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JULES ANGST, EDITOR: CLASSIFICATION AND PREDICTION OF OUTCOME OF DEPRESSION

CLASSIFICATION AND PREDICTION OF OUTCOME OF DEPRESSION
Stuttgart/New York: F.K. SchattauerVerlag; 1974 (313 pages):
Reviewed by Jules Angst

CONTENTS: This book reports the proceedings of a symposium with the same title, chaired by Jules Angst. It was held in Schloss Reinhartshausen on the Rhine from September 23 to 26, 1973 and was the 8thof the Symposia Medica organized and published by Hoechst AG. The material is organized according to the symposium's five sessions, with discussion either after the single presentations or at the end of the session. The book opens with the editor’s (chairman’s) Introductory Remarks and ends with his Conclusions.

In Session One two classifications of depressive disorders are presented, one by P. Kielholz and the other by M. Roth, R. Garside and C. Gurney. These are followed by a review of R.E. Kendell, P.Pichot and M. Von Cronach on the “Differences in concepts of affective disorders amongst European psychiatrists”.

Session Two deals with the “unipolar” and “bipolar” distinction. Two papers are presented: in one, G.L. Klerman reviews “Theoretical and empirical issues in establishing the validity of nosological concepts in the classification of affective disorders” and in the other C. Perris addresses “The heuristic value of a distinction between bipolar and unipolar affective disorder”.

In Session Three, the emphasis shifts from diagnosis and classification to the course, long-term treatment, prophylaxis and prognosis of depression. Six papers are presented in this session: following W.E. Bunney’s Introduction, A. J. Coppen’s review of “The morbidity of recurrent affective disorder and the effect of long-term lithium treatment”, and R.F. Prien’s “Observations from a multihospital collaborative study” on “Prophylactic treatment of recurrent depression”, three papers deal with the course of depression. In the first, B. Davies and T. Blashki present findings from their study comparing the course of depression in general practice and in hospital. In the second, P. Grof, J. Angst and T. Haines discuss practical issues related to the clinical course of depression, and in the third, T.Taschev gives an account of “The course and prognosis of depression on the basis of 652 deceased patients”.

Pharmacokinetics and the dependence of the effect of treatment on variables related to the metabolism of the drug used in treatment are dealt with in Session Four, which comprises eight papers. In the first, G.D. Burrows, B.A.Scoogins and B. Davies present findings on a relationship between “Plasma nortriptyline and clinical response”, and in the second, M. Asberg, P. Kragh-Sorensen, L. Bertillson, B. Cronholm, Ch. Egggert-Hansen, F. Sjöquist and J.R. Tuck discuss methodological problems in “Studies of relationship between plasma level and clinical effects of nortriptyline”. In the third paper, A.J. Coppen provides support for the “Clinical significance of plasma levels of tricyclic antidepressant drugs (amitriptyline and nortriptyline) in the treatment of depression,” and in the fourth, N.S. Kline and T.B. Cooper propose “Methods for the evaluation and interpretation of drug (doxepin) plasma levels”. In the remaining four papers, B.K. Shah and N.S. Kline draw attention to “Data analysis problems in the area of clinical response, plasma levels and kinetic parameters”; J.Angst and R. Rothweiler report on “Blood levels and clinical effects of maprotiline”;  O.J. Rafaelsen and L.F. Gram review “Interactions between antidepressants and other psychopharmaca”; and D.S. Robinson, A. Nies, C.L. Ravaris, J.O. Ives and R. Lamborn present findings on the “Relation to depressive typology and blood platelet MAO inhibition” in the treatment response to MAO inhibitors.

Finally, in Session Five, M. Hamilton discusses “Prediction of response to ECT in depressive illness”; D.F. Klein introduces the diagnostic concept of “Endgenomorphic depression”; and J. R. Wittenborn presents findings supporting the hypothesis of depression-prone personality (in women).

As mentioned, the volume includes the participants' discussion of the presentations.  In alphabetical order the 33 participants, including the speakers, were : J. Angst, W.E. Bunney, A. Coppen, B. Davies, R.R. Fieve, P. Grof, M. Hamilton, K. Heinrich, H. Helmchen, H. Hippius, R.E. Kendell, P. Kielholz, L.G. Kiloh, D.F. Klein, G.L.Klerman, N.S. Kline, P. Kragh-Sorensen, J. Levine, N. Matussek, M. Perel, C. Perris, R.F. Prien, O.J. Rafaelsen, D.S. Robinson, M. Roth, R. Rubovits, N. Sartorius, M. Schou, B.K. Shah, G.M. Simpson, T. Tashev, G. Winokur and J.R. Wittenborn.      

EDITOR’S COMMENT: This symposium was an example of the fruitfulness of gathering together experts from different continents, which at the time posed very considerable organizational and financial difficulties. 

Jules Angst
September 25, 2014