Book Review

The Molecular Foundations of Psychiatry

N Engl J Med 1993; 329:1973December 23, 1993

Article

The Molecular Foundations of Psychiatry
By Steven E. Hyman and Eric J. Nestler. 239 pp., illustrated. Washington, D.C., American Psychiatric Press, 1993. $35. ISBN: 0-88048-353-9

This brief but important book fills a gap between clinical psychiatry and the rapidly evolving field of molecular neuroscience. Conceived neither as a textbook nor as a monograph, it is an overview of the molecular mechanisms of synaptic transmission, neuropsychopharmacology, neuroplasticity, and psychotropic drug actions. There is a lucid discussion of the pitfalls and promise of psychiatric genetics, along with a review of such techniques as linkage analysis and molecular cloning.

Because of the lag time inevitable in the publication process, there is no mention of the more recent advances in the field such as nitric oxide and carbon monoxide neurotransmission. Yet the material that is presented -- discussions of major neurotransmitters, the transsynaptic regulation of gene expression, the serotonergic system, and the like -- is basic enough to constitute a thoroughgoing inventory of the core concepts in the field of molecular psychiatry.

The authors have anticipated that not all readers may be interested in many of the technical refinements of their subject, such as recombinant plasmid construction and subtraction hybridization. Accordingly, sections devoted to such matters are set apart by a stripe in the margin. But the book is written in such an accessible style that it is hard to imagine a reader unwilling to read these portions to the end.

There is a certain element of faith in the main premise of this book -- namely, that molecular neuroscience will eventually yield objective tests, specific treatments, and preventive strategies in psychiatry. Molecular psychiatry, however, is currently still in its infancy, unable as yet to explain enduring questions about depression, psychosis, addictions, and anxiety disorders in any but the most empirical and, too often, pharmacocentric manner. But no description is more apt for this field at the moment than “exciting.” The development of the capacity to unravel first- and second-messenger systems, identify, clone, and transfect genes, and manipulate them to alter signal transduction between neurons is setting the stage for a neurobiologic revolution in psychiatry. This book, then, is a welcome introduction for those who would like to understand its progress.

Henry David Abraham, M.D.
St. Elizabeth's Hospital, Boston, MA 02135