Depression is an illness that is oft misunderstood and, despite growing public awareness, is still very much stigmatised. Dealing with depression is a book that coves new ground in understanding the different types of depression, how it affects people, and offers suggestions for management systems through both psychotherapy and medications.
The author, Gordon Parker, is a leading international expert on depression and mood disorders, a Scientia Professor of Psychiatry, and also the Executive Director of the Black Dog Institute. The Black Dog Institute, based in Sydney, Australia, is a not-for-profit organisation and world leader in the diagnosis, treatment and prevention of mood disorders such as depression and bipolar disorder.
The difference between Dealing with depression and other books about depression that I have read is that this book goes beyond the general outlook of categorising people as suffering from either major or minor depression. Instead, Gordon Parker argues for an alternative model, one that is more complex than a time frame. He and his researchers believe that personality types predispose people to developing the various depressive conditions, which are all markedly different. They also suggest that “personality style shapes the clinical depressive pattern, and perhaps more importantly, influences the chance of responding to differing treatments”.
So, rather than advocating a “horses for courses” generalised approach to depression, this book takes a more holistic approach, which considers life events, biological factors and personality style, and then formulates suggestions for treatments. Instead of following the “major” and “minor” diagnosis, common in North America, which Parker states are simply too vague and do not do enough to describe the actual problem that the person is experiencing, he classifies clinical depression disorders into three categories:
- melancholic and
- psychotic melancholia.
Each of these forms of depression and their subtypes requires different considerations for treatment.
Non-melancholic depression is caused by excessive stress or a major life event combined with personality style and displays a lack in psychomotor disturbance (PSD). There is often has a high spontaneous remission rate whereby suffers get better naturally, without intervention or help from therapists or medications.
Melancholic depression is much more severe, PMD is evident, but there is a low rate of spontaneous remission. This form of depression is believed to be biological in nature, and as such responds well to antidepressant medications but treatments such as counselling and psychotherapy have little impact.
Psychotic melancholia features severe depression, PMD, hallucinations and delusions, and pathological feelings of guilt. The only treatment that works is antidepressant medications.
Bipolar disorder and its classifications of bipolar I and bipolar II are also closely discussed. Dealing with depression also lists the general features of depressive and bipolar disorders, which highlight the differences in behaviour, thought processes, and emotions experienced by suffers of these disorders. Parker also presents in-depth information on personality styles and behavioural traits; what a medical assessment for determining depression might cover; what patients should be told; and various antidepressant drug treatments that are available and their effectiveness on the depressive subtypes.
What I found particularly interesting is that Parker does not advocate staying on one medication for an extensive time period to see if it works. He argues that not all medications are equal, that this is a myth, and that some antidepressants are “far more powerful than others in helping certain types of depression”. If a medication does not work, he recommends changing it, trying another medication, until the person finds one that works for them and their condition. Parker writes that some sign of improvement should occur with the first 10 days, and that if no improvement has been seen within 2 weeks then reassessment of dosage levels, or change to another drug may be required.
“It’s important to challenge the myth that antidepressants need to be trialled for many weeks or months so as to ensure that patients are not left on an antidepressant for an extended period with the view that it might start working after two or three months.”
I found this advice exciting and refreshing as it challenged what many GPs advise. I have a close family member who suffers from depression. They asked their GP to change their medication because they weren’t noticing any changes, weren’t feeling any better after 3 months on the medication. The GP refused to change the medication, revise the dosage or alternative options claiming that they needed to be on the medication for another 3 months before any real improvement could be seen.
Dealing with depression contains a lot of useful information and clearly explains the different types and subtypes of depression in easy to understand language. Real life examples are used to support the research and claims. The exploration and reclassifying of depression using the Black Dog Institute’s categories was stimulating and encouraging to read and certainly made more sense than the major/minor depression classification system that is so predominant in the health care system.
This book is an excellent resource for anyone suffering from depression; for family and friends of suffers; or for anyone interested in learning more about the complexities of what it means to suffer from a depressive disorder.
Dealing with depression: A common sense guide to mood disorders – 2nd edition (Allen & Unwin 2004) ISBN: 1741142148