Review of "Handbook of Depression"

This book is a classic multi-author undertaking, aimed at furnishing an updated view on the many facets of the most common of mental disorders, depression.

The editors have succeeded in obtaining contributions from leading researchers in the field, all of them working in American universities, with the exception of one chapter, authored by a team belonging to the Institute of Psychiatry, in London. Even the contribution on depression across cultures has been penned by researchers based in America!

This does not affect the academic quality of the publication, which is remarkable, but it makes it less representative in international terms. To a certain extent, this is compensated by the fact that the book includes information derived from cross-cultural research on depression.

The Handbook is divided into an introduction and four parts. The introduction provides a detailed plan for the book. The editors believe that the explosion of knowledge about depression, accrued in the last decade, called for a summary presentation in the shape of a handbook, covering the major areas in which this breakthrough has taken place.

A part has been assigned to each of these areas; part I deals with the descriptive aspects of depression, part II with vulnerability, risk and models of depression, part III with the prevention and treatment of depression, and part IV with depression in specific populations.

Each of the sections provides state-of-the-art information on its topic. All authors were asked to write something about the future directions in the field at the end of their contribution.

The first part of the book includes six authoritative chapters on crucial matters such as epidemiology, course and outcome of depression. Epidemiological data indicate that mood disorders are growing in frequency ?despite our significant progress in their treatment-, and that lifelong recurrence might be the rule rather than the exception. Some populations, such as teenagers, seem to be under increased risk. Improvements in the methodology of epidemiological studies are critical for the implementation of adequate policies at the national level to face these new challenges.

The Handbook lends special attention to the phenomenon of comorbidity, an issue that was relatively neglected in the past. Major depression is the most common comorbid disorder, but secondary disorders to depression are quite common, too. Personality disorders, in particular, are usually associated with depression, posing interesting diagnostic and therapeutic questions.

The section closes with a chapter on phenomenology and psychosocial predictors of unipolar and bipolar depression. Our current diagnostic criteria provide a clear cut separation of unipolar and bipolar disorders, but we know that in clinical practice these differences are not so obvious, giving place to difficult therapeutic decisions.

The second part, devoted to the vulnerability to depression, lists seven contributions, about half of which deal with neurobiological and genetic issues. The different pathways to depressive disorders are analyzed; I particularly enjoyed the chapter on the representation and regulation of emotion from the perspective of affective neuroscience. We finally seem to be making progress in understanding how early adverse experiences affect our neurobiology.

This part also examines the role of severe life events and of the interpersonal context in the causation and triggering of depression. Finally, there is a chapter that deals with cognition and vulnerability. Thus, the merits and shortcomings of the theoretical background of cognitive therapy and interpersonal psychotherapy -- the dominant psychotherapies in the field -- are examined in detail.

Part III begins with a paper on the prevention of the onset of major depression. This is an issue of utmost importance, since the "WHO Global Burden of Disease Study has ranked major depression as the single most burdensome disease in the world in terms of total disability-adjusted life years among people in the middle years of life" (page 1 of the Introduction). As we have said before, if depression becomes more prevalent despite our considerable progress in treating mood disorders, then we urgently need some ideas on how to prevent it on a national scale.

Part III analyzes the dominant forms of treatment for unipolar and bipolar depression, with a special consideration for children and adolescents. Pharmacological, cognitive and interpersonal approaches are covered in state-of-the-art, authoritative contributions. I found S. Hollon's article on the achievements and difficulties of cognitive behaviour therapy not only thorough in its review of the literature, but also revealing in its analysis of the future directions in the field. This chapter also addresses a major clinical problem: we know that there are several treatments for depression that do work. However, we are still quite in the dark about who will benefit from which treatment. After many years of research, there are no clear variables that can predict treatment outcome, enabling us to perform evidence-based treatment selections.

This section also highlights the considerable advances achieved in the psychological treatment of bipolar disorders, a recent and promising breakthrough of psychotherapy. Progress is also significant in the field of marital disruption and depression, with validated psychological interventions now available for couples.

The fourth and final part of the book is dedicated to special populations and depression, or, to put it simply, when depression affects somebody who is not an all-American adult. Age, gender and culture are very strong variables when it comes to assessing and treating depression. Suicide is the subject of one the chapters in this section, that comes to an end with an article penned by the editors on the directions of research in the next decade.

One of the conclusions that we can draw from this impressive mass of data is that the time seems to be ripe for approaches that try to integrate the advances of these lines of research. Some attempts at this sort of integration have been insinuated in different chapters.

Meant for clinicians, graduate students of the mental health professions and researchers, the Handbook of Depression is a valuable reference book. The blend of topics is particularly interesting, and it compares favorably to other publications on mood disorders.

The austerity of its graphic design sends a clear message: this is science with capital "S". But then again, I guess that, a hundred years from now, our times will be remembered as the Age of the Times New Roman 12.

 

© 2003 Eduardo Keegan

 

Eduardo Keegan, Professor, Chair of Clinical Psychology and Psychotherapies. University of Buenos Aires, Buenos Aires, Argentina.