The American Psychiatric Publishing Textbook of Mood Disorders

There is something about a large and heavy book on a single topic that repels as much as it attracts. Intended as a reference and unlikely to be read in its entirety even by its contributors, such a work promises to be both definitive and comprehensive, allowing the reader to dip in on occasion, to clarify a point or skim a review. And yet, its dimensions alone raise questions. With 101 authors, can a level of quality and focus be maintained? Has the length of time between writing and printing made its facts less timely and its recommendations dated? Is it practical as well as authoritative? Weighing in at 5 pounds and extending for almost 800 pages, the Textbook of Mood Disorders is a book that physically announces its presence on both your bookshelf and your lap.

Admirably, the text aspires to and succeeds in being both scholarly and pragmatic. Michael Stone’s historical review is an enjoyable sojourn over 2,500 years of cultural awareness of mood disorders, while Pierre Blier provides a succinct and rational guide for the clinician wondering what to do next in a case of treatment-resistant depression.

Yet some unusual choices in coverage and balance are made, and some topics receive less attention than they might. Does vagus nerve stimulation really deserve a chapter all to itself, equivalent in length to that devoted to antipsychotic medications, when the best evidence is still so weak? Among the underdeveloped topics are such issues as grief and bereavement, couples, family and group therapies, depression in dementia and developmental disability, bipolar mixed states, and teratogenicity and breast feeding considerations in drugs other than antidepressants. A future edition might also strive to bring better integration between chapters by providing internal linked references. Although brain imaging findings and cognitive processing changes are discussed extensively in their own chapters, there is no discussion of their possible usage as endophenotypes in the chapter on genetics, nor for that matter, any reference to the term itself in the index. A more substantive critique might be that the textbook generally seems to avoid controversy or to critique areas of research that are methodologically weak and thus far disappointing in their progress. One exception is the chapter by Richard Shelton and Natalie Lester on selective serotonin reuptake inhibitors, in which they offer a thoughtful dissection of the issue of antidepressants, possibly increasing suicidal risk in select individuals. Comparable analyses of such topics as the dramatically decreased utilization of lithium over the last decade, the stigma of psychiatric illness, or the role of antidepressants in the treatment of mild depression are absent and represent missed opportunities in an otherwise far-reaching text. Yet another issue, more relevant than ever in the present, is that of potential bias or conflict of interest. One chapter includes an extensive disclaimer, but nearly all of the others do not, despite well known pharmaceutical support of some of the authors asked to review a specific topic.

Such considerations should not be viewed as overpowering, however. There is no more comprehensive or current review of mood disorders to be had, and practitioners and educators will find much value in an easy-to-access form.