Treatment of Recurrent Depression

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.