For the traveller who is forced to undertake it, the journey through a prolonged episode of severe anxiety and depression can feel like one for which there is no end. Your GP may feel unable to help you because of the severity of your symptoms, but the local mental health services do not consider you to meet their criteria for what constitutes ‘severe mental illness’, so you are forever tossed between the two, not getting adequate help from either. The author of this book works at the interface between psychiatry and primary care and acknowledges the important role our profession still has to play in helping people with severe non-psychotic illness and in supporting GPs to care for those who do not need to see a mental health professional more than briefly, if at all. It reads throughout as the distilled knowledge of a skilled and experienced clinician.
I did, however, find myself wondering who the intended audience was. It is not written in language that a person suffering from depression could necessarily understand; I must admit that, as someone who has experienced mood disorder, I found the use of the term ‘strength of character’ unhelpful in considering whether a person can ‘survive the index episode’ following a ‘psychological insult’. Moreover, the focus of the book goes beyond what a general practitioner would need or be expected to know as it deals with some specialist therapies for treatment-resistant depression, yet it does not fully address the current guidance on treatment from the National Institute for Health and Care Excellence. The case studies are written from the viewpoint of a specialist and there is discussion of the multiple different diagnoses that might be applied to a person with common mental health problems without acknowledgement that specialist classification has less to offer in the primary care setting.
Overall, the book would have benefited from a more attractive layout and further editing to simplify what, at times, can seem an overly complex journey to the reader. In conclusion, this is a book for a young psychiatrist who is interested in stepping up to the challenge of the complex mix of problems beyond the world of psychosis, or the generalist who desires to understand more.
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