The Encyclopedia of Depression.

Roberta Roesch.

263 pp.

Facts on File, New York. 1991.

ISBN 0-8160-1936-3

Those who work in mental health areas know the vast scope of multidisciplinary information and resource material on depression. The Encyclopedia of Depression is quite remarkable, encompassing entries ranging from Dostoevski to Prozac and food to funerals. The book is very accessible and will appeal to interested individuals in the world’s oldest professions and youngest interest groups. For people suffering from mood disorders it provides useful basic information on treatment strategies such as diet, aerobic exercise, psychotherapy, drug therapy and electroconvulsive shock. There is good cross-referencing, and many of the entries have references for further exploration.

The book will be invaluable to members of the public who wish to know more about depression. As well, because of its scope, health professionals will find the book useful for themselves and for easily accessing important and interesting capsules of information for their patients and colleagues. In browsing through the entries I sensed that many of the occasional public requests for research information directed to clinics or research centre’s could be conveniently and effectively answered by referring the caller to such a text.

The book consists of items of information organized alphabetically, six appendices, a bibliography and an index. In addition to the main entries, appendices 5 (chemical and trade names of psychiatric drugs) and 6 (sources of information) will be useful to the general readership. Appendix 6 has addresses and, for most, telephone numbers of organizations. Canadian provincial and territorial agencies are widely covered. Health professionals will appreciate the data from the World Health Organization study on standardized assessment of depressive disorders (Appendix 1) and the epidemiology catchment area programs of the National Institute of Mental Health (Appendix 2).

Apart from their practical value, good encyclopedias like this are interesting for the sake of curiosity. Roesch’s collection of entries provides fuel for such an appetite with its inclusion of various morsels about historical figures who suffered from the mental aberrations of depressive illness. Further interesting entries include one on the Kahili people of New Guinea, who apparently deal with loss through the ritualized right to dance up and down and scream at a culpable neighbour! Laughter, light therapy and baby boomers, along with Nebuchadnezzar, are all to be found in these pages. The text is not exhaustive, but it is admirable for a first edition, and the author suggests that it is a work in progress.

Ask the Doctor: Depression

Vincent Friedewald

Andrews McMeel Publishing, Kansas City. 1998. 114 pp. Illust.

ISBN 0-8362-2711-5

Overall rating: Very good

Strengths: Complete, well written, organized, comfortable style

Weaknesses: Requires high school education level to read

Audience: Patients and families

This book was written to provide just enough information about the common and important condition of depression to a sophisticated lay audience. It achieves that goal in a comfortable, readable format at reasonable cost.

The information provided is much more complete and helpful than any brochures I’ve seen. Its style is friendly and logical and should encourage healthy behaviour in patients who would benefit from more information than most physicians have time to provide.

Questions at the end of each chapter review important facts, ask patients about their personal experiences and encourage discussion with their doctor. This suggests effective action; however, I would like to see research regarding the actual effects before deciding its value.

The book avoids becoming a competing authority. Throughout the text and the questions there is a respectful implication that further information can be obtained from the patient’s physician or other professional. It summarizes a conservative, middle-of-the-road, scientifically supported approach to understanding and treating depression. It is up-to-date and includes brief summaries (equal treatment) of recently introduced medications, the older agents, the psychotherapies and electroconvulsive therapy. It does not prefer one treatment type. Excess detail that might confuse or frighten a patient is avoided.

I like this little book and selectively recommend it to a sophisticated (at least high school education) audience of patients and their families. It would be most useful for patients who are already recovering from, or are currently experiencing the less severe depressions.

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.

Natural Prozac: Learning to Release Your Body’s Own Anti-Depressants.

Joel C. Robertson and Tom Monte.

215 pp.

HarperCollins Publishers, Inc., New York; HarperCollins Canada Ltd., Toronto. 1997.

ISBN 0-06-251353-2

Strengths: Clearly written and easy to understand.

Weaknesses: Downplays the role of medication in the treatment of depression, which may lead patients to delay seeking medical help or to discontinue treatment prematurely; some of the program plans are not substantiated.

Audience: Patients with mild symptoms of depression or in remission who do not require drug treatment.

Natural Prozac is a useful layperson’s guide to understanding and modifying the factors that may trigger or perpetuate mild depressive symptoms. These modifiable factors include activity level, dietary habits, lifestyle behavior as well as thoughts and emotional responses. These factors are causally linked to “chemical imbalances” of 3 main neurotransmitters in the brain: dopamine, norepinephrine and serotonin. Each neurotransmitter is responsible for various states of mental functioning. Serotonin is linked to “peace, concentration and well-being”; dopamine is responsible for “alertness, energy and aggression”; and norepinephrine is involved in “speeding up your thoughts.” Alteration in the levels of each is postulated to cause malfunction of the brain and to produce an overly passive “satiation” or an overly active “arousal.” Corresponding depressive symptoms may result when triggered by 1 or more of the modifiable risk factors. Genetic, generational or conditional and situational factors are used to explain the underlying mechanisms.

To explain the effect of neurotransmitters in an easy-to-understand way, the authors use lay terms such as “gas and brake pedals.” Some concepts may be misleading and even harmful to certain patients who require continuing drug treatment. For example, references to “ending depression — safely and permanently” and to “start[ing] to taper off medication gradually” may be taken out of context by some readers. Simple outlines of the criteria from the Diagnostic and Statistical Manual of Mental Disorders are given for self-assessment of serious or suicidal depression. Situations that may trigger symptoms are well outlined with the use of case histories.

Part of the book describes “programs for healing depression,” including very specific diets and exercises to “boost the levels” of each of the neurotransmitters. Entertainment, play-acting, writing techniques and spiritual and religious practices are recommended in the context of structured daily and weekly plans for each personality type.

The book ends with a mail-in “mood optimization survey.”

The book makes indirect references to scientific studies, but there is no formal reference list or bibliography. The cover, foreword and introduction tend to exaggerate claims of “scientific proof and the “remarkable effectiveness” of the methods for “every depression sufferer.” However, there is little or no supporting evidence to substantiate these claims.

Natural Prozac is easy to read, with simple, clear vocabulary. It may be recommended for patients who have only mild symptoms of depression or are in remission. Symptoms may be attenuated in motivated readers who can modify clearly identifiable lifestyle or personality factors. However, care and caution must be exercised in regard to those who need continuing drug therapy. The book may create a false sense of security leading those with serious or recurrent symptoms to avoid seeking medical help or to discontinue therapy prematurely.

Speaking of sadness.
Depression, disconnection, and the meanings of illness

David A. Karp

Oxford University Press Canada, 1996, 240 pp

Strengths

Excellent description of isolation and disconnection of sufferers. Excellent bibliography.

Weaknesses

Philosophical discussion might not interest everyone. Pharmacologic treatment and its outcomes need more discussion from patients’ perspective

Audience

Chronically depressed people, medical students, family practice residents, family physicians, and specialists

Depression is a terrifying illness and one that needs to be documented and understood from the viewpoint of the person suffering. As family physicians we see depressed people daily and often find it challenging to support them. The author has done an excellent job of exposing some terrifying experiences that chronically depressed people go through. The author explains the stages of the “depression career.” I found this very helpful.

I welcomed the discussion of how “infectious” depression is when depressed people are near anyone, but I found the discussion on the pharmacologic treatment of depression negative. I can understand the author’s frustration with the medication he has tried, but recent use of the newer selective serotonin reuptake inhibitors has made treatment much more effective.

A lot of what is written in this book should come as nothing new to family physicians, especially in Canada. The author has written this book from an American perspective, and I suspect the criticisms regarding psychiatric care might be justified.

The author’s objective was to write about depression as sufferers see it. I think he manages his objective very well. However, I think the philosophical discussions at the end might not interest everyone. But the concepts elucidated in this book could help family physicians manage chronic depression better.

Book “Speaking of sadness. Depression, disconnection, and the meanings of  illness” – amazon.com