Treatment Resistant Depression: A Roadmap for Effective Care

The book Treatment Resistant Depression: A Roadmap for Effective Care was edited by three experts from the University of Michigan's Comprehensive Depression Center. It aims to summarize and educate on recent advances in treatment-resistant depression. In many ways, it is a continuation of Treatment of Recurrent Depression, edited by Greden in 2001. Both books call for advancements in research to address the disability and cost burdens associated with depression, particularly over the course of a lifetime of intermittently treated symptoms. Treatment-resistant depression is defined as “failure to achieve remission after two evidence-based antidepressant treatment courses known to have been of acceptable dose and duration.” The book suggests that rapid recognition and assertive treatment earlier in the disease, rather than later, are critical in managing depressive symptoms. There is a focus on chronicity of illness and on self-management of depressive symptoms.

Several authors with years of expertise in treating mood disorders contribute chapters on various topics, including pharmacotherapy for depression, psychotherapy for depression, approaches to sleep hygiene, nutrition, concomitant substance abuse, and medical comorbidities. Treatment-resistant depression is examined in multiple populations, with separate chapters devoted to adolescents, college students, pregnant women, and the geriatric population. Each chapter is written by a different set of authors with different styles, leading to a mosaic of topics. For the most part, the book maintains its focus in proposing multiple treatment modalities in different populations. However, the chapter on the medical care model for bipolar disorder is discontinuous with the treatment-resistant depression theme and would have been better placed in a separate volume.

Given that the authors originate from the University of Michigan, a strong research university and authority on electroconvulsive therapy (ECT), there is a heavy focus on evidence-based medicine guided by research, as well as a chapter containing detailed information on the use of ECT and neuromodulation to treat depression. There is a well-written chapter on psychotherapy, but in the context of the book as a whole, this approach is underemphasized. There is an interesting and informative chapter on the role of peer support and community resources for individuals suffering from depression and a concise and easily understandable chapter focusing on the genetics of mood disorders—an important area of development in depression research. The book is well referenced and has a comprehensive and organized index.

The book is complete and accurate; however, it is rather dry and not stimulating to read. Instead of feeling motivated to use these treatment algorithms, I quietly filed away the information and looked forward to the next vignette. The case vignettes are very enlightening, and I would have liked to see more of these. The Key Clinical Concepts sections are useful summaries and may be all a busy clinician has time to read. Overall, I am glad to have the material as a reference and will remember various points to benefit the patients I treat.

This book would be most useful to psychiatrists, psychiatric residents, and medical students. More specific information on therapy would make the book more useful to psychologists, social workers, and other therapists. For consumers of mental health care and legislators, this book may not be a good starting place to understand this complicated, debilitating, and multifactorial set of illnesses. A more patient-centered book with more illustrations, first-person accounts from patients, and details about how individuals utilized their roadmap toward achieving health would be more appropriate for this audience. Graphics in each chapter depicting individuals with treatment-resistant depression would have breathed life into the information presented.

In summary, this volume is a good start for addressing the dearth of information available on treatment-resistant depression. It is well referenced and complete and contains summaries of critical research studies. It will be helpful for psychiatrists and psychiatrists in training. In the next edition, the inclusion of more illustrations and a more patient-centered approach could greatly expand the audience who would benefit from this highly informative book.