Abstract
This is a stimulating book. It is unlike the average psychopharmacological textbook, or the usual text on the management of depression. Rather, it provides an up to date theoretical understanding of depression, unashamedly from the biological viewpoint, supplemented by several chapters on pharmacological treatments and another focusing on sleep deprivation and light therapy.
The authors are predominantly European, with a few North Americans, and most chapters convey the enthusiasm of active researchers who in general have the capacity to present an at times dauntingly complex subject in a comprehensible manner.
In particular, the relationship between the now generally accepted neuroplasticity of the brain and its responses to external stressors and antidepressants is explored well in chapters on ‘Antidepressants and postreceptor events: the “serotonin/noradrenaline link” revisited’ and ‘Disorder of synaptic homeostasis as a cause of depression and a target for depression’ by Rossby and Sulser, and Grahame-Smith, respectively, with the latter chapter especially drawing on the concept of what Edelman has termed ‘Neural darwinism’.
The order of chapters is somewhat idiosyncratic. A review of ‘The prevalence of depression’ by Angst appears mid way through the book, but as one has come to expect of Angst, it provides a succinct overview of the subject. Angst draws into doubt the often reported increase in depression, which may be explained by memory artefacts.
The chapters on treatment are not comprehensive and, inevitably in a multi-author text, there is some repetition. However, there is much practical clinical information. Von Knorring and Bingefors in their chapter ‘Resistant depression: the need for better antidepressants’ note that there appear to be increasing data that some antidepressants may be more effective than others and, perhaps of particular interest in the Australian context where there is keen debate about the combined use of tricyclic and selective serotonic re-uptake inhibitor antidepressants, Nelson reviews favourably their efficacy in his chapter ‘Synergistic effects of serotonergic and noradrenergic antidepressants in combination’.
Other chapters of interest are ‘Adjunct treatments for rapid onset of action and greater efficacy in major depression’ by Blier, Bergeron and de Montigny, and ‘Non-pharmacological treatments for depression—focus on sleep deprivation and light therapy’ by Kasper and Neumeister, which would be required reading for anyone interested in pursuing research in these areas.
One other chapter should be singled out: that by Leonard on ‘Animal models of depression’. It provides a fascinating historical review of such models, with recent developments having been pushed to the limits of what could ethically reasonably be allowed, a fact acknowledged by Leonard.
There are shortcomings in a book with such an ambitious title. For example, although mentioned in passing, it was unexpected that transcranial magnetic stimulation was not considered worthy of detailed analysis. Similarly, although reference to electroconvulsive therapy occurs on a number of occasions in relation to the theoretical understanding of depression and in terms of the need for follow on medication, it is not dealt with in any detail.
Although there is a certain lack of cohesion, and no attempt has been made to provide an overview, this book has sufficient excellent review chapters to recommend it. These provide a sound theoretical understanding in an area which has seen so many new drugs introduced at a time when neurobiological research has provided us with tantalising insights into the relationship between stressors, the brain, psychiatric illness and its treatment.