August 2009  << Back  

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Integrated Management of Depression in the Elderly

Alan D. Schmetzer, MD

Indiana University School of Medicine, Indianapolis, IN, USA

This book is written by 52 contributors—including the 3 editors—from 13 countries and is divided into only 7 chapters. As one might gather from this description alone, this book tries to pack a lot into a relatively small space. The first chapter discusses the epidemiology, etiologies, and presenting symptoms of depression in later life as they might occur in different ethnic groups found in Great Britain, with a rather brief overview of assessment and possible management, or treatment strategies. Chapter 2 is devoted entirely to management with sections on goals of treatment, self-help interventions, stepped care and collaborative approaches, available medications (in Great Britain’s pharmacopeia), and psychological and social interventions. The following 4 chapters are sets of brief case vignettes followed by extensive commentary by primary care physicians (GPs), geriatric psychiatrists, social workers, case workers, psychologists, and nurses. The sixth chapter on how other healthcare systems in different countries might respond and a seventh and final chapter on resources—practice guidelines, brochures, assessment and screening tools, legal forms, protocols, and so forth—round out the book. Each chapter includes an extensive listing of references, and there is an index at the conclusion of the book.

Edited by Carolyn Chew-Graham, Robert Baldwin, and Alistair Burns; Cambridge University Press, Cambridge, UK; 2008; ISBN 978-0-521-68980-9; pp 200; $60.00 (paperback).

The 3 middle chapters, composed of case vignettes with practitioner commentary, are completely focused on the current health system in the United Kingdom with vocabulary, some medication alternatives, and systems of care mentioned in terms that may be unfamiliar to the average American reader. This does not mean that there are not points to learn from a chapter such as “Management of more complicated depression in primary care,” but rather that some of the guidelines and protocols the authors refer to are not well known or frequently used outside of their country. These chapters make a strong case for a systems-based approach to assessment and management of late-life depressive disorders, including obtaining history from both the patient and significant family members, appropriate education of everyone involved, close collaboration with other disciplines, and active communication among the involved physicians. I think it would be rare for practitioners to quarrel with any of these points.

The sixth chapter includes a final vignette with summaries of commentary from clinicians in Australia, Bulgaria, Canada, Denmark, France, Hong Kong, Japan, the Netherlands, Norway, Romania, Spain, and the United States. Certainly, this chapter makes the point that older depressed adults present in similar ways across international boundaries—of note, their tendency to emphasize physical complaints over psychological symptoms and the likelihood of several co-occurring physical ailments along with the depression. This chapter might be of particular interest to American readers because it includes views from professors of family medicine and psychiatry in the United States. An appendix presents specific comments by authors from each of these dozen non-British nations regarding the case vignette in Chapter 6.

This book looks at how late-life depression might be recognized and approached by non-psychiatrists. Collaboration with psychiatry, especially geriatric psychiatry, is encouraged, but the authors recognize that in most areas the primary care physician or a community worker will assess the need for—or even the availability of—more specialized mental health care. The first practitioner who is consulted has a vital role regarding treatment, which is an important concept in this book. Certainly this clinician’s approach is an important factor in the patient’s eventual acceptance of any further treatment is recommended.

This book will be of great interest to those in the mental health field—or perhaps to medical students—who are considering a short- or long-term stint of service provision or education in one of the featured countries. For example, someone contemplating a mental health locum tenens position in Australia might find valuable insights here. The lessons about collaborative care and cultural competence are valuable, and potentially of interest to any primary care or psychiatric physician, regardless of where he or she practices. Social workers, case managers, psychologists, nurses, and others may be interested in the comments on ethical variations within a larger culture. The chapter on resources includes selected depression rating scales, indexes, outlines, and quick measures of cognition that would be instructive for anyone not already familiar with them.