Book Review
Treatment of Depression: Bridging the 21st Century
N Engl J Med 2001; 345:301July 26, 2001
- Article
Treatment of Depression: Bridging the 21st Century
Edited by Myrna M. Weissman. 357 pp. Washington, D.C., American Psychiatric Press, 2001. $64. ISBN: 0-88048-397-0This book is a compilation of contributions to the 1999 American Psychopathological Association meeting on depression. A distinguished cast of researchers from the United States and Europe provides an authoritative overview of the history and empirical basis of psychotherapies and physical treatments. The authors avoid simply congratulating each other on the progress made in the diagnosis and treatment of depression during the past 50 years; they highlight the problems and developments that we may expect in the coming decades. In this respect, two chapters alone — one by Michels on the treatment of depression in the new health care system and one by Weissman herself on the paradox of psychotherapy — justify the price of this book.
The first section of the book begins with an exploration of the global burden of depression as highlighted by the World Bank and the World Health Organization. Their report suggests that the disability associated with depression worldwide ranks above that associated with other common and chronic physical disorders. This report has done much to focus attention on the need to improve the identification and treatment of depression and to emphasize that treatment is not simply about reducing acute symptoms, but also about preventing recurrence or relapse. Ustun reminds the reader that as people in the developing world increasingly survive into adulthood, they are also increasingly at risk for the chronic psychological and medical disorders of middle and later life. Thus, the global burden of depression will continue to rise and is likely to be one of the top 10 causes of disability for many decades to come.
The contributors also address challenges closer to home. For example, Healy restates his controversial but nevertheless interesting hypotheses about the evolution of the concept of depression and the role of drug companies in legitimizing this diagnosis and shaping the treatment. He postulates that, like any commercial group, drug companies shape markets in order to sell their products and do not simply follow market forces. Whether one agrees with his idea or not, one cannot fail to reflect on the haphazard way in which scientific facts about effective therapies emerge and to consider the political and social forces that influence the promotion or acceptance of a treatment at any given time. The first section of the book ends with a thoughtful contribution from Michels. He offers a timely reminder of how recent changes in the U.S. health care system may not be to the advantage of patients with depression. He rightly points out that if cost containment becomes the imperative that drives the system, it may impede rather than promote the use of evidence-based treatments for depression.
The other two sections of the book explore current research in genetics and the basic sciences, as well as trends in medical and psychological treatment in the United States and Europe. The chapters do not aim to provide a comprehensive overview of all aspects of the etiology of depression or its treatment. However, two clear themes emerge: changes in our understanding of depression from the viewpoint of how clinicians have translated research into useful, practical knowledge, and the need for a rapprochement between science and therapeutics.
This book offers a thoughtful and wide-ranging review of depression. It helps the reader to understand both how we arrived where we are now and how we can move forward to improve the prognosis of depression in the future. Anyone involved in research on depression will find it a valuable resource. However, it is not simply a textbook for those with a specialist's interest in affective disorders. Anyone with a general interest in depression will find much to enjoy and admire.
Jan Scott, M.D., F.R.C.Psych.
University of Glasgow, Glasgow G12 0XH, Scotland
jan.scott@clinmed. gla. ac. uk - Citing Articles (1)
Citing Articles
1
L. C. Santos, J. Simões, M. Severo, J. Vazquez, H. Lecour. (2007) Bacterial Meningitis in an Urban Area: Etiologic Study and Prognostic Factors. Infection 35:6, 406-413
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