© 2002 The Royal College of Psychiatrists
Book reviews |
Treatment-Resistant Mood Disorders
Department of Psychiatry, University of Newcastle Upon Tyne, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NEI 4LP, UK
EDITED BY SIDNEY CROWN and ALAN LEE
Edited by Jay D. Amsterdam, Mady Hornig & Andrew A. Nierenberg Cambridge: Cambridge University Press. 2001. 535 pp. £65.00 (hb). ISBN 0 521 59341 7
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Given the strong evidence of the high prevalence of treatment-resistant
and/or chronic affective disorders in the population and the impact that these
conditions have on our services (not least in psychiatric out-patient clinics)
a book on this topic is welcome. Each chapter is written by an expert and
contains a wealth of detail and a good review of the literature. It is
slightly out of date and this is a particular problem in relation to the
chapters on neurobiology: for example, the imaging chapter does not include
Shah et al's (1998)
influential study. The main problems, however, are that many of the chapters
are written by people with strong views supporting their particular strategy
and the chapters written by those taking an overview have an uneven use of
evidence. These two problems amplify rather than counteract each other. For
example, the chapter on electroconvulsive therapy (ECT) is written by Max
Fink, who is over-whelmingly positive about the role of ECT in these cases
(e.g. he writes, ‘When depression is still debilitating after two
adequate medication trials, ECT is the proper treatment’), and the
debate on whether ECT response is reduced in patients who fail on medication
is not discussed despite much recent controversy and research in this field.
The overview chapter rehearses some of the studies without analysing the
quality of the evidence. A further example is the use of T3: this
is enthusiastically supported by Joffe and lukewarmly supported in the
overview chapter but nowhere is the fact that much of the evidence is based on
open and/or poorly designed studies discussed. This part of the book therefore
compares unfavourably with publications on the use of ECT that give
recommendations and also indicate the strength of the evidence (e.g.
Anderson et al,
2000). 
However, in the chapters away from evidence base and algorithms the book has considerable strengths and gives very good summaries and a distillation of clinical wisdom about these disorders in a variety of populations, including adolescents, the elderly and the current or recently pregnant. These discussions would help the clinician with the assessment and management of cases and provide a logical basis for therapeutic trials. The book is also strong on the psychological aspects and it is pleasing to note that dysthymia — a difficult concept in relation to these disorders — is sensibly handled, as this has often caused confusion in the US/UK literature.
One often looks in these American books for tricks that will help in one's clinical practice, and I thought that I had found one with the description of the concept of tachyphylaxis, which was described as the loss of initial response to treatment despite maintenance of the drug at the initially effective dosage — I could see my patients telling their friends that the doctor had said they had a bad case of tachyphylaxis. However, a dictionary definition of this term is the rapidly decreasing response to a drug after a few doses, and so this does not fit the common clinical scenario (sometimes called, usually on the internet, ‘poop-out’). Perhaps we need a new term? Bradyphylaxis? Or perhaps good old-fashioned tolerance would suffice.
REFERENCES
- Anderson, I. M., Nutt, D. J. & Deakin, J. F. W.
(2000) Evidence-based guidelines for treating depressive
disorders with antidepressants: a revision of the 1993 British Association for
Psychopharmacology guidelines Journal of
Psychopharmacology, 14,
3
-20.
[Abstract/Free Full Text] - Shah, P. J., Ebmeier, K. P., Glabus, M. F., et al
(1998) Cortical grey matter reductions associated with
treatment-resistant chronic unipolar depression. Controlled magnetic resonance
imaging study. British Journal of Psychiatry,
172,
527
-532.
[Abstract/Free Full Text]
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