Based on powerful epidemiological data such as numbers afflicted, mortality rates from suicide, personal and familial consequences, and skyrocketing fiscal costs, major depressive disorder (MDD) has the sad and ignominious distinction of being a leader among disabling disorders worldwide.
With lifetime prevalence risks of 13% for men and 21% for women, the magnitude of this crisis cannot be understated. This hard-hitting volume focuses on recurrences-perhaps most important among the many factors (others include extreme underdiagnosis and undertreatment, genetic vulnerability, frequent recurrences, severe stigma and poor adherence with maintenance treatment, and brain tissue degenerative changes associated with recurrences and chronic depression) that contribute to MDD's high morbidity.
Following an introduction by the editor detailing the overwhelming personal and societal burden created by MDD, the distinguished authors of this volume emphasize five critical topics:
- The lifetime impact of gender on recurrent MDD in women, emphasizing the clinical features, treatment, and prevention strategies of the illness during three key periods of hormone transition (adolescence, childbearing years, and middle life) and including recommendations on where future research should focus.
- Treatment strategies for chronic and recurrent depression to help prevent acute episodes from developing into long-term depression, specifically addressing the continuing question of whether pharmacotherapy and psychotherapy combinations are superior to either alone.
- Prevention of recurrences in bipolar patients, updating the demonstrated benefits of several new anticonvulsant mood stabilizers and integrative treatment approaches and suggesting that treatment success depends on a multifaceted approach that combines old and new pharmacotherapy.
- Potential applications of new somatic treatment strategies involving minimally invasive brain stimulation that have greatly reduced the stigma but done little to advance the diagnosis and treatment of neuropsychiatric illnesses, with exciting data suggesting the efficacy of vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (TMS).
- A "call to arms" with updated recommendations on how to ensure demonstrable, lasting progress in preventing recurrences of depression, which--along with other chronic diseases such as diabetes, heart disease, and schizophrenia--progresses throughout life unless actively treated.
This highly informative volume, clearly written and exceptionally well referenced, is a "must-read" for every clinician, including specialists in depression and clinical neurosciences, primary care physicians and mental health clinicians interested in learning more about how to successfully treat what remains one of our most recalcitrant, debilitating illnesses.
John F. Greden, M.D., is Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences, Chair of the Department of Psychiatry, Senior Research Scientist at the Mental Health Research Institute, and Director of The University of Michigan Depression Center at The University of Michigan in Ann Arbor, Michigan.
