Abstract
This book contains contributions from mainly North American authors, with some European and one Japanese author, and aims to update the practitioner on current issues associated with the treatment of depression. Chapters on many of the most relevant areas of interest for the clinician: treatment of major depression; bipolar depression; non-major depression; depression in patients with somatic disease; the elderly; and the use of electroconvulsive therapy and light therapy are included. Treatment resistance is dealt with indirectly in several chapters and an interesting and extremely relevant topic, the role of the patient in treatment decisions, is addressed.
The quality of the chapters is variable, some containing greater clinical emphasis while others are more theoretical. Mostly, evidence-based treatment approaches are emphasised, although there are some gems stemming from clinical experience.
The first chapter by Potter and Schmidt is very general and discusses treatment of major depression and selection of initial drugs. It is a reasonable overview, briefly written, but probably no better than any of the standard texts such as Kaplan and Sadock that are currently available.
The Nierenberg paper titled ‘Declaration of treatment failures’ gives a careful discussion of the clinical issues involved in deciding whether a particular agent is or is not working. Although not directly dealing with treatment resistance, it does allude to some of the issues involved.
The chapter addressing augmentation strategies for the treatment of unipolar depression is very much from a North American perspective. Practices in this respect are quite different in Australia as well as other regions of the world and I think they therefore have a limited usefulness for the Australian psychiatrist. For instance, the use of augmenting a selective serotonin re-uptake inhibitor with a tricyclic is not as widely used nor as accepted in this country as it is in the United States. The chapter relies heavily on anecdotal information rather than on the data that is available from placebo controlled studies.
A useful, brief but to-the-point paper follows discussing switching strategies for the treatment of unipolar major depression: that is, the pitfalls of swapping from one antidepressant to another. Four chapters follow from different authors on the treatment of bipolar disorder. Possibly this important topic warrants such an intensive treatment; however, it should have received greater editorial involvement. There is too much overlap and repetition. Of these chapters, I thought the one by Post et al. was the most useful, being an excellent overview of our current state of knowledge concerning the treatment of bipolar mania.
The non-major mood disorders (i.e. dysthymic disorder, recurrent brief depressing disorder and premenstrual depressive disorder) are covered in a satisfactory way by Yonkers et al., summarising our current limited state of knowledge. This comment applies also to the chapter on depression in medical disorders.
The important area of treatment of depression in the elderly was inadequately discussed, and the chapter dealing with this was the most disappointing in the textbook. Although displaying substantial clinical wisdom, it failed to address some of the most important advances in this area over the past decade. It is enough for me to point out that the most recent reference was 1990!
Linden's chapter concerning the role of the patient in treatment decisions is a most refreshing addition to the literature and comprehensive and thoughtful overview of a most important topic.
Electroconvulsive therapy was well summarised by Max Fink, as one would expect, but the topic is also quite well covered in most of our standard texts and the chapter did not present new information for the psychiatrist who specialises in the treatment of mood disorders. Indications for light therapy is then well covered by Lam et al., and the final chapter on maintaining and discontinuing psychotropics is a clinically useful chapter.
Mostly, the chapters were well written, although frequent spelling and grammatical errors are annoying. The book seems to be mostly aimed at an American audience. The drugs not available in the United States are mostly not discussed. The problem with most books is their becoming dated before they are even published. To some extent this is true for this book, as the field is evolving so rapidly. The book is too complex for the primary care physician or even the trainee psychiatrist and would be most appropriate for the psychiatrist whose practice is very much to do with mood disorders. However, the specialist clinician might be better off by reading key review articles from the journals.