This book is a classic multi-author undertaking, aimed at furnishing an
updated view on the many facets of the most common of mental disorders, depression.
The editors have succeeded in obtaining contributions from leading
researchers in the field, all of them working in American universities, with
the exception of one chapter, authored by a team belonging to the Institute of
Psychiatry, in London. Even the contribution on depression across cultures has
been penned by researchers based in America!
This does not affect the academic quality of the publication, which is
remarkable, but it makes it less representative in international terms. To a
certain extent, this is compensated by the fact that the book includes
information derived from cross-cultural research on depression.
The Handbook is divided into an introduction and four parts. The
introduction provides a detailed plan for the book. The editors believe that
the explosion of knowledge about depression, accrued in the last decade, called
for a summary presentation in the shape of a handbook, covering the major areas
in which this breakthrough has taken place.
A part has been assigned to each of these areas; part I deals with the
descriptive aspects of depression, part II with vulnerability, risk and models
of depression, part III with the prevention and treatment of depression, and
part IV with depression in specific populations.
Each of the sections provides state-of-the-art information on its topic.
All authors were asked to write something about the future directions in the
field at the end of their contribution.
The first part of the book includes six authoritative chapters on
crucial matters such as epidemiology, course and outcome of depression.
Epidemiological data indicate that mood disorders are growing in frequency
-despite our significant progress in their treatment-, and that lifelong
recurrence might be the rule rather than the exception. Some populations, such
as teenagers, seem to be under increased risk. Improvements in the methodology
of epidemiological studies are critical for the implementation of adequate
policies at the national level to face these new challenges.
The Handbook lends special attention to the phenomenon of
comorbidity, an issue that was relatively neglected in the past. Major
depression is the most common comorbid disorder, but secondary disorders to
depression are quite common, too. Personality disorders, in particular, are
usually associated with depression, posing interesting diagnostic and
The section closes with a chapter on phenomenology and psychosocial
predictors of unipolar and bipolar depression. Our current diagnostic criteria
provide a clear cut separation of unipolar and bipolar disorders, but we know
that in clinical practice these differences are not so obvious, giving place to
difficult therapeutic decisions.
The second part, devoted to the vulnerability to depression, lists seven
contributions, about half of which deal with neurobiological and genetic
issues. The different pathways to depressive disorders are analyzed; I
particularly enjoyed the chapter on the representation and regulation of
emotion from the perspective of affective neuroscience. We finally seem to be
making progress in understanding how early adverse experiences affect our
This part also examines the role of severe life events and of the
interpersonal context in the causation and triggering of depression. Finally,
there is a chapter that deals with cognition and vulnerability. Thus, the
merits and shortcomings of the theoretical background of cognitive therapy and
interpersonal psychotherapy -- the dominant psychotherapies in the field -- are
examined in detail.
Part III begins with a paper on the prevention of the onset of major
depression. This is an issue of utmost importance, since the "WHO Global
Burden of Disease Study has ranked major depression as the single most
burdensome disease in the world in terms of total disability-adjusted life
years among people in the middle years of life" (page 1 of the Introduction).
As we have said before, if depression becomes more prevalent despite our
considerable progress in treating mood disorders, then we urgently need some
ideas on how to prevent it on a national scale.
Part III analyzes the dominant forms of treatment for unipolar and
bipolar depression, with a special consideration for children and adolescents.
Pharmacological, cognitive and interpersonal approaches are covered in
state-of-the-art, authoritative contributions. I found S. Hollon's article on
the achievements and difficulties of cognitive behaviour therapy not only
thorough in its review of the literature, but also revealing in its analysis of
the future directions in the field. This chapter also addresses a major
clinical problem: we know that there are several treatments for depression that
do work. However, we are still quite in the dark about who will benefit from
which treatment. After many years of research, there are no clear variables
that can predict treatment outcome, enabling us to perform evidence-based
This section also highlights the considerable advances achieved in the
psychological treatment of bipolar disorders, a recent and promising
breakthrough of psychotherapy. Progress is also significant in the field of
marital disruption and depression, with validated psychological interventions
now available for couples.
The fourth and final part of the book is dedicated to special
populations and depression, or, to put it simply, when depression affects
somebody who is not an all-American adult. Age, gender and culture are very
strong variables when it comes to assessing and treating depression. Suicide is
the subject of one the chapters in this section, that comes to an end with an
article penned by the editors on the directions of research in the next decade.
One of the conclusions that we can draw from this impressive mass of
data is that the time seems to be ripe for approaches that try to integrate the
advances of these lines of research. Some attempts at this sort of integration
have been insinuated in different chapters.
Meant for clinicians, graduate students of the mental health professions
and researchers, the Handbook of Depression is a valuable reference
book. The blend of topics is particularly interesting, and it compares
favorably to other publications on mood disorders.
The austerity of its graphic design sends a clear message: this is
science with capital "S". But then again, I guess that, a hundred
years from now, our times will be remembered as the Age of the Times New Roman
© 2003 Eduardo Keegan
Eduardo Keegan, Professor, Chair of Clinical Psychology and
Psychotherapies. University of Buenos Aires, Buenos Aires, Argentina.