Treating people with depression

By Greg Wilkinson, Bruce Moore and Pascal MooreRadcliffe Medical Press 155 pages£17.95

This book was conceived as a practical guide for general medical practitioners and others working in primary care to help them provide better services for people affected by depression. It succeeds in offering this.

Although more oriented to the needs of GP readers than those of, say, practice nurses or community pharmacists, all primary care practitioners will benefit from reading it. So, too, could service users with an interest in understanding not only depression, but also the strengths - and possible limitations - of those from whom they may seek support.

The book's strongest appeal is as a resource for those involved in individual case management. It offers a wide range of useful, simply expressed information about what remains a prevalent and often inadequately treated form of illness.

But it has some weaknesses. For example, it could have benefited from a full discussion of the systematic use of assessment scales in the care of depressed individuals. This is important for the delivery of integrated support, aimed at both maximising and maintaining the quality of recovery. Further, 'received facts' are on occasions quoted uncritically. It is not the case, for instance, that 15 per cent of people who experience even major depressions commit suicide. Such statements can promote needless fear and loss of confidence, and may reinforce negative attitudes among groups such as employers and insurers.

Another concern is that more should be done to link social, psychological and biomedical insights into the causes of depression, and its alleviation. The authors quote data on relapse rates, which range from 50 to 90 per cent in individuals with a history of major depression. Some of the most vital questions facing health services across the world relate to the extent that such figures can be cut through.

The most likely ways forward include earlier (and where necessary long- term) intervention, and using medicines and social and psychological interventions together more effectively than in the past.

Doctors and other professionals working in the area of depression need to overcome traditional barriers to achieving fully integrated therapeutic strategies and care delivery programmes. The attitudes and guidance communicated in Treating People with Depression witness the fact that significant advances are being made.

But more progress will be needed before all those involved in combating depression and allied forms of psychiatric illness achieve a genuinely shared understanding of problems such as under-dosing with antidepressants, and the inadequate supply of problem-solving, focused, social and psychological support in many primary care settings.

Arguably, the most important message to take away from Treating People with Depression is that the potential for synergies between care improvements on both sides of the increasingly anachronistic biomedical-psychosocial divide must be better understood. Otherwise there is little prospect that warnings from bodies such the World Health Organisation about the increasing burden of depressive illness in the 21st century will be met by the most appropriate, and efficient, service responses.

Professor David Taylor

School of pharmacy, London University.