The Many Faces of Depression in Children and Adolescents
The five chapters in The Many Faces of Depression in Children and Adolescents provide a review of the research as of 2001 on depression and youths and cover topics such as assessment, psychotherapy, pharmacotherapy, bipolar disorder, and suicide. In Chapter 1, we are reminded that children and adolescents could not be diagnosed as having depression until the publication of the DSM-III in 1980. This volume, the 21st in the Review of Psychiatry series, is a testament to how much has been learned in the past 25 years and how little is yet known about depression among youths.
Chapter 1 provides an overview of the diagnosis, epidemiology, etiology, natural history, and clinical course of depression. Chapters 2 and 5 overlap somewhat. Chapter 2 reviews psychotherapy for depression and suicide, whereas chapter 5 provides a more detailed review of suicide, including epidemiology, clinical manifestations, underlying etiological risk, prevention, assessment, and treatment. The fact that the authors of chapters 2 and 5 review many of the same studies points to how little research is available in the area. The limited research leads the authors of both chapters to conclude that the most efficacious treatment for suicidal youths is dialectical behavior therapy. They present practical information on suicide assessment and treatment, including a model for how suicides occur and how they can be prevented. The most significant limitation of these chapters can be blamed on the passage of time. Neither chapter includes the 2005 Food and Drug Administration's warnings about selective serotonin reuptake inhibitors and suicide among youths or information from the Campbell or Cochrane Collaborations' systemic reviews.
Chapter 3 reviews the use of pharmacotherapy in acute-phase treatment and continuation and maintenance therapies, as well as the use of pharmacotherapy in the treatment of resistant major depressive disorder. Chapter 4 is a review of research on bipolar disorder, including epidemiology, comorbidity, obstetrical complications, genetics, assessment, and treatment.
This volume is clearly intended for professionals rather than parents or consumers. The language is similar to that found in journal articles and assumes that the reader is familiar with professional terminology. This volume serves as a resource for grant writers, administrators, educators, and researchers who need quick access to the key findings and concepts from research literature. It also serves as a primer for clinicians or primary care providers who are unfamiliar with depression and youths. For example, chapter 3 would be useful for nonmedical clinicians—such as social workers and counselors—who are expected to understand the basic mechanisms behind depression-related medication. Although the series editors suggested that the stress-diathesis model is central to our understanding of depression, only chapter 5 includes a discussion of stress, and "stress" was not included as an index term.
Although information on the back cover suggests that this book is a must-have for clinicians and the series is characterized as a how-to, the research focus and lack of practical information make this more of a what-is volume. For example, although the efficacy of three therapies is discussed in detail, there is no instruction on how to implement these treatments. Two of the chapters conclude with implications for research, rather than practice. Perhaps this is to be expected, though. The authors do a valiant job of presenting what little research is available and make whatever clinical pronouncements the limited data will support. The fact that chapters 1, 2, and 5 contain overlapping information suggests that there are fewer faces of depression than is suggested by the title. This volume is a valuable reference for what we know and a palpable reminder that we are only beginning to understand depression among youths.
