Martin M. Katz: Depression and Drugs: The Neurobehavioral Structure of a Psychological Storm. Springer International: New York, 2013 (92 pages).
INFORMATION ON CONTENT: The discovery in the early 1950’s of the role of the central neurotransmitters and that of the new drug treatments for the mental disorders sparked a wave of research in the new science of neuropsychopharmacology. In the first two chapters, the book describes the impact of the new drugs on theory and research on the major depressive disorders, focusing on the interactions between neurochemistry and behavior and the role of diagnosis in clinical research. The author sets the stage for later detailing the misplaced reliance on diagnosis and introduces dimensional analysis to replace it in framing both basic and clinical research. In Chapter 3, “depression is a storm, not a lowering of spirit”, he describes the psychological factors that have been seriously neglected in the burgeoning of recent neurochemical studies. He reports results of empirical studies of the clinical phenomena and the need to turn to literary artists who have been afflicted, to characterize the personal experience. Combining these approaches led to a new strategy of measurement. In Chapters 4 and 5 he describes the “Rashomon” approach to measuring the state, the “multivantaged method”, and the resultant dimensions of anxiety-agitation-somatization, depressed mood-retardation, hostility-interpersonal sensitivity that represent the major part of the variance underlying its structure. Chapter 6, “False Assumptions,” critiques the basis of most current drug research. Much of that work is guided by earlier misconceptions of the disorder and of the nature and timing of drug actions. New evidence contradicts these assumptions and cites a new path to research in this area. Chapter 7, “New Hypotheses”, reports results from a follow up study that compared differently targeted antidepressants. It was designed to test hypotheses about drug actions derived from the earlier NIMH’s Collaborative Depressive Study and to extend knowledge on how neurochemical and behavioral changes interact to resolve the disorder. Chapter 8, in describing a “more effective model for the clinical trial of new drugs,” demonstrates the advantages of applying the dimensional conception of depression and the “componential” model, in place of the now 50 year old established “diagnostic” model, Finally, in Chapter 9, the author presents conclusions and describes a new theory about the nature of the depressive state, “the conflictual neurobehavioral state” hypothesis, a concept that views it as one of turmoil, not as unidimensional, but as one of conflicting central nervous system states, a “down, depressed retarded state” concurrent in the experience with an opposed “aroused, negatively excited,anxious” state.
AUTHOR’S STATEMENT: The book is a product of the author’s experience in two major Collaborative studies of the Psychobiology of Depression that extended over a period of several decades. The themes covered ranged from results of basic studies which detail the specific relationships between central neurotransmitter systems, serotonergic and noradrenergic, and the elements of behavior, to a rethinking of the neurobehavioral concept of the disorder itself. Noting the neglect of behavior in more recent drug research it views depression, not as a singular disorder, but as comprised of multiple dimensions. It further recommends replacing the dominant role that diagnosis plays in framing most all clinical research with the dimensional profile. To achieve that goal, a new conception of the disorder is presented and a new strategy of measurement, the multivantaged method, as the framework for future research. The empirical results of two collaborative studies characterize the behavioral phenomena. The components of depression are then combined with the descriptions by literary artists of the actual experience of the disorder. These results lead to a re-conceptualization of how the drugs act to resolve the disorder, and a new theory as to the experience of the depressed state, based on the interaction of opposed neurobehavioral states. In introducing the new methodology the author seeks to change the approach to clinical trials. The established model, developed more than 50 years ago, is out dated and does not do justice to the many drug actions and forms in which the disorder is manifested. There is a Postscript. In the appendices, detailed descriptions are presented of the brief form of the Multivantaged Assessment Method and the newly developed Video Interview Behavior Evaluation Scales (VIBES).
Martin M. Katz
August 8, 2013