General management of depressive illness. Psychosocial issues

This is a complex field of inquiry in which there has been research along several lines. There are as yet however, few generalizations that are widely accepted as applying to human depressive illness. Animal models that have been extensively studied are separation, learned helplessness, and stress. However, their relation to human depression is not conclusively established. Human studies suffer from greater methodological problems than animal studies. One of the few firm findings is that there is an excess of major life events prior to the onset of depressive illness, but the effect is not highly specific, and there is no consensus on what aspect of life events is important for the production of depression. With regard to vulnerability factors, there are contradictory findings. Surprisingly for clinicians in day-to-day practice, social support and self-esteem also lack conclusive evidence identifying them specifically as causing clinical depressive illness. It is not at present possible to draw definite conclusions in this field. There are, however, promising lines of inquiry which will require increasing complexity and sophistication of method in the future.