by Francis Mark Mondimore
Johns Hopkins University Press, 2006
Review by Kevin M. Purday on Mar 11th 2008
There are many books about depression currently available. What makes this one so special is its sheer comprehensiveness within a two hundred page limit. Having said that, it must be stressed that comprehensiveness is allied to readability to make this both a useful and a reader-friendly guide. The author is a psychiatrist and faculty member of the John Hopkins University School of Medicine and has already published books on bipolar disorder and adolescent depression. The first edition of this book came out in 1990 and the second edition in 1993. Since our understanding of the causes of depression has evolved greatly in the last fifteen years or so and since the pharmacological solutions have become considerably more sophisticated during the same period, this third edition of the book is of necessity virtually a new book.
The author's basic position about depression is that it is essentially a biochemical disorder. In other words, it is not just a 'psychological' problem which can be solved by, for example, counseling alone. It can be brought about by any one of numerous causes and be linked with any one of numerous other problems. The author deals with the biochemical processes and then works his way through the various manifestations of depression.
There has been a huge debate in psychology about the nature of mental illness. Is it psychological and caused by the situation one finds oneself in or is it biological and brought about by physical causes? The third way -- an amalgam of the two -- may well be forged in the future but currently the debate is polarized. The author is unashamedly in the biological/physical camp. His first chapter on the nature of 'mood' is basically an appraisal of the chemistry of brain function. He deals with the evolution of neuro-pharmacology -- that branch of medicine which concerns itself with rectifying brain deficiencies by administering drugs of one sort or another. He looks at the role of dopamine and the other neurotransmitters and makes a case for depression affecting the neurons' ability to respond -- their neuroplasticity -- in such a way as to nullify the normal function of these neurotransmitters. He theorizes that, although we are currently unclear about how precisely the medications work, it seems likely that they restore neuronal plasticity.
The author then goes on to look at the various states of depression. He starts with major depression and makes a useful distinction between endogenous or primary depression which suddenly hits a person for no apparent reason and reactive or secondary depression which is triggered by a clearly identifiable external event. He makes good use of case studies to illustrate the two types. He then proceeds to look at medication and gives a comprehensive account of the options. He is especially helpful on the drug remedies. This reviewer, however, has distinct reservation about the use of electro-convulsive therapy (ECT) which the author wholeheartedly supports. Much less objectionable, from this reviewer's point of view, are the alternatives to ECT - vagal nerve stimulation and the still experimental transcranial magnetic stimulation which the author describes in easily comprehensible terms.
The various ways in which depression can be combined with other factors are then studied. There is an extremely helpful chapter on bipolar disorder and its varying manifestations -- the extreme form, the hypomanic form and the least severe form known as cyclothymia. Once again the possible forms of treatment are extremely well documented. There are then two chapters on depression as it affects the elderly, children, and women; the links between depression and strokes or chronic pain; depression and seasonal affective disorder (SAD); depression and schizoaffective disorder; depression and panic attacks; the inherited proneness to depression; depression and alcohol/drug abuse; and the links between depression and sleep disorders.
The final section of the book is made up of down to earth advice about where to gain practical help. The author encourages sufferers and their families to start with their family medical practitioner and then not to be reluctant if s/he refers them to a specialist. Since the author is a staunch advocate of the use of medications to control and treat depression, it is not surprising that he advises people not to be reluctant to go down that route so long as they consult the proper professionals. There is also practical advice about how to cope with living with a mood disorder. At the end of the book is a useful reading list, a list of support organizations and an excellent index.
This is a highly comprehensive account and is to be recommended to sufferers and professionals in the mental health field.
© 2008 Kevin M. Purday
Kevin M. Purday, Principal of the Shanghai Rego International School