Comments (Martin M. Katz)

In a relatively brief, inviting Preface, Tom Ban recounts the history of research in European psychopathology during the 20th century. He details the contributions o f many of its leading figures and covers ground unfamiliar to many American psychiatrists. These early workers arrive at different formulations of depression, different diagnostic systems and different treatments. Of specific interest is the development of “phenomenologic psychopathology” referencing the roles of Karl Jaspers and Kurt Schneider, noting that they reopened the science in a more enlightened context. The new antidepressants have clearly shaken the approaches to treatment. Such earlier theoretical concepts have been set aside as clinicians adopt a more practical trial and error approach with the new drugs and show less concern for lessons in this historical sphere. Ban is more at home in that context because the approach which relies less on ideas about etiology, provides the foundation for the methodology he will use in the book to “deconstruct major depression, (to) open the path in the study of the biology and genetics of the different depressive subtypes” In so doing he hopes to achieve a “personalized medicine” capable of individualizing the treatment approach for each depressed patient. Ban’s approach will attempt to provide psychiatrists with a new context within which to work. One can look forward to a more complete blueprint for this strategy in the text that follows.

Martin M. Katz
 July 25, 2013


Reply (Martin Katz)

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It is difficult in a brief commentary to capture the main themes of a book in which the author attempts to rethink the nature of a major mental disorder and evaluate the impact of diverse new drug classesin its treatment. I have Per Bech to thank for grasping my intentions as well as the technical recommendations for changing the direction of research on the mechanisms of action of antidepressants. In linking the results of our experiments to the early ideas of the astute Paul Keilholz on how the drugs work clinically, and to the sequence of neurochemical actions uncovered by Carlsson, he provides a meaningful context for the observation that we are currently approaching research problems in this area in the wrong manner. Depression as Bech, notes from our results, is multidimensional and agrees that we must cease relying so heavily on diagnosis in the structure of research in psychopharmacology. If we adopt the dimensional approach, it will have major effects on how we design clinical trials of new agents.  It will also, hopefully, stimulate experimentation on agents with novel mechanisms, research that will restart development in an area that has uncovered no “new” classes of antidepressant drugs for several decades. Bech with his depth in the field of methodology places our work in the proper context for psychopharmacology and reinforces the need to move ahead in drug discovery with a new concept of depression and a broader range of approaches to behavioral measurement.

Martin M. Katz
November 14, 2013


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