Treatment of Depression: Bridging the 21st Century

This book presents papers from the 89th annual meeting of the American Psychopathological Association, which was held in March 1999. The topic of the meeting was chosen by Myrna Weissman, Ph.D., professor of epidemiology in psychiatry at Columbia University and a well-known researcher in the areas of epidemiology in psychiatry and psychotherapies for depression. The volume's contributors are renowned experts in the area of mood disorders.

Treatment of Depression aims to "examine where we are now…in the treatment of depression and also what promises the next millennium holds." The book is organized into four sections and 15 chapters. Although all the chapters are well written, they vary in quality, scope, and intellectual stimulation.

The first section, titled "The Past and the Future," looks critically at some aspects of the recent shift in the treatment of depression. The most fascinating and thought-provoking is the first chapter, "The Antidepressant Drama." It provides a historical and political review of the development and testing of antidepressants. The reader is presented with interesting ethical and cultural issues. For example, in many non-Western countries, benzodiazepines are often prescribed for mood disorders and antidepressants are prescribed for anxiety states. The question is whether the Western practices are the result of the market development strategies of pharmaceutical companies. Another important question posed in this chapter is whether pharmaceutical companies follow what the market dictates or, like other corporations, can shape the marketplace in which they sell their products. This chapter also warns that "the psychobabble of yesteryear is being rapidly replaced by a new biobabble."

Section 2, "Basic Understanding of Depression," focuses on the contributions of modern neurosciences to the development of new treatments, the implications of genetics for research and treatment, and psychobiology's contribution to understanding maintenance treatment of depression.

The third section, on treatment, provides a slightly uneven overview of the broad range of currently available "biological" treatments and various methodologic and other problems associated with the development, testing, and application of these treatments in clinical practice (practice guidelines and algorithms). I especially liked the critical review of physical treatments, although one caveat is that the question of whether transcranial magnetic stimulation or vagal nerve stimulation works in the treatment of depression is not answered.

The chapters of the last section, "Psychotherapy and Evolving Health Care," review cognitive-behavioral therapy for depression and the ways to learn new psychotherapies. The last chapter discusses the paradoxes of psychotherapy—that is, that there are too many different psychotherapies, yet only a few have demonstrated efficacy, and that psychotherapy has been overused, yet its use is decreasing. Although short-term therapies such as cognitive-behavioral therapy have been demonstrated to be useful for depression, training in these modalities is lacking, and not only in psychiatry. Interestingly, according to this book, in 1995 only 14 percent of psychology internship programs required training in cognitive-behavioral therapy for depression, and only 3 percent required training in interpersonal therapy.

Treatment of Depression is an interesting, thoughtful, and thought-provoking book. For the most part, it meets its objective of reviewing the current state of treatments for depression. It will be enjoyed by mental health professionals who are seriously interested in all facets and methodologic problems of the treatment of depression, especially psychiatrists and psychologists. Educators may especially enjoy the section on psychotherapy. However, a busy clinician may find the book a bit theoretical and not useful in everyday practice.

Dr. Balon is affiliated with the department of psychiatry and behavioral neurosciences at Wayne State University in Detroit, Michigan.