Essential Psychopharmacology

by Stephen M. Stahl
Cambridge University Press, 2005
Review by Christian Perring, Ph.D. on Jun 9th 2005

Like Stephen Stahl, I want to start with a disclaimer. He and his publisher want to insist that his is just providing a guide for clinicians, and they can provide no warranties that the information is accurate. They don't want to get sued for any harm that might come to people using the book. My disclaimer is not motivated by a fear of being sued, but rather because I do not want to pretend to be more qualified than I am. I am not a psychiatrist nor do I have any scientific background in psychopharmacology. I am not an pharmacological expert and so if there are mistakes in the book, I would be unlikely to notice them.

The Prescriber's Guide is a guide to the most common psychotropic drugs. It lists 101 medications, and for each, it has sections on

· Therapeutics

· Side Effects

· Dosing and Use

· Special Populations

· The Art of Psychopharmacology

· Suggested Reading

The alphabetical listing of the drugs takes 543 pages, and then there is a table of contents, an introduction, and indices for drugs by name, by use and by class, as well as a list of abbreviations. The sections for each drug are color coded and they use icons to illustrate repeated points, such as a skull and crossbones in a green circle for life threatening or dangerous side effects, an exclamation point in a yellow triangle for other warnings/precautions, and a pearl necklace for Stahl's pearls of information about how to use the drug.

The different sections have subsections, and within each, the essential facts are listed using bullet point. For example, for haloperidol, the Therapeutics section says it has the brand name Haldol, and refers the reader to the index for additional brand names. It is available in generic form, and is a conventional antipsychotic. Then under "Commonly Prescribed For," 7 classes of disorder are listed. The first five are in bold, indicted that they are FDA approved. "How The Drug Works" gives a very brief neurobiological explanation, saying that it blocks dopamine 2 receptors. "How Long Until It Works" says that psychotic symptoms can improve within a week, but it may take several weeks to reach full effect. "If It Works" explains what symptoms the drug can reduce or eliminate if treatment should be considered successful. "If It Doesn't Work" suggests what supplemental or alternative approaches to use, and this is followed by a more specific section called "Best Augmenting Combos for Partial-Response or Treatment-Resistance." "Tests" list what medical tests should be performed before or while prescribing the drug.

The next section, on side effects, does not give numerical lists, bur rather just lists notable side effects, the dangerous ones, the frequency of weight gain and sedation, what to do about side effects, and the best augmenting agents for side effects. As with nearly every drug, the main recommendations about what to do about side effects are

· Wait

followed by some more active suggestions.

The dosing section is full of useful information, including the usual dosing range, dosage forms, how to dose, dosing tips, overdose, long-term use, whether the drug is habit forming, how to stop, pharmacokinetics, drug interactions, other warnings/precautions, and conditions where the drugs should not be used. The special populations section has subsections for renal, hepatic and cardiac impairment, the elderly, children and adolescents, pregnancy and breast feeding.

The most distinctive feature of the book is the section on the art of psychopharmacology. The four subsections here are "Potential Advantages," "Potential Disadvantages," "Primary Target Symptoms," and "Pearls." It is here that Stahl mostly inserts his own opinions formed from his own clinical experience. He sets out the pros and cons of the medication compared with others, some of the history of its use, or any distinct features of the medication that have not been covered in other sections. For example, for Haldol, he explains that it was one of the most preferred antipsychotics prior to the introduction of the atypicals, and it may still be useful at low doses for patients who need a conventional antipsychotic or who can't afford an atypical. He gives 11 other points about the medication, all of which could be useful for prescribers.

Stahl does not indicate if this book is aimed at a particular subsection of prescribers. Presumably psychiatrists who already specialize in psychopharmacology will have little to learn from the book, because most of the information will already be familiar. It will probably be more appropriate for general psychiatrists, training psychiatrists, general practitioners, and others with prescribing privileges. It might also be useful to psychologists who want to know more about psychiatric medications and patients and their families who want to learn more about what medications they are taking. While some of the language of the book is highly technical, most is not, and those with a moderate knowledge of the language of psychiatry should be able to understand the central facts.

Presumably physicians already have access to the scientific information about medications, through information supplied by the manufacturers and works such as Physician's Desk Reference. The attraction of The Prescriber's Guide is that it presents the information in a form that is much quicker to access and decode. It is an easy book to handle and navigate.

I still prefer Psychotropic Drugs Fast Facts (reviewed in Metapsychology August 2003)as a resource because it is more quantitative and groups the drugs by their type, giving more direct comparisons between different drugs of similar types, and contains more detailed information. But that book is not color-coded and does not have attractive icons, so readers who care about those things may prefer to use The Prescriber's Guide.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review. His main research is on philosophical issues in medicine, psychiatry and psychology.