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Handbook of Depression. Second Edition

EE Beckham, WR Leber, editors

New York: Guilford Press; 1995. 628 p

This multiauthor book is edited by E Edward Beckham, PhD, and William R Leber, PhD, both associate professors in the Department of Psychiatry and Behavioral Sciences at Oklahoma University. Its 628 pages contain 5 sections and 2 appendices: 1) Defining the Boundaries of Depression (epidemiology, diagnostic classification, assessment of severity and symptom patterns, and relations to other Axis I, Axis II, and Axis III disorders); 2) Biological Processes and Treatments (genetics, biological processes, somatic therapies including drugs, and medical diagnostic procedures); 3) Psychological Therapies (cognitive, behavior, interpersonal, analytic, couple and family, integration, and comparing and combining psychotherapy with pharmacotherapy); 4) Special Populations (children and adolescents, geriatrics, people at risk for suicide, women); and 5) Psychological and Social Contexts (life context and coping processes). The appendices provide information on rating scales available for assessment of depression in children and adults, the adult section including the full Hamilton and Zung rating scales.

This book largely succeeds in its goal of offering a comprehensive and up-to-date review of the field. As a 2nd edition, a number of chapters are polished updates of the 1st edition, and the approach is a scholarly one with plentiful references.

The 1st section on epidemiology, diagnosis, and comorbidity deals successfully with difficult conceptual issues. It also provides useful sections on depression and cancer and other important cardiovascular, neurological, endocrinological, and immunological diseases, including treatments.

The chapter on genetics is restricted, surprisingly, to bipolar illness, in a book otherwise devoted to depression. The chapter on biological processes in depression is substantial (at 66 pages with references) and excellent. The identification of melancholia as a black mood rather than black bile in discussing the views of Hippocrates suggests that the editors need a brushup in the classics!

Treatment for depression is overly weighted toward the psychological therapies, with 6 chapters on psychotherapies, 1 on somatic therapy, and 1 on the combination. The chapter on somatic treatments, brief at 22 pages, succeeds best in its description of the pharmacology of antidepressant drugs. For the psychiatrist reader, the book would have benefitted from separate chapters on electroconvulsive therapy and treatment-resistant depression. Electroconvulsive therapy receives only one-half page, with no reference more recent than 1989 and no reference to the important work of Harold Sackeim and his coworkers at Columbia University. Only a page and a half are given to the treatment of resistant depression; no mention is made of leucotomy, and the references for thyroid hormone augmentation of antidepressant medication are no more recent than 1984, ignoring, for example, recent contributions by Russell Joffe and colleagues. Regarding some statements and recommendations in this chapter, some changes would be advisable: 1st, it takes several weeks (rather than days) to recover normal function of monoamine oxidase after discontinuation of irreversible monoamine oxidase inhibitors; 2nd, 3 to 4 weeks (rather than 2) should elapse after discontinuing an irreversible monoamine oxidase inhibitor before starting serotonin reuptake inhibitors, particularly clomipramine and venlafaxine; and 3rd, it can take considerably longer than 5 weeks for adequate washout of fluoxetine in some patients, and fluoxetine plasma levels can assist in determining when it is safe to commence an irreversible monoamine oxidase inhibitor.

While based on a level of scientific rigor no more advanced than a review of cases treated, the chapter on long-term analytic treatment contains a review of the developments in the psychoanalytic theory of depression and some case descriptions that would be of value to students. The authors assert that “medication ameliorates the more biologically based symptoms (e.g., early morning insomnia, anorexia, or anergia), whereas psychotherapy exerts an effect on the individual’s more psychological functions (e.g., social withdrawal, suicidality, or low self-esteem)” and advocate medication in appropriate cases to permit successful psychotherapy. While it is clear that many patients with depression require psychotherapy in conjunction with medication and that successful pharmacotherapy often creates ideal conditions for successful psychotherapy, it is also clear that medication alone can completely resolve severe “psychological” symptoms of depression, and recent research shows that fluoxetine can even lift mood in normal subjects.

The chapters on special populations are generally balanced and comprehensive. The chapter on women and depression concludes that the female:male ratio for depression of 2:1 is accounted for by social and psychosocial factors rather than biological ones and ends with the warning that DSM nosology may be “a means of perpetuating a white male Eurocentric understanding of what constitutes mental health for this world’s population.” This chapter seemed somewhat 1-sided, but perhaps that is because this reviewer is a biologically oriented white male psychiatrist of European descent!

While the book does appear to have been carefully reviewed and proofed, small errors are inevitably present in a book of this size and scope. For example “ondanserton [sic]” is identified as a 5-HT3 agonist rather than an antagonist at this receptor, and tertiary and secondary amine tricyclics are said to have 3 and 2 methyl groups respectively, rather than 2 and 1.

On balance, the strong points of this book outweigh its weaknesses. It would be a valuable addition to libraries (health sciences, psychology) and would be useful to students in the clinical psychological sciences (psychiatry, clinical psychology) and clinicians and researchers with an interest in depression.