Depression and Physical Illness Edited by Andrew Steptoe. Cambridge University Press. 2007. 434pp. £45.00 (pb). ISBN 9780521603609

An important relationship between depression and medical disorders has long been recognised and variously conceptualised according to prevailing beliefs – from black bile in ancient Greece to psychoanalytic theories in which the body is a theatre of the mind and a myocardial infarction can result from unexpressed emotions. For most of the 20th century the term psychosomatic medicine encompassed an interaction between the psychological and the physiological. However, in many ways this term made the divide between body and mind even wider, with many patients and clinicians continuing to regard a psychological condition as not real. Depression is still described as psychological rather than biological, yet, in the light of our current knowledge, what could be more biological than a neuroendocrine brain disorder with multiple manifestations in various organ systems?

In this excellent new book, Andrew Steptoe brings together a wide group of experts to give us a 21st-century view of the associations between depression and physical illness. While addressing psychological aspects of depression, it also presents a carefully balanced view that critically evaluates the biological underpinnings of the disease associations. (Interestingly, the term psychosomatic does not even appear in the index.)

The book is divided into three parts. The first gives a clear account of the importance of the definition of depression and its methods of measurement. It also provides a comprehensive overview of how psychosocial factors, such as low socio-economic status and education, predict not only depression but also affect physical risk profiles. A range of specific health problems is covered in the second part and in the third possible underlying biological and behavioural processes are explored.

The most robust links are between depression and coronary heart disease and this is reflected by the inclusion of three chapters giving a balanced and thorough presentation of the evidence that individuals with depression are more vulnerable to heart disease and even if their depression can be successfully treated this will not necessarily improve the course of the cardiac disease. The evidence linking depression with other medical disorders, such as diabetes and cancer, is not as strong but is nevertheless consistent. The chapter on pain and depression gives a fascinating overview of these two conditions as related symptom complexes associated with neuroendocrine and immune activation. Similar links are described for other disorders and these findings are integrated in the final section in working models that indicate future opportunities and possible pitfalls in this field of study.

I recommend this book highly to all mental healthcare professionals and my only criticism is that I would have liked to read more about potential treatment approaches but, as this field continues its rapid expansion, we can look forward to a larger, later edition. But most of all, I would recommend this book to other medical specialties – on checking the contents of the latest editions of several prominent textbooks of medicine, I could find no reference to the role of depression despite the overwhelming evidence presented in Depression and Physical Illness.