Andrew Solomon

Virginia Woolf has written about this state with an eerie clarity: “Jacob went to the window and stood with his hands in his pockets. There he saw three Greeks in kilts; the masts of ships; idle or busy people of the lower classes strolling or stepping out briskly, or falling into groups and gesticulating with their hands. Their lack of concern for him was not the cause of his gloom; but some more profound conviction—it was not that he himself happened to be lonely, but that all people are.”

There is a Russian expression: if you wake up feeling no pain, you know you’re dead.

Kay Jamison thumps the table when she gets going on this subject. “It’s not like depression’s an innocuous thing. You know, in addition to being a miserable, awful, nonconstructive state, for the most part, it also kills people. Not only through suicide, but also through higher heart disease, lowered immune response, and so on.” Frequently, patients who are medication-responsive cease to be responsive if they keep cycling on and off the medications; with each episode, there is an increased 10 percent risk that the depression will become chronic and inescapable.

George Brown said succinctly, “Depression is a response to past loss, and anxiety is a response to future loss.” Thomas Aquinas proposed that fear is to sadness as hope is to pleasure; or, in other words, that anxiety is the precursor form of depression.

I try to be cautious with my friends who are too sane. Depression is itself destructive, and it breeds destructive impulses: I am easily disappointed in people who don’t get it and sometimes make the mistake of telling off those who have frustrated me.

psychoanalysis, I had studied my own past in detail. I have since decided that my mother was also depressive. I can remember her once describing the sense of desolation she had felt as an only child. She was irritable as an adult. She used pragmatism as a force field permanently to shield her against uncontrolled sadness. It was, at best, only partially effective. I believe that she kept herself from ever experiencing a breakdown by regimenting and regulating her life; she was a woman of remarkable self-discipline. I believe now that her blessed rage for order was ordained by the pain she so fastidiously relegated to a place just below the surface.

The wish for a more visible illness was, I would later learn, a commonplace among depressives, who often engage in forms of self-mutilation to bring the physical state in line with the mental.

Most people who take benzodiazepines will develop tolerance and dependence, which means that they cannot stop them suddenly; but they will not take escalating doses to obtain therapeutic benefits. “With these drugs,” says Friedman, “addiction is a problem mainly in people with a history of substance abuse. The addictive risk of the benzodiazepines is greatly overestimated.”

If many remedies are prescribed for an illness,” Anton Chekhov once wrote, “you may be certain that the illness has no cure.”

More striking than the popular but vague focus on hormones is that men actually synthesize serotonin about 50 percent more rapidly than women do, which may well give men greater resilience. Women’s slower replenishment of serotonin reserves may leave them prone to lagging depression.