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Clinical Guide to Depression and Bipolar Disorder

Findings From the Collaborative Depression Study

Edited by Martin B. Keller, M.D., William H. Coryell, M.D., Jean Endicott, Ph.D., Jack D. Maser, Ph.D., and Pamela J. Schettler, Ph.D.

  • ISBN 978-1-58562-433-1
  • Item #62433

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Conceived in the early 1970s to study the phenomenology, diagnosis, genetics, and clinical course of depression, the NIMH Collaborative Depression Study (CDS) has influenced research and practice since its inception. Clinical Guide to Depression and Bipolar Disorder: Findings From the Collaborative Depression Study summarizes key findings from the study and the related literature to provide comprehensive and up-to-date knowledge on the course and outcome of illness in mood disorders. Nowhere else can clinicians find such detailed longitudinal data, combined with astute clinical analysis of the current research. The volume offers:

  • Historical background on how psychodynamic psychiatry was overtaken by psychobiological perspectives, and the challenges and controversies that gave rise to the CDS, providing the context necessary to understand the profession's development to the present day.
  • A wealth of information on nosology, natural history, phenomenology, and treatment response in depressive and bipolar disorders.
  • Detailed descriptions of the study methods employed, providing information and insights that will assist researchers in the longitudinal design of prospective cohort studies.
  • Comprehensive review of outcomes in mood disorder, including delineation of the long-term course of bipolar I, bipolar II, and unipolar major depressive disorders, the implications of which will continue to be instrumental in the development of psychiatric nosology and indispensable to clinicians engaged in assessment and treatment.
  • Critical information clinicians need in order to read the clinical signs in their patients and predict the switch from unipolar to bipolar disorder.
  • A fascinating review of the evolution of diagnostic thinking about the role of anxiety in mood disorders, and the contributions of the CDS to the newly published DSM-5.

Each chapter is accompanied by a time-saving summary, as well as a section on clinical implications that translates the findings into practical points and key recommendations clinicians need to know to provide optimal care. Psychiatrists, clinical psychologists, residents, and fellows will turn to Clinical Guide to Depression and Bipolar Disorder: Findings From the Collaborative Depression Study to better understand the course and outcome of their patients' mood disorders and, ultimately, to improve their clinical skills.


  • Contributors
  • Dedication
  • Chapter 1. Introduction
  • Chapter 2. Collaborative Depression Study Procedures and Study Design
  • Chapter 3. Dimensional Symptomatic Structure of the Long-Term Course of Unipolar Major Depressive Disorder
  • Chapter 4. Dimensional Symptomatic Structure of the Long-Term Course of Bipolar I and Bipolar II Disorders
  • Chapter 5. Risk Factors for Suicide Attempts and Completions
  • Chapter 6. Psychotic Features in Major Depressive and Manic Episodes
  • Chapter 7. Development of Mania or Hypomania in the Course of Unipolar Major Depression
  • Chapter 8. Comorbidity of Affective and Substance Use Disorders
  • Chapter 9. Treatment Effectiveness and Safety in the Longitudinal Course of Mood Disorders
  • Chapter 10. Personality and Mood Disorders
  • Chapter 11. Family History and Genetic Studies in Mood Disorders
  • Chapter 12. Clinical Course and Outcome of Unipolar Major Depression
  • Chapter 13. Predictors of Course and Outcome of Bipolar Disorder
  • Chapter 14. Undertreatment of Major Depression
  • Chapter 15. Impact of Anxiety Severity on Mood Disorders
  • Chapter 16. Contributions of the NIMH Collaborative Depression Study to DSM-5
  • Index


    Hagop S. Akiskal, M.D.
    Robert Boland, M.D.
    Paula Clayton M.D.
    William Coryell, M.D.
    Jean Endicott, Ph.D.
    Jan Fawcett, M.D.
    Jess G. Fiedorowicz, M.D., Ph.D.
    Deborah Hasin, Ph.D.
    Robert M.A. Hirschfeld, M.D.
    Lewis L. Judd, M.D.
    Martin B. Keller, M.D.
    Bari Kilcoyne, B.S.
    Andrew Leon, Ph.D.
    Jack Maser, Ph.D.
    John P. Rice, Ph.D.
    Pamela J. Schettler, Ph.D.
    David Solomon, M.D.

About the Authors

Martin B. Keller, M.D., is Professor in the Department of Psychiatry and Human Behavior at Alpert Medical School, Brown University; and Chief Academic Strategic Planning and Director of the Mood and Anxiety Disorders Research Program at Butler Hospital in Providence, Rhode Island.

William H. Coryell, M.D., is Professor in the Department of Psychiatry at the University of Iowa, Carver College of Medicine in Iowa City, Iowa.

Jean Endicott, Ph.D., is Professor of Clinical Psychology in the Department of Psychiatry at College of Physicians and Surgeons, Columbia University; and Director of the Division of Clinical Phenomenology at the New York State Psychiatric Institute in New York, New York.

Jack D. Maser, Ph.D., is Adjunct Professor in the Department of Psychiatry at the University of California, San Diego, in La Jolla, California.

Pamela J. Schettler, Ph.D., is Principal Statistician in the Department of Psychiatry at the University of California, San Diego, in La Jolla, California; and Senior Research Associate in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine in Atlanta, Georgia.

This work is a veritable tour-de-force, a 'Who's Who' of scholars and scientists in mood disorders, and a treasure trove of data and practical clinical advice. I am inspired by the duration of this heroic study, its magnitude and import, and by the patients who magnanimously allowed themselves to be subjects over decades. I particularly valued the clinical pointers at the conclusion of chapters. Every psychiatrist will want this book within easy reach.—Alan J. Gelenberg, M.D., Shively/Tan Professor and Chair, Department of Psychiatry, Penn State University, Hershey, PA

The Collaborative Depression Study involved a 31-year follow-up of about 1,000 patients who had mood disorders. This study has provided the core information which is currently used to diagnose and predict clinical outcome of patients with major depression and bipolar mood disorders and has heavily influenced several DSM revisions, including DSM-5. Clinical Guide to Depression and Bipolar Disorder: Findings from the Collaborative Depression Study is a 'must-read' for clinicians who wish to explore the rationales for clinical diagnosis of mood disorders and the data used to support the current subtypes of depression.—David L. Dunner, M.D., FACPsych, Director, Center for Anxiety and Depression, Mercer Island, WA; Professor Emeritus, Department of Psychiatry and Behavioral Sciences, University of Washington

More than any other study, the Collaborative Depression Study has influenced our understanding of the clinical presentation and natural history of depression and mania, and shaped our view of mood disorders as chronic/recurrent conditions. This ground-breaking study, meticulously conducted over 30 years, has produced major insights into the importance of subclinical symptoms, switching from major depression to bipolar disorder, the impact of comorbid anxiety and substance misuse, the role of psychotic features, and the prediction of suicide, as well as providing influential advances in clinical assessment and statistical modeling. This volume summarizes many of the key findings that have emerged from the CDS, updates previously published results with final analyses based on 30 years of intensive follow-up, and traces the implications for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It is a 'must-read' for all mental health professionals concerned with understanding and treating mood disorders.—Daniel N. Klein, Ph.D., Professor and Chair, Department of Psychology, Stony Brook University, Stony Brook, NY

The Collaborative Depression Study is a monumental contribution to the field of mood disorders beyond comparison. It represents a gold standard example of evidence-based guidelines for clinicians and patients in regards to course of illness and treatment implications in mood disorders.—Mauricio Tohen, M.D., Dr.P.H., M.B.A., Chair, Department of Psychiatry, School of Medicine, University of New Mexico, Albuquerque, NM

This book memorializes one of the most important and innovative studies ever funded by NIMH. It is both a history and a primer of how the longitudinal study of mood disorders developed in the United States. The authors describe not only how instruments commonly employed by clinicians and researchers were developed but how their systematic use led to many of the fundamental tenets that are the foundation for our modern understanding of mood disorders. It is an invaluable work for any clinician or researcher to have.—Mark Hyman Rapaport, M.D., Reunette W. Harris Professor & Chairman, Dept of Psychiatry & Behavioral Sci, Emory Univ School of Med; Chief of Psychiatric Services, Emory Healthcare; Co-Editor of FOCUS

The CDS is without a doubt one of the longest and most intensive psychiatric studies ever conducted. At least 285 empirical reports have been published based on CDS findings, and the CDS has led to a rethinking of the terminology of mood disorders and a new appreciation of their devastating, long-term course. A study of such extraordinary magnitude and paramount importance demands a book to summarize its key findings. This is that book.—Bradley R. Cutler, M.D., Doody's Book Review

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