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Book Review   |    
Victoria A. Shea
Psychiatric Services 2007; doi:
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by Rif S. El-Mallakh and S. Nassir Ghaemi; Arlington, Virginia, American Psychiatric Publishing, 2006, 277 pages, $49 softcover

Dr. Shea is assistant professor of psychiatry at the University of Massachusetts Medical School, Worcester.

This paperback book is devoted to bipolar depression. Clinicians, especially those who treat patients with bipolar disorder longitudinally, will find the book useful. The long-term course of bipolar illness is often complicated by periods of increasingly treatment-refractory depression. Clinicians are often faced with the dilemma of initial-onset depression—determining whether the depression is a part of bipolar or unipolar illness—and worry about antidepressant-induced mania.

The book has two editors; one is Rif S. El-Mallakh, who is the director of the Mood Disorders Research Program and associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine, is the major contributor to the treatment section of the book, in particular discussing the use of lithium and anticonvulsants, antidepressants, and antipsychotics in the treatment of bipolar depression. S. Nassir Ghaemi is the director of the Bipolar Disorder Research Program at Emory University. Dr. Ghaemi has authored other books and numerous articles on clinical psychiatry. Interestingly, Dr. Ghaemi obtained a postdoctoral master's degree in philosophy and authored a book titled The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness.

The chapters are written by various contributors, and the covered topics include diagnosis, biology, special topics, treatment, and prevention, divided into 11 chapters. The authors have done extensive literature reviews to accompany each chapter, so if the reader decides to delve further into the subject matter, the information is easily accessible. The subtitle claims that this is a comprehensive guide, which is a bit misleading. The treatment of the multiple subjects relating to bipolar depression in the book is perhaps more accurately described as a "review." The strength of the book is in its scope, and the weakness is the lack of depth of the subjects covered.

The topic of bipolar depression is an important one, as depression is most often the first manifested illness in bipolar disorder. It would be helpful to be able to distinguish the phenomenology of depression in bipolar disorder from unipolar depression. The authors point out that there is a list of symptoms that are more common in bipolar depression than in unipolar depression, including, "atypical symptoms, psychosis, depressive mixed state, anxious or agitated depression, anergic depression, irritability or anger attacks."

In the first several chapters, the authors pay attention to such issues as the complexity of the phenomenology of manic states, especially mixed manic states; the problems in differentiating the ever-popular attention-deficit hyperactivity disorder from bipolar illness; and the complexity of personality disorders, especially borderline personality disorder, which have overlapping symptoms.

Although there is no philosophical bent to the current book, Dr. Ghaemi gives the background on why bipolar depression needs to be understood more clearly, which is one of the highlights at the beginning of the book.

In addition to this book, the reader may want to review texts that cover the whole syndrome of the bipolar diathesis.




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