Beyond Depression: A new approach to understanding and management

Is there an epidemic of depression sweeping the world, or are we radically altering our interpretation of normal human experiences? Do we need a dose of medication or a renewed sense of meaning? In this second edition of Beyond Depression, Christopher Dowrick - an academic general practitioner - takes a critical insider's look at commonly held views about the diagnosis and management of depression. He argues that our belief in depression as a medical condition is based on commercial, professional, organisational and cultural factors which combine to sustain the popularity of depression as a concept, which is based more on our values than on science. Based on the best contemporary evidence available, this second edition includes new research findings on the management of mild and recurrent depression, the possibility of a genetic basis to depression, and extended arguments on the limitations of screening, and the placebo effects of antidepressant medication. The author considers alternative ways of understanding the thoughts and feelings that we currently describe as depression, drawing on cross-cultural, religious, political and literary sources. He proposes a conceptual framework that provides a means of moving beyond depression as a medical concept and as a personal problem. When applied to encounters between doctors and patients in primary care it leads us towards enabling narratives, with an emphasis on listening and understanding rather than diagnosis and prescription. Beyond Depression combines a comprehensive analysis of current scientific evidence with an impressive review of linguistic, literary and philosophical perspectives. Moving seamlessly between controlled trials and Camus, from prescribing to Proust, the book is informed throughout by a series of sensitive case studies drawn from the author's personal experience.

Table of Contents:
1: Points of Departure 2: Depression as a Medical Condition 3: Disputed diagnoses 4: Drivers to Diagnosis 5: Broadening the Mind 6: Coherence and engagement 7: Encounters in Primary Care

About the Author :
Christopher Dowrick is Professor of Primary Medical Care in the University of Liverpool, and a general practitioner with the Aintree Park Group Practice. He is a Senior Investigator with the National Institute for Health Research in England, and a Professorial Fellow with the University of Melbourne, Australia. He is editor of the international journal Chronic Illness. His research expertise is in the field of primary care mental health, with a portfolio of grants and over 100 publications on depression and medically unexplained symptoms. He leads a major NIHR R&D programme (2007 to 2012), designed to increase equity of access to high quality mental health services in primary care.

Review :
`Review from previous edition Doctors can feel that depression just doesn't fit the box they have been taught to put it in. They can feel cynical, frustrated or irritated by their inability to make sense of this multi-faceted problem in conventional terms. At best, they may construe it as a complicated and difficult clinical challenge to which conventional diagnostic reasoning and treating don't do justice ... This book can help clinicians think differently about the problems which depressed patients present, and offers some reflections to inform that thinking ... Many readers might benefit from this book, but I would suggest it may be most valuable for novices in training who are interested in the problems of depression, or for those in service feeling overwhelmed or unsuccessful in managing depressed patients.' Family Practice Advance Access `This is what psychiatry should be like in primary care, and for those who both suffer and treat depression it is simply inspirational.' Quarterly Journal of Mental Health `At a time when many well meaning, but surely misguided, people are pushing for financial incentives to be offered for the medical management of depression within the UK general practitioner contract, this is a book that is both brave and timely.' BMJ `Do you ever feel the idea of depression as a disease misses something? If so you may be interested in this intriguing book. It is based on a rejection of the concept of depression as a disease that should be diagnosed, and instead argues for an approach that is characterised by viewing people as unique selves whose distress has a particular meaning to them, based on their situation and valuesthis is a polemical book' Primary Care and Community Psychiatry, Vol. 10, No. 1 `The book is easy to read and relevant to day to day practice. The advice in the book is practical and I have since employed the suggestions successfully within my own consultations . . . With it's reference to literature, history and philosophy the book is a diverse and interesting read. I have recommended this book to colleagues in general practice and to GP registrars. It would also be relevant reading for anyone involved in the management or care of people with depression.' Reviewer on Amazon.co.uk `Christopher Dowrick's thoughtful, sensitive and sometimes poetic book makes a good case for supposing that the present, perceived, epidemic of depression deprives from causes more closely related to the 'ecology' of our profession than the condition of our patients.' Journal of the Royal Society of Medicine, Vol 97