A number of volumes, both single-authored and edited, have appeared in recent years which focus upon late-life mood disorders (usually depression). Therefore, a reviewer of yet another volume must ask the question, ‘How is this volume unique or especially valuable to the reader?’ Given the list price of nearly $200.00, this question is especially relevant.
The volume under review is the 41st of the Medical Psychiatry Series published by Informa Healthcare (some such as this volume are second editions). The volume is edited by clinicians at McLean Hospital and many of the chapters are authored by their faculty. However, other noted experts in the field have made contributions. These include George Alexopoulos, Jeffrey Lyness, Helen Lavretsky, Ben Liptzin, Sidney Zisook, and Charles Reynolds. From a quick thumb through of the volume, one unique characteristic does emerge. This is a thoroughly referenced volume and therefore offers an excellent source for delving into the extant literature on late-life mood disorders for those who are writing dissertations and writing grants.
The volume consists of nineteen chapters with the usual topics evident: diagnosis, epidemiology, suicide, neurobiologic aspects, vascular depression, medical illness and depression, bereavement, pharmacological treatment; and psychotherapeutic treatment. A second unique characteristic of the volume is the chapters which are not the usual suspects in such an edited volume and for this the authors are to be commended. I will comment on three of these unique chapters.
First, Lavretsky and Lyness provide a comprehensive, up-to-date, and useful chapter on subsyndromal depression in the elderly, including dysthymia. The topic of subsyndromal psychiatric conditions has increased in importance with each new edition of the Diagnostic and Statistical Manual since the Third Edition. A paradox has emerged from clinical and community-based studies. On the one hand, some have criticized the DSM for being over-inclusive, casting its net far too wide and capturing over 25% of the population as suffering from a psychiatric disorder. On the other hand, empirical studies have emerged which document that psychiatric symptoms which do not meet the threshold of a DSM diagnosis such as major depression lead clearly to both increased risk of more severe symptons over time and a decline in functional status. Subsyndromal depression in late life is an especially important case of this paradox and the authors of this chapter have helped us sort through the paradox with an even-handed review of the evidence.
A second chapter which caught the eye of this reviewer was written by Verma and Silverman on the economic burden of late-life depression. Usually relegated to a paragraph or two, pulling out this most important issue into a self-contained chapter is a credit to the editors. The chapter is thorough and considers not only economic costs which very well may limit access (even though Medicare is considered ‘universal’) but also the intangible costs, especially costs to caregivers.
Finally, I was struck by the chapter by Coleman and Ahmed on cultural barriers to psychiatric treatment. The chapter was shorter than I would have preferred but covers the major racial/ethnic groups, topics again which are often relegated to a paragraph or two in most traditional texts. I do, however, have a concern about the chapter. The chapter is unidirectional, namely suggesting that racial and ethnic factors are ‘barriers’ to what should be done for these different groups. In other words, our task is to find ways to educate them so they will be more responsive to our traditional treatments. Perhaps psychiatry, especially in this era of rampart biological psychiatry, could be educated by these cultures as to both how to interpret symptoms that we label ‘depressed’ and to the best approach to facilitating healing within these cultures (which may not include our traditional therapies). The area deserves much more study as the authors well know.
Overall, this volume is a valuable resource which, unfortunately, will probably frequent more group than individual libraries due to the price. Yet we know it is out there.
