Depression and the Body

The Good News About Depression: Cures and Treatments in the New Age of Psychiatry by Mark S. Gold MD, with Lois B. Morris (Villard Books: $18.95).

This might be the best of times to suffer depression, believes Mark S. Gold, a psychiatrist who has done extensive research in the new field of biopsychiatry, which examines both mental and physical causes of depression, a condition affecting 100 million worldwide, he estimates.

His landmark book has two purposes: to inform the layman who has failed to respond to talk-it-out therapy and to wake up--and shape up--the profession. Gold charges that psychiatrists have set up shop as psychologists and fail to practice old-fashioned “black bag” medicine; only 35% perform physical examinations, run lab tests or go beyond traditional “couch-potato” therapy.

Further, psychiatrists often prescribe antidepressants (today, primarily, tricyclic drugs) without considering whether the patient’s symptoms might be “mimickers” or real disorders. Depression frequently is a result of hormone dysfunction or endocrine imbalance (most often thyroid dysfunction). Infectious and central nervous system disease imitators, such as epilepsy, Huntington’s chorea and multiple sclerosis, are often the true culprits, as are alcohol and numerous prescribed and illegal drugs.

“Medical psychiatry,” Gold insists, should include a complete medical history, a period when the patient takes neither drugs nor medication in order to run clearly described lab tests, followed by psychological assessment.

If patients fail to respond to the target drug within three weeks (and 85% of the author’s patients do respond), this treatment should be discontinued and re-evaluated. Combining current research and compassionate, no-nonsense advice, Gold establishes realistic guidelines that begin to answer that ubiquitous question: “Why are you depressed?”