These days the initial first port-of-call for definitive information on the practical management of medical conditions comprises guidelines produced by national bodies, such as in the United Kingdom the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). They have the great advantage of being authoritative, evidence-based and free to down-load from the Internet. On the other hand, they are limited in scope and the guidance is usually for all adults and does not focus on the specific needs of older people. Affective disorders are so common in older people that all health and social care professionals who treat them ought to know the key facts. These include what is meant by the term affective disorder, what are its causes and consequences, and how it is prevented and best treated. Books covering these areas are therefore welcome.
I suppose it is a little churlish to start with criticism of the book's title, but I wonder if all practitioners will know what is meant by the term ‘affective disorders’ and whether it would have been better to add ‘mood’ or ‘depression’ to the title. It would be a shame if a casual reader overlooked this well-written volume because they did not fully appreciate that the book is essentially about depression and its variants and associations. I would also like to have seen much clearer linkage between the interventions discussed in the book and the NICE guidance on depressions – it is all there but can be difficult to find. For example, the NICE recommendations on non-pharmacological approaches are summarised in one of the chapters on drug treatment. I would also have liked to see more consistency in the chapters' contents; some end with key points but others do not. The useful case histories in some chapters could have been extended to those on drugs.
Each chapter has been written by an expert, and the book has a fairly conventional approach, with the introduction followed by chapters on diagnosis, aetiology and treatment modalities (pharmacotherapy, electroconvulsive therapy and psychotherapy). A wealth of information is presented; that on aetiology by Adrian Lloyd has over 300 references, and that on psychotherapy is particularly useful, although getting hold of therapists is easier said than done. I would have liked to see clearer discussion on the overlap between depression and less serious mood disorders and between depression and anxiety. There then follow important sections on the relationship between physical illness and depression, depression in primary care, and the contribution of nurses, occupational therapists and social services to the management of depression. The final chapters cover carer and service-user perspectives, cultural differences in black and minority elder communities and the relationship between depression and spirituality. The latter two discuss broad clinical areas rather than affective disorders specifically. Drew and Koenig bravely suggest how clinicians might incorporate a patient's religious views into practice, something that NICE has not yet attempted. The last chapter, an overview of human drug development, although interesting, seems somewhat out of place and does not adequately comment on the really big issue – the low recruitment of people aged over 75 years into clinical trials. There are now a number of books on depression in later life written from a UK perspective. This volume is a welcome addition, worth including on a multi-disciplinary bookshelf and in the health library.