Cases for Affective Disorders

Mood Disorders
Review of: The American Psychiatric Publishing Textbook of Mood Disorders.
(2006  Dan J. Stein, David J. Kupfer, Alan F. Schatzberg, Ronald Friedman )

Disorders of mood, what we once termed affective disorders, have become the centerpiece of psychiatry and clinical psychology. This is due in large measure to the predominance of these disorders, primarily depression in its many forms, but also reflects the rapid advances in scientific understanding and diagnosis of the conditions as well as in biological and psychological treatment. Depression is the second most disabling of all medical disorders worldwide, exceeded only by heart disease in the United States (Murray & Lopez, 1996). Mood disorders are the most common presenting complaint in mental health practices and represent a significant number of the visits adults make to medical practitioners of all types.

A number of excellent and comprehensive psychiatry texts have addressed the diagnosis and treatment of mood disorders over the past few years. Among the best known and most commonly referenced are Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (Sadock & Sadock, 2000) and The American Psychiatric Publishing Textbook of Clinical Psychiatry, edited by Hales and Yudofsky (2002). Neither of these volumes, however, is devoted exclusively to mood disorders, and their treatment of depression and bipolar disorder is necessarily limited. Until now, there had been no comprehensive text dealing with mood disorders that integrated basic research across the spectrum of mood disorders and offered clinical guidance based largely on empirical research. This need is well met by the publication of The American Psychiatric Publishing Textbook of Mood Disorders, edited by Dan J. Stein, David J. Kupfer, and Alan F. Schatzberg and published by American Psychiatric Publishing. This is an outstanding book, valuable as a desk reference for clinicians, psychologists, or psychiatrists as well as researchers interested in basic or clinical topics.

The book is divided into eight parts, each containing four to seven chapters, with a total of nearly 100 authors. This book is a thorough review of the current knowledge about mood disorders, with enough depth and breadth to satisfy anyone. Part 1, Symptomatology and Epidemiology, provides an excellent overview of the symptoms and incidence of mood disorders. The final chapter in this section, “Global Burden of Mood Disorders,” makes clear the immense social and financial toll taken by mood disorders.

Part 2, Pathogenesis of Mood Disorders, covers neurochemistry, psychoneuroendocrinology, cognitive processing models, and social perspectives, and concludes with a chapter on the evolutionary explanation for mood disorders. Although rigorous and often quite technical, the material in all chapters is presented in a way that makes it accessible to most psychologists and psychiatrists, no matter what their own clinical or research interests may be. Part 3, Investigating Mood Disorders, is, for the most part, an extension of the preceding section, although the chapters on anatomical pathology, molecular neurobiology, and brain imaging are more detailed and will be of interest primarily to specialists in these fields.

Part 4, Somatic Interventions for Mood Disorders, includes succinct but thorough reviews of new drugs as well as medications of long-standing use, such as tricyclic antidepressants. A chapter on antipsychotic medication used to treat mood disorders and another, “Targeting Peptide and Hormonal Systems,” offer information that psychologists often know little about. Neurological treatment is also addressed in chapters dealing with electroconvulsive therapy, transcranial magnetic stimulation, and vagus nerve stimulation.

Part 5, Psychotherapy of Mood Disorders, contains five chapters covering cognitive–behavioral therapy, interpersonal psychotherapy, and psychodynamic therapy. These chapters do an excellent job of integrating clinical research with an overview of the strategies of psychotherapy. This is not a how-to manual, but there is sufficient detail to understand these therapeutic approaches. A separate chapter discusses psychotherapy with depressed children. Odd enough, this section of the book seems the least useful. Research reviews put different modes of treatment into perspective, but this text is not intended for the novice, and, although this is a pretty good survey of psychotherapy for mood disorders, it is hard to image readers of the book taking much time with these chapters. In fact, this section, although interesting, seems more appropriate for an introductory volume than for this professional resource.

Part 6, Integrative Management of Mood Disorders, provides guidelines for the somatic and psychosocial treatment of depression and bipolar disorder but also includes a chapter, “Medication Combination and Augmentation Strategies in the Treatment of Major Depression,” that covers treatment of resistant depression with multiple drugs as well as aggressive medical treatment to achieve greater symptom relief than is often possible with just one or two pharmacologic agents. This section also includes an excellent chapter on suicide in children and adolescents.

Although integrated management is the focus of this section, the authors of many chapters throughout the book have taken care to emphasize an integrative approach to management of mood disorders. For example, in their chapter, “Neurochemistry of Mood Disorders,” Pedro Delgado and Francisco Moreno write,

It has become clear that full understanding of the biology of mood disorders must incorporate knowledge of a much broader range of neurochemicals than the monoamines, take into account the possible toxicity of stressful life events and general health status, consider the role of multiple genetic influences that confer vulnerability, and, finally, be able to explain how these effects converge to alter the structure and function of the brain’s emotion and cognition circuits, culminating in the symptoms that define mood disorders. (p. 131)

This statement, although quite a challenge that cannot be met in full with our current knowledge, nonetheless is an excellent thesis for the entire volume.

Part 7, Subtypes of Mood Disorders, addresses seasonal affective disorder, atypical depression, psychotic depression, and depression in geriatric populations. Part 8, Additional Perspectives on Mood Disorders, is a collection of chapters that do not fit anywhere else, but all are noteworthy, especially the chapters on depression and sleep, mood disorders and substance abuse, and depression across cultures.

It is hard to find any fault with this book. One might argue that a particular topic should receive more attention, but those are editorial decisions by editors who have done a remarkable job. The coverage is broad and deep. Editors of each section have seen to the fact that there is little redundancy.

Research reports and literature reviews are comprehensive and of sufficient depth to interest the specialist as well as the general reader. Yet the writing is so good and the choice of material so carefully made that reading summaries of research done in areas that may not be the reader’s area of expertise is not burdensome. In fact, the accessibility of almost all of the material in the book will, I hope, tempt clinicians to read more basic research and basic researchers to read much of the clinical material.

There is a treasure of material here, some of immediate application and other elements that amplify or clarify what most people already know, but all will enrich the reader. For example, clinicians recognize thinking patterns of depressed people that focus disproportionately on negative events and experiences. In fact, these cognitive processes are often the focus of psychotherapy. Yet the suggestion that these are learned patterns of behavior or even that such thought patterns might reflect early experiences must be evaluated in light of studies such as the report that in a dichotic listening experiment, when negative words were presented to the nonpreferred ear, depressed people remembered more of them than did controls, which emphasizes how highly tuned depressed patients are to negative stimuli in their environment. It is unlikely that most psychiatrists, or most psychologists for that matter, are familiar with much of the basic research of this sort that provides a context for what is observed in practice. This is just one example of a large number of such studies summarized in this work in ways that make them interesting to read and applicable to the day-to-day concerns of researchers and clinicians.

Textbook of Mood Disorders would be an outstanding text for a graduate course on the topic and should be in the library of any clinical psychologist, psychiatrist, or other mental health professional who deals with mood disorders.

References

1. Hales, R. E. & Yudofsky, S. C., (2002) The American psychiatric publishing textbook of clinical psychiatry, Washington, DC: American Psychiatric Publishing.

2. Murray, C. L. & Lopez, A. D., (1996) Global burden of disease: A comprehensive assessment of mortality and disability for diseases, injuries, and risk factors in 1990 and projected to 2020, Geneva, Switzerland: World Health Organization.

3. Sadock, B. J. & Sadock, V. A., (2000) Kaplan & Sadock’s comprehensive textbook of psychiatry, Philadelphia: Lippincott Williams & Wilkins.

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