Akiskal HS, Cassano GB (editors)
New York: The Guilford Press; 1997. 228 pp with index
ISBN 1-57230-089-2 (cloth)
This is a very good book about a difficult subject. Akiskal and Cassano, both internationally renowned for their own research in this area, have compiled works from just about all of the prominent experts in research on chronic depression and dysthymia. While some chapters are more conclusive then others, this book provides a robust list of scientific literature that has been, for the most part, succinctly reviewed and interpreted.
Dysthymia is a difficult condition to study because of its chronicity, subsyndromal characteristics and lack of representation in most epidemiological research. Initially, the chronic depressive complaints common in dysthymia were classified as character disorders; as such, they were cause for a lifetime of untreated impairment in quality of life for most sufferers. Only in the past few decades has the condition been defined and placed under the spectrum of mood disorders, particularly because of research that has identified the presence of the disorder before the onset of more severe, episodic mood disorders in many individuals. Also important to the new classification are family studies, which report a high prevalence of mood disorders and alcoholism in the first-degree relatives of individuals with dysthymia. But perhaps most convincing are treatment studies, which have shown that long-term treatment with thymoleptic medications can significantly improve chronic depressive symptoms when compared with placebo.
This book begins with a review of dysthymia and similar clinical syndromes and continues with short chapters covering the development of diagnostic classifications (and continuing contentions), etiology and treatment (psychotherapy, pharmacology and rehabilitation). There are no conclusions regarding the spectrum of chronic depressions because, for the most part, this work is still continuing. For the editor to make too definitive a statement at this point of inquiry would be a disservice to readers. I applaud the editors for reminding readers that we are only at the threshold of inquiry into these disorders. This book allows the reader to become familiar with the current state of knowledge and does not propose to do more than that.
The chapters in this book are well written and easy to read. The discussions of diagnosis and treatment are timely, evidence based and of practical use to practitioners. Because patients with chronic depression are bound to show up in most treatment settings, this book is appropriate for all types of health care professionals. In addition, the comprehensive reference lists are a great resource for academic researchers and students.