Book Review
Mood disorders 
Treatment-Resistant Mood Disorders. Jay D Amsterdam, Mady Hornig, Andrew A Nierenberg, editors. Cambridge (UK): Cambridge University Press; 2001. 535 p. US$ 95.00.
Reviewer
rating*: Very Good
Review by: Sagar V Parikh, MD, FRCPC
Toronto, Ontario
Both from a prevalence viewpoint and from a review of continuing medical education (CME) requests, treatment- resistant mood disorders constitute the most vexing problem for psychiatrists. Thus, an authoritative treatise on the topic is most welcome, and the distinguished editors complement their own prominence as outstanding investigators with an impressive array of internationally acclaimed scientists and clinical researchers. The book comprises 5 parts, including a short description of the clinical problem of defining treatment- resistant mood disorders, a review of the biological basis for these disorders, a general treatment section, a special populations’ anthology, and a brief conclusion on issues of economics and ethics.
The first section, surprisingly, is the weakest section of the book, because multiple definitions of treatment- resistant depression, in particular, are trotted out. Surely, the editors could have imparted some wisdom here, encouraging the chapter authors to ultimately recommend a definition for most contributors to respect; instead, in this section and in the treatment section, the authors use their own classification of response and ultimately use this to make therapeutic recommendations. Further, basic issues such as revisiting the diagnosis and exploring comorbid conditions as complications relevant to inadequate treatment response should have been flagged in the introduction and not left for later in the book. In contrast, the basic science section shines as a lucid, compelling summary of key preclinical findings that integrate smoothly with clinical data. Key neuroendocrine findings are sensibly organized, and the chapter on neuroimaging provides a compelling overview of recent advances.
The treatment section has some uncomfortable aspects, which is unfortunate because it is the section that most readers will consult. Each chapter is allowed to define its own aspects of response and to use its own criteria for judging the merit of specific data—and does so in a repetitive fashion. I suspect some chapters were completed early, as their references suggest, thus leaving us with several clearly dated recommendations. For instance, 2 chapters independently cite early data, promising the utility of pindolol as an augmentation strategy; a third chapter correctly includes more recent double-blind data that deny the efficacy of pindolol. It would have helped if the editors had reduced the redundancy and emphasized the most recent results. As often happens, bipolar disorders receive insufficient attention; therapeutic strategies for treatment-resistant mania and mixed manic episodes were omitted. This is really a book about depression with some bipolar issues addressed sporadically, except for 1 marvellous chapter on bipolar depression.
Included in the treatment section are 2 chapters that address treatment modalities at either extreme of the continuum; namely, electroconvulsive therapy (ECT) and psychosocial interventions. The ECT chapter, however, reads too much like an editorial, with adequate references but a style that does not do full justice to the evidence it cites. Many of the chapters about medications include tables with summaries of relevant studies that are scholarly, helpful, and ultimately more convincing than a single-sentence conclusion with all the correct references. ECT proponents will be unable to easily marshall data advocating ECT use from this chapter. In contrast, the “Cognitive Therapy and Psychosocial Interventions” chapter is much more specific about the evidence, both in text and in table form, and provides specific suggestions for modifying interventions for refractory disorders.
The anthology on special populations is again extremely well done, with outstanding reviews on depression during pregnancy, bipolar depression, and comorbidity in treatment-resistant depression. The breadth of special populations covered, including all age groups, is also much appreciated. In the same way, aspects that deal with the medically ill are also very useful. The final 2 chapters on economics and ethics are marginally useful; the economics chapter provides some useful statistics from earlier studies and a significant new calculation of the overall health care cost impact of inadequate medication use.
In summary , this is a very good book. Its individual chapters are well written, the layout is clean, and it is free of typographical errors. Chapters by Price and others about drug combination strategies, by Stowe and others about depression in pregnancy, by Alpert and others about comorbidity, by Post and others about bipolar depression, as well as the biological basis chapters, are particularly superb and would be suitable as key references for psychiatrists at all levels. The remaining chapters are all well done and serve further as comprehensive reviews of the pertinent literature. More active editing to achieve some progress in the definitions and approaches would have assisted in helping to advance the field. Likewise, it would have been extremely effective educationally to use more clinical case scenarios. Compared with some texts, the price is rather reasonable. Every major psychiatric department should consider purchasing this text, and residents in psychiatry will find this tome very useful.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
|
