Abstract
This is a very good book which, in 130 readable pages, provides a clear framework for the management of depression. Its 10 chapters are logically presented, from the signs and symptoms to diagnosis and classification, assessment and investigations, the biological basis, and then physical treatments. Psychosocial aspects are dealt with sensitively, as is the management of depression in the community and also in the hospital. The chapters conclude with a brief overview of depression in specific populations before dealing with the consequences of depression.
The fact that depression is often a recurrent disorder and that one must consider its longitudinal nature is highlighted by an excellent life chart of the treatment history of a depressed patient. Indeed, that provides an ideal pictorial model for portraying the various treatments of depression in individual patients. This is particularly so for those who appear to be treatment-resistant, but in whom, in retrospect, the resistance is not so much of the illness to the treatment, but in the therapist in implementing different treatments. The inevitable diagrams of neurotransmission are as clear and concise as one would wish and another useful table provides a clear delineation of cognitive, psychodynamic and interpersonal therapies.
There are occasional ambiguities such as: ‘Overall, the SSRIs have few side-effects of less severity than the TCAs and the MAOIs’, and a very sensible reference to pursuing open-ended questions is followed by two examples which most would consider closed, as they invite a ‘yes’ or ‘no’ response.
The book is aimed at those pursuing postgraduate examinations, but, as noted in the foreword by Professor Ted Dinan, it would be of value to general practitioners, psychologists and also basic scientists wishing to obtain an overview of depression. However, the trainee psychiatrist should peruse this book critically, as it is not without its contentious areas, and it is certainly not without fault. For example, the cautious combination of TCAs and SSRIs is endorsed with the statement that ‘Clinically, the combination may produce a more pronounced antidepressant effect with faster onset’, and the use of Pindolol as an augmenting therapy is given as much prominence as lithium, although recent studies have drawn into question its effectiveness. The authors also appear to be unaware of the fact that there has been a revision of the long-held, but erroneous, belief that depression and alcoholism both have lifetime risks of suicide of 15%. Indeed, the authors could perhaps feel let down by those whom they have thanked for not having picked that up.
Perhaps the best aspect of this book is that it is relatively brief, and it is cohesive because it is not multiauthored. Despite some minor reservations, it is endorsed as a good introduction to the management of depression.