Treating Child and Adolescent Depression
For an engaging, thoughtful, scholarly yet practical coverage of child and adolescent depression, this new text edited by Rey and Birmaher, two heavyweights in the academic world from Australia and the United States, is highly recommended. Many errors of texts with similar aims are deftly avoided here, as the editors have delivered a well-constructed and comprehensive set of guidelines in the packaging of a relatively slim and approachable book, avoiding redundancies across chapters and maintaining a consistent writing style throughout. While wading confidently into the theoretical and the academic, the well-collected and widely renowned international group of authors nearly exclusively maintains a keen eye on the practical. This text would be most obviously well-placed on the shelves of practicing general and child psychiatrists, as well as psychiatry residents, but also would be useful for psychotherapists, academics, primary care physicians, and those in training.
Overall, the text is nicely organized, progressing sensibly from the provision of a historical context for understanding current dilemmas in child treatment, onward to an analysis of causes and risk factors for developing childhood depression, and subsequently moving into a thorough review of key issues in evidence-based assessment and treatment. The practical focus of the book is captured by the titles of many of the "how to" chapters (eg, "How to Use Medication to Manage Depression," "How to Use CBT for Youth Depression: A Guide to Implementation," "Using Family Therapy"). Each chapter is helpfully summarized at its onset, with CliffsNotes-style bullet points for the reader who only has time for skimming. For those with the time available to give the text what it deserves, we believe readers will be rewarded by the adept balancing of basic science and applied recommendations. Most chapters include readily accessible and pertinent tables that succinctly organize sets of clinical guidelines, which practitioners will undoubtedly find useful as quick reference tools. Further, excellent and extensive reference lists are provided, including references for online resources that will be of use for both professionals and parents.
More specifically, sensitivity is demonstrated throughout the text to clinical issues that many of us struggle to manage in our daily practice. Thoughtful discussions are provided to assist with navigating the complexity of child and adolescent assessment, including the all-too-common fact that multiple informants typically provide contrasting reports. Similarly, an honest treatment is given of the difficulties that sometimes emerge in attempts to form alliances with adolescents, combined with a selection of helpful hints to circumvent these challenges. Throughout the portions that cover the treatment of depression, the discussion of psychopharmacology is rooted firmly in the evidence base available at the time of publication, with consistent use of the Texas Children’s Medication Algorithms. The algorithms are no longer being updated, but with small changes (eg, escitalopram is now approved by the US Food and Drug Administration for depression in adolescents) still provide useful thinking about an evidence-based approach to the psychopharmacologic treatment of pediatric depression. Further, the book provides numerous case examples, which bring to life the often stale portrayal of cognitive-behavioral therapy and interpersonal therapy and, to a somewhat lesser extent, even the variety of biological interventions. Further, the inclusion of family therapy, psychodynamic approaches, and the controversies involved with and potential role for complementary and alternative medicine offer often-ignored but quite important considerations in the treatment of child and adolescent depression.
In addition to coverage of assessment and treatment noted above, the text also features timely discussions of many "special cases," the use of quotations indicating that most of us experience one or most of these on a regular basis. Some of the highlights of this latter section of the book include the identification of key factors in approaching the treatment of refractory depressions, the management of depression and comorbid substance abuse, the complexity of assessing and treating depressive symptoms in those with chronic illness, treating depression in the developmentally disabled, and assessing and treating depression in minority populations. Uniquely, the chapter on depression in primary care delivers suggestions for screening and managing depressed patients that both primary care physicians and consulting psychiatrists will find useful. And finally, in addition to the wealth of information alluded to, the text wraps up by using its international perspective to remind us that all of the youth we see are embedded in social and cultural contexts, which always must be considered in the provision of culturally competent care.
In summary, this new text will be a welcome addition to the libraries of all who are involved in treating depressed youth. Its reliance on the current evidence base, consistent balancing of theoretical and practical issues, attention to depth as well as breadth, use of an international perspective, and well-designed and user-friendly style are particular strengths that will be appreciated by readers.
Author affiliation: University at Buffalo School of Medicine & Biomedical Sciences, Buffalo, New York. Potential conflicts of interest: None reported.
© Copyright 2012 Physicians Postgraduate Press, Inc.