Book Review

Diagnosis and Treatment of Chronic Depression

N Engl J Med 1996; 334:1143April 25, 1996

Article

Diagnosis and Treatment of Chronic Depression
Edited by James H. Kocsis and Daniel N. Klein. 178 pp. New York, Guilford Press, 1995. $27.50. ISBN: 0-89862-849-0

Depression is a common, often debilitating illness that remains underdiagnosed and undertreated. Despite the belief that patients with acute major depression recover completely, 15 to 20 percent of patients have chronic forms of the disorder. In addition, 3 percent of the population has dysthymic disorder, a chronic mood disorder that does not fully meet the criteria for major depression. Diagnosis and Treatment of Chronic Depression places these two disorders under the microscope. The current thresholds for diagnosis and intervention are challenged by a comprehensive and systematic review of empirical data on the subject.

The book reviews the evolution of a classification system for chronic mood disturbances and supports the current classification of dysthymia as a disorder of mood rather than personality. The candid presentation of the absence of qualitative differences between dysthymic disorder and major depression stimulates the reader to consider that the two may represent different phases of a single process. With these diagnostic caveats in place, the book sets the tone for a discriminating look at studies of coexisting conditions.

Clinicians are urged to look for dysthymia as a pervasive disturbance that underlies symptoms of anxiety or other coexisting conditions, such as acute major depression or substance abuse. The book effectively counters the pessimism of clinicians who continue to focus on character disorders in setting treatment goals for patients with these illnesses. A review of clinical trials of antidepressant medication for dysthymia, with or without coexisting major depression, clearly supports a recommendation that aggressive pharmacotherapy be offered for chronic mood disturbances.

Researchers will probably find that this book raises as many questions as it answers. This is a byproduct of its careful, academic style and the paucity of formal studies in many areas it covers. For example, it appeals for further research on children and adolescents with protracted mood disturbances to minimize developmental insults and provide better predictions of the risk of affective illness in adulthood.

Herbert E. Ward, M.D.
University of Florida, Gainesville, FL 32610-0256