The first edition of Beck and Alford's Depression: Causes and Treatments was published over 40 years ago with the goal of addressing firmly established aspects of the nature, causes, and treatment of depression. Significantly, the first edition included Beck's outline of cognitive therapy, a treatment whose impact in the intervening decades has been profound. The second edition has much the same goal as the first: it provides updates on previously reviewed topics; introduces aspects of the study of depression that have become relevant more recently; and provides an historical perspective on depression research. The book is well-organized and well-written, and manages to be both informative and satisfying for the reader.
The authors begin with extensive descriptive information about depression, including symptoms of depression, its course and prognosis, and a variety of definitions. Also included is an informative background on the classification of mood disorders and the history thereof, providing context for subsequent chapters. This section is particularly helpful in that the authors include objective descriptions of depressive symptoms as well as case studies, effectively demonstrating that some degree of continuity exists between clinical and research-based approaches.
The second section of the book explores experimental studies, beginning with a substantial addition to the first edition of the book – the biological underpinnings of depression. Psychiatric researchers remain frustrated by the absence of unequivocal biological indicators of depression. However, evidence supports the hypothesis that depression is heritable; indeed, this is one of the more consistent findings across research on depression's biological influences. The authors provide only a brief discussion of such work, but devote a great deal of time to a variety of other biological studies – even including research on topics that have mostly proven fruitless, such as blood glucose and chloride levels in depressed patients. While the discussions of endocrine and neurophysiological studies are of great interest, portions of these sections are rather specific, making a ‘take-home’ message elusive for the reader. Whether this reflects the interests of the authors or simply the incomplete status of biological research on depression is not entirely clear, although the authors accurately state that ‘there is little solid knowledge of the specific biological substrate of depression’. Hopefully, the resources being channeled toward this research will merit a change in that conclusion in future editions.
Theoretical aspects of depression are covered in the third section of the book. The first chapter of this section includes brief summaries of a broad range of theories, from evolutionary and existential theories to a description of animal models (e.g. learned helplessness), and demonstrates the degree of variety in past and present conceptualizations of depression. Most useful, however, is the following section, which begins with the ‘primary triad’ of depression: negative view of self, negative view of the world, and negative view of the future. The authors provide eloquent descriptions of the manifestation and consequences of each component of this triad. The relation between negative cognition and negative affect is explored thoughtfully, although its precise nature evades resolution. These chapters are often written from a personal perspective: the observations and conclusions draw not just from a review of published literature, but also from the authors' interactions with patients, affording them insight beyond the realm of the typical researcher. While such experiences may be subjective, they seem to afford an invaluable understanding, and appreciation, of the depths of depression.
The emphasis on negative cognitive style and negative affect continues into much of the remaining text. In the chapter on the development of depression, the authors devote some time to a discussion of biological predispositions and vulnerability factors, but focus primarily on the ways in which negative cognition influences how an individual misinterprets events, loses objectivity, and succumbs to rumination. Once these consequences have been established, they provide a logical segue into the final section of the book, which covers treatments of depression. Given the expertise of Dr Beck, the eloquence of the chapter on psychotherapy comes as no surprise. Happily, equal time and energy are devoted to the chapters concerning somatic therapies (pharmacotherapy and ECT) and an evaluation of the effectiveness of different approaches. The authors are even-handed, carefully describing the strengths and weaknesses of different treatment strategies, and ultimately suggesting that both somatic and behavioral therapies can be effective in the treatment of depression and in the prevention of relapse, though no method is effective for all patients.
Depression: Causes and Treatment (Second Edition) is thoughtfully written and informative, and is a valuable contribution to the current literature. Most readers will find the style quite accessible. While some sections can be tedious, much of the detail provided goes a long way toward illustrating nuanced concepts, which is invaluable for audience members from diverse backgrounds. The book benefits from the historical and professional perspectives of its authors: Beck and Alford provide appropriate context and are able to speak to both psychiatric researchers and practitioners, although the former seem to be the target audience. An additional benefit of this book is that it provides, across several sections, a complete and rather fascinating story of the development of Beck's cognitive theory of depression and the subsequent creation of a specific therapy based on that etiologic theory. Readers from a variety of disciplines are likely to benefit from the summaries, conclusions, and suggestions for future research provided by the authors. In summary: a recommended read.
