The Secret Strength of Depression, 3rd ed., by Frederic Flach, MD, KHS. New York: Hatherleigh Press; 2002. 279 pages, paperback, $15.95.

In The Secret Strength of Depression, Dr. Frederic Flach encourages individuals who experience depression to view their situation as an opportunity for self-examination. The central theme of this book is that depression, instead of signifying personal weakness, can actually serve as a "catalyst for important changes" that can force people to "take a good look" at themselves and at life choices that may have contributed to both acute (short-term) and chronic (long-term) unhappiness. First published in 1974, this third edition features updated information reflecting the increase in rates of depression from the 1980's to the 1990's and current research on the relationship between depression and chronic disease.

This book seems most appropriate for potential consumers of mental health care services who may be battling the societal stigma associated with depression and who, therefore, may not seek the treatment that they need to facilitate their recovery. The book begins with prefaces to each of the three editions, providing an introduction to concepts that readers will encounter further in the text, such as the author's theory of "resilience." The 22 chapters that follow address a multitude of topics including the expectations that one should have of psychotherapy; the relationship between sex and depression; and the ways in which depression may be encountered and successfully dealt with across the life span.

The initial chapters delineate between acute and chronic depression, arguing that it is acute depression that serves as a warning signal that changes are needed. Flach provides some brief examples of how this warning mechanism works from his own clinical experiences. If a person does not heed the warning that acute depression provides, he or she may become "entrapped" by their previous choices and long-term, chronic depression can ensue.

The author does a fine job of explaining how both environmental and biological factors can contribute to depression. He describes the characteristics of environments that can trigger depression. Flach also explains how sometimes even success can be a trigger if a person's self-esteem is built solely on "external evidence of accomplishment." Flach also provides a straightforward, accessible overview of the role of neurotransmitters and hormones in the occurrence of depression, and how antidepressant medications alter the body's chemistry to alleviate symptoms. Clear explanations are provided regarding the dosage, the treatment effects, and the side effects of commonly used antidepressants. Consumers are advised on how they may evaluate mental health care professionals and how various kinds of therapy may facilitate their recovery.

The main weaknesses of the book are a lack of consistent citations and a need for more detailed footnotes regarding the sources that the author has drawn from in the text. The multiple topics could perhaps have been presented in a more coherently organized fashion. Finally, only a small portion of the material presented actually addresses the purported central theme of the book, depression's secret strength, and only a small number of clinical examples are provided to illustrate the central theme.

Despite these shortcomings, Flach's book is a clearly written, comforting text for individuals who are struggling to address their own possible depression and who may be wondering what they can expect from working with a mental health care professional. Flach offers a balanced perspective on the integration of both pharmacologic and psychotherapeutic approaches to treatment. His book would be a valuable resource for potential consumers of mental health care services, for those who have just started to receive treatment and for family members of individuals attempting to come to grips with their possible need for mental health care services to treat depression.