefit, and still others get no response or develop suicidal tendencies.