Not Just Singing the Blues

Depression is a serious medical affliction that can alter quality of life, or in extreme cases, end it.

But Dr. William Lawson, chair of the department of psychiatry at Howard University, says there might be a different reason that African Americans appear to have a lower risk for depression.

“We have different idioms of distress,” says Lawson. “It’s not always easy to convince others of the importance of cultural competence training. We speak a common language and we live in the same geographical area [as whites], so it is assumed that [even though] we may look a little different, we’re really just white people when you scratch away the skin. But there are some profound cultural differences that are persistent and important, that need to be looked at.” For one thing, admitting depression is a cultural taboo among African Americans. Lawson says he has worked with black churches where people were more ready to accept people with HIV than those who were depressed. In addition, since most African Americans will seek help from their primary care physician when faced with symptoms of depression before seeing a mental health professional, they are more likely to be given medication and nothing else.

“If a patient comes in and sits down and you give them pills, they’re not going to take them,” says Lawson. “African Americans will often prefer psychotherapy over medication, and the research shows that psychotherapy is just as helpful.” In fact, the combination of psychotherapy and medication has frequently been shown to be effective in treating major and chronic depression. Lawson notes that there is a strong ne
ed for African Americans to be included in more clinical trials to determine how medications might affect them specifically. He also says that African Americans should generally be prescribed lower doses of some antidepressant medications because they metabolize them differently and therefore have higher instances of side effects.

“With respect to African Americans, falling prey to mental illness places you in a vulnerable position, and we’re already in a vulnerable position,” says Boris Thomas, a psychotherapist and social worker based in Chicago. Thomas acknowledges that the situational differences African Americans experience in this country because of race can be significant stressors that may cause depression in some people. “There’s a great deal of pressure to succeed in society, but there’s also pressure on that person to manage issues of race. Being depressed can feel like it affirms some kind of weakness.” But he urges people to get control of depression because ignoring the symptoms will not make them go away. They might even get worse. “Understanding that other people have similar problems, or ‘universalizing’ an ailment, can be a great help and reduce the sense of isolation,” he says. “In this regard, group therapy can be very effective.”

For Ruballo, the changes he experienced were not subtle, and people who are truly depressed will be able to identify the severity of what they are feeling. “I was very outgoing [before]. I was very happy. It was a big change from being an extrovert to an introvert,” he says. “Sometimes the kids felt that they

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