The heart of this book is a set of ten illustrative vignettes of older people with depression presenting in primary care. The cases are of varying complexity, ranging from bereavements to depressive episodes with psychotic symptoms. They are immediately familiar to anyone working in this field, either in primary care or in older people's specialist services. Different cases touch upon the common companions of depression in this age group, including co-morbid physical illness, social isolation, cultural differences, alcohol abuse and, of course, cognitive impairment.

Each scenario has then been allocated by the editors to two or more contributors, usually one general practitioner and another professional with a relevant interest. Each contributor then discusses over a few pages how they would approach the case, giving their initial thoughts, detailing their approach to assessment and setting out possibilities for management and treatment. To give an international perspective, the last case was sent to experts in 12 countries and their comments are collated into chapter 6 and given in more length as an appendix. As well as the case material, there are introductory chapters on depression in late life and its management, and a later chapter with a useful set of resources, including rating scales and patient information material.

The result is accessible and very readable and although the introductory material is quite brief it is authoritative and well summarized. The focus on primary care is clear throughout and the book uses the stepped care approach proposed by NICE (National Institute for Health and Clinical Excellence) that will be familiar to many people in the UK. The authors point out that there is in fact limited evidence to support the some of the elements of the stepped care model. Although it does seem to be a reasonable approach given the high prevalence and variable severity of depressive symptoms in the population, there is limited evidence about the stepped care model as a whole, and also some of approaches to management that it advocates, such as so-called ‘watchful waiting’, a rather nebulous concept. The book provides some useful information about guided self-help, an approach strongly advocated by the NICE guidance although, again, the evidence for its effectiveness is promising rather than uniformly positive.

In many Western countries, the numbers of older people from minority ethnic backgrounds are increasing. This presents a challenge for health services, including primary care and mental health, as there is good evidence that these groups are less well served than the indigenous population. There are several reasons for this including barriers of language and culture and, often, socio-economic disadvantage and poor general health. It is therefore welcome that this book pays due attention to these issues, with a section in the opening chapter and three cases from diverse backgrounds, where cultural issues are a key feature in managing the case. Of course, cultural factors are important in the management of all older people, since one often has to consider the historical period they have lived through, the prevailing social attitudes of their formative years, and how their occupations may belong to industries now consigned to history.

How well does the imaginative format of the book work? The cases are typical of everyday practice and raise important issues. The vignettes could themselves be used for teaching and discussion purposes, before making reference to the discussion. There is inevitably some repetition and overlap between the contributions. For example, the international commentaries on the last case are notable more for the common ground between them than for their differences. However, depression in old age is rather like that: one has to consider factors like physical health, medication, cognition, cultural factors, the possible role of specialist services, and so on in every case in order to generate a sensible and effective plan. Reading and listening to stories is something that draws us to other people, and its emphasis on stories is what helps to bring this book alive.