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A bidirectional approach to depression and neurological disease
In Context
Book A bidirectional approach to depression and neurological disease The editor’s preface to this book recognises serious shortcomings in the appreciation of depressive illness in patients with a wide variety of neurological disorders, and states explicitly that the volume’s aim is to address these deficiencies and attempt to overcome them. Andres Kanner, the aforementioned editor, recommends that neurologists be alert to the presence of depressive disorders in all their patients, and although he doesn’t advise that neurologists necessarily treat such disorders themselves, he strongly urges prompt referral to mental health professionals when appropriate. The book’s subtitle, Diagnosis and Management, does not adequately cover the scope of the book. The first two chapters are entirely given over to the epidemiology and neurobiology of depressive phenomenology and syndromes. The second chapter is a highly comprehensive—if not exhaustive—review of current biological theories of symptom development, and includes illustrations that are presented as colour plates after appearing, somewhat unnecessarily and unclearly, among the text in black and white. Subsequent chapters in the first part of the book, General Considerations, cover the basics of idiopathic depressive disorders, clearly with a non-psychiatrist readership in mind; screening instruments for depression; neuro-
Depression In Neurologic Disorders: Diagnosis And Management Andres M Kanner (ed). Wiley-Blackwell, 2012. Pp 212. £54·99. ISBN: 978-0-470-74122-1
Louise Williams/Science Photo Library
See Articles Lancet 2011; 378: 403–11
940
psychological aspects of depression and suicidality; depression in children and adolescents with neurological disorders; and fundamental principles of treatment. Part two, Depression and Neurologic Disorders, addresses, chapter by chapter, the presentation and management of depression in individual neurological disorders, including migraine, stroke, epilepsy, movement disorders such as Parkinson’s and Huntington’s disease, multiple sclerosis, Alzheimer’s disease, and traumatic brain injury. The research is painstakingly up to date, including, for example, the somewhat dispiriting conclusion of the HTASADD study that neither of two commonly prescribed antidepressants (sertraline and mirtazipine) produce substantial improvement on depression scores in patients with Alzheimer’s disease. Nonetheless, the authors stress the importance of considering antidepressant medication in individual cases, and of non-pharmacological approaches to managing depression in these patients. Throughout the volume, the emphasis is on the bidirectional relation between neurological disorders and depression, and there is much fascinating information in this regard; I had no idea, for example, that depression has been found to be associated with an increased risk of subsequent stroke. The complex relation between cognitive deficits and depressive syndromes is also intelligently and comprehensively explored here, and as a psychiatrist I was pleased to see outlined the theory that depressive symptoms in older adults may lie at one end of a continuum that includes mild cognitive impairment and later frank dementia: a notion that is not entirely new but which deserves wider coverage. Each chapter has a box at the end titled “Pearls To Take Home”, which includes, in bullet form, the essential points elaborated on previously in the chapter. This serves as a useful summary and stimulates rereading of the relevant sections of the chapter when necessary. Another effective feature is the use of case studies in many of the chapters, particularly those in the second half of the book, which are at once realistic, recognisable vignettes and concise illustrations of the disorders described in the text. Depression In Neurologic Disorders is aimed primarily at neurologists, but is essential reading for psychiatrists as well as general physicians. As a relatively short yet detailed overview of this most common of psychiatric disorders and their occurrence in a broad range of neurological diseases, this volume is the best in its field. I recommend it unreservedly.
Tim Stevens [email protected]
www.thelancet.com/neurology Vol 11 November 2012
Book A bidirectional approach to depression and neurological disease The editor’s preface to this book recognises serious shortcomings in the appreciation of depressive illness in patients with a wide variety of neurological disorders, and states explicitly that the volume’s aim is to address these deficiencies and attempt to overcome them. Andres Kanner, the aforementioned editor, recommends that neurologists be alert to the presence of depressive disorders in all their patients, and although he doesn’t advise that neurologists necessarily treat such disorders themselves, he strongly urges prompt referral to mental health professionals when appropriate. The book’s subtitle, Diagnosis and Management, does not adequately cover the scope of the book. The first two chapters are entirely given over to the epidemiology and neurobiology of depressive phenomenology and syndromes. The second chapter is a highly comprehensive—if not exhaustive—review of current biological theories of symptom development, and includes illustrations that are presented as colour plates after appearing, somewhat unnecessarily and unclearly, among the text in black and white. Subsequent chapters in the first part of the book, General Considerations, cover the basics of idiopathic depressive disorders, clearly with a non-psychiatrist readership in mind; screening instruments for depression; neuro-
Depression In Neurologic Disorders: Diagnosis And Management Andres M Kanner (ed). Wiley-Blackwell, 2012. Pp 212. £54·99. ISBN: 978-0-470-74122-1
Louise Williams/Science Photo Library
See Articles Lancet 2011; 378: 403–11
940
psychological aspects of depression and suicidality; depression in children and adolescents with neurological disorders; and fundamental principles of treatment. Part two, Depression and Neurologic Disorders, addresses, chapter by chapter, the presentation and management of depression in individual neurological disorders, including migraine, stroke, epilepsy, movement disorders such as Parkinson’s and Huntington’s disease, multiple sclerosis, Alzheimer’s disease, and traumatic brain injury. The research is painstakingly up to date, including, for example, the somewhat dispiriting conclusion of the HTASADD study that neither of two commonly prescribed antidepressants (sertraline and mirtazipine) produce substantial improvement on depression scores in patients with Alzheimer’s disease. Nonetheless, the authors stress the importance of considering antidepressant medication in individual cases, and of non-pharmacological approaches to managing depression in these patients. Throughout the volume, the emphasis is on the bidirectional relation between neurological disorders and depression, and there is much fascinating information in this regard; I had no idea, for example, that depression has been found to be associated with an increased risk of subsequent stroke. The complex relation between cognitive deficits and depressive syndromes is also intelligently and comprehensively explored here, and as a psychiatrist I was pleased to see outlined the theory that depressive symptoms in older adults may lie at one end of a continuum that includes mild cognitive impairment and later frank dementia: a notion that is not entirely new but which deserves wider coverage. Each chapter has a box at the end titled “Pearls To Take Home”, which includes, in bullet form, the essential points elaborated on previously in the chapter. This serves as a useful summary and stimulates rereading of the relevant sections of the chapter when necessary. Another effective feature is the use of case studies in many of the chapters, particularly those in the second half of the book, which are at once realistic, recognisable vignettes and concise illustrations of the disorders described in the text. Depression In Neurologic Disorders is aimed primarily at neurologists, but is essential reading for psychiatrists as well as general physicians. As a relatively short yet detailed overview of this most common of psychiatric disorders and their occurrence in a broad range of neurological diseases, this volume is the best in its field. I recommend it unreservedly.
Tim Stevens [email protected]
www.thelancet.com/neurology Vol 11 November 2012