A blanket of blue smothers millions of Americans.

The Thinkers
This monthly series will highlight people from Western Pennsylvania who are on the forefront of new ideas in their fields.

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Tony Tye, Post-Gazette Name: Dr. Michael E. Thase Age: 52 Position: Chief of adult academic psychiatry, University of Pittsburgh School of Medicine. Education: Wright State University, bachelor's in psychology, 1975; Ohio State University, M.D., 1979. Previous work: Professor of psychiatry; director of mood, anxiety and related disorders; director of research, adult psychiatry, all at Pitt medical school. Publications: "Beating the Blues: New Approaches to Overcoming Dysthymia and Chronic Mild Depression," book, with Susan S. Lang, 2004. Nearly 250 refereed articles in scientific journals and other publications. Honors: Fellow, American Psychiatric Association. Marie Eldredge Award for research, American Psychiatric Association. Click photo for larger image.

Chronic emotional depression afflicts nearly 10 percent of all adults in the United States -- nearly 20 million people nationally and 170,000 in the Pittsburgh region alone.

This largely silent epidemic means that one out of every 10 of your neighbors has trouble getting out of bed each day, can't sleep through the night, chronically misses work, has a dulled appetite or sex drive, and can't enjoy the reading or TV or children or friends or yard work or shopping that once gave life such pleasure.

Yet it doesn't have to be that way, says Dr. Michael E. Thase, a University of Pittsburgh psychiatrist and a leading expert on depression and other mood disorders.

Despite major advances in treating depression in the last few decades, the richest nation in the world still falls far short of where it could be in helping people who suffer from this debilitating disorder, Thase says.

Part of the gap is economic and social.

At any given moment, he says, about a third of depressed patients are getting no treatment whatsoever, and they are disproportionately concentrated among lower-income citizens who have less health insurance and a greater fear of seeking help because of the stigma of mental illness.

Another third are getting some kind of treatment, usually antidepressants prescribed by their family doctors, but it's not very helpful for any number of reasons -- they aren't taking it regularly, or the dose is too low, or they have the wrong medication.

Only the remaining third are getting reasonably effective treatment, and even in that group, the therapy carried out each day in the United States hasn't caught up with the latest research findings.

One of the strongest recent discoveries, and one that Thase has been heavily involved in verifying, is that there are certain forms of "talk therapy" that are every bit as potent in treating depression as drugs.

And these standardized types of psychotherapy produce even better recovery rates when they are used in combination with drugs.

Thase may be uniquely qualified to talk about combined treatments, because he is an expert in both pharmacology and psychotherapy.

He also is known for his high energy level and administrative skills, says Dr. Stephen Hollon, a psychologist at Vanderbilt University who co-authored a recent magazine article with Thase in "Scientific American Mind."

"I'd say a lot of research scientists like me are a little more tweedy and stuffy, but he's very active and energetic. He could be anybody's department chair if he chose."

Thase is promoting psychotherapy even as drugs are gaining an ever stronger foothold in treating mental health problems.

A recently completed Consumer Reports survey showed that in the past decade, the percentage of patients taking drugs as their primary treatment for mental illness rose from 40 percent to nearly 70 percent.

Bolstering this trend, Thase says, is the fact that many health insurance plans are more likely to cover drugs than psychotherapy, and that drug companies increasingly advertise directly to the public.

But not all psychotherapy is the same, and some of the blame for its failure to make greater inroads against depression lies with the therapy profession itself, Thase says.

While traditional talk therapy can help a lot of people if it's carried out by a knowledgeable, caring professional, he says, it often isn't as effective as two forms of standardized therapy that many counselors don't use.

They are known as cognitive-behavioral therapy and interpersonal therapy.

One common theme that separates these two concepts from much traditional therapy, he says, is that neither approach spends much time trying to get people to understand what forces in their past lives have made them the way they are now.

Instead, both methods concentrate more on the present and future.

Cognitive therapy was born across the state in Philadelphia, where its founding guru, Dr. Aaron Beck, still practices, and has been called by some the most influential psychotherapist since Sigmund Freud.

Cognitive-behavior therapy, an elaboration of Beck's original work, concentrates on getting depressed people to recognize distorted patterns of thinking that contribute to their despairing moods, and to change behavior patterns that reinforce those moods.

Thase used the newspaper interview itself as an example of how this vicious circle can play out.

"If during this interview I was depressed, I might be thinking 'This won't work. Why bother? This is like all the other messes I've gotten myself into.' And so that feeling that I didn't have much to contribute would also influence my posture, and my facial expression, and my voice being flat, so there'd be this reciprocity that means you might not continue as long with the interview.

"With a depressed person, there are constantly these self-reinforcing interactions with their significant others."

Cognitive therapy tries to break that cycle by getting people to recognize that their defeatist thoughts aren't accurate or realistic, and tries to cut down on the time they spend in destructive behaviors, such as complaining, or crying, or isolating themselves from others.

Interpersonal therapy focuses on depression as a disorder that hits a person during certain key moments, particularly times of grief; when someone's role in life is changing, as in going from work to retirement; when there are conflicts over that role, as in disputes with spouses over sharing responsibilities; or when the person is isolated.

Interpersonal therapy's goal is to get patients to see how their depression fits into these categories, Thase says, and then help them move away from the disabling situation.

If a woman was depressed after a divorce, for instance, the therapist might say something like, "Let's talk about this grief that you're not able to get past -- your thoughts of 'He's left me, he was my world, he was everything and now I'm nothing.' What would it take to let go of that and move on?"

Thase and fellow researchers have been able to show that more patients are helped by a combination of these talk therapies and drugs than with either approach alone.

In a 2000 study published in the New England Journal of Medicine, he and his colleagues showed that patients undergoing cognitive-behavioral therapy while taking an antidepressant scored significantly better on a standard depression rating scale after 12 weeks of treatment than either the drug-only or psychotherapy-only groups.

Another study showed patients who continue going to interpersonal therapy sessions while taking an antidepressant have a lower relapse rate than groups that stick with either type of therapy alone, and a major study last year of depressed adolescents showed a much better response rate with a combination of cognitive-behavioral therapy and Prozac than with either one alone.

Evidence from brain scans suggests the two types of therapy work on different parts of the brain, helping to explain why they have an additive effect.

In general, Thase says, antidepressant drugs seem to work by dampening the overactive emotional parts of the brain, while talk therapy seems to boost activity in parts of the "thinking brain" that depression tends to shut down, particularly the areas that govern the ability to focus and work to achieve goals.

If combination therapy is so much better, why isn't it being done more?

One big obstacle is cost, he says. Another is that many psychotherapists aren't well-trained in the cognitive-behavior or interpersonal therapy techniques.

If it were up to Thase to create an ideal therapeutic world, he would base insurance reimbursements for depression therapy on how well it was working.

"We have very reliable depression rating scales," he says. "They're almost as reliable as checking blood pressure or cardiograms."

In his model, patients would go to a therapist for a certain number of sessions and then take the rating test. If there wasn't a significant improvement, they would be switched to a therapist with specialized training, or possibly revert to drug treatment only.

Limiting the number of visits before checking how effective they were would help hold down unnecessary costs. Therapists could also explore using cognitive therapy in group sessions, so more patients could be reached at the same time.

Right now, the typical successful response by depressed patients to either drugs alone or psychotherapy alone is 50 percent, Thase said.

The simple reason he advocates a more rigorous, well-tested combination of drugs and psychotherapy?

"I'd like it so your chances of getting better were above just flipping a coin."