Book Review

The American Psychiatric Press Textbook of Psychopharmacology

N Engl J Med 1995; 333:134-135July 13, 1995

Article

The American Psychiatric Press Textbook of Psychopharmacology
Edited by Alan F. Schatzberg and Charles B. Nemeroff. 896 pp. Washington, D.C., American Psychiatric Press, 1995. $100. ISBN: 0-88048-389-X

Once, one could select from among just about three categories of psychiatric drugs -- antidepressants, major tranquilizers, and minor tranquilizers. The choice depended on whether the patient appeared depressed, looked psychotic, or was feeling nervous. For other problems, there was electroshock therapy or psychoanalysis.

Things have changed. Over the past 20 years, psychopharmacology has grown exponentially, and comprehensive textbooks have barely been able to keep up. Consequently, students have had to rely largely on journal articles, chapters in general textbooks, and problem-oriented primers. The American Psychiatric Press Textbook of Psychopharmacology thus fills a large gap.

This book aims to cover both basic science and clinical practice. The first two thirds gives a thorough background in neurobiology and pharmacology, setting the stage for the discussion of the treatment of mental illness.

Physicians may buy this book for its clinical applicability. But they should also find it rewarding to read about the physiologic background of the conditions they treat. This book shows that planning pharmacologic treatment for a person with mental illness is a complex clinical science. The algorithms derived from the text help the practitioner answer difficult differential therapeutic questions, such as the choice between heterocyclic antidepressants and the newer serotonin-reuptake inhibitors. The authors include environmental variables in their discussions of the decision-making process.

The book is strongest when it adheres strictly to its main purpose, the discussion of psychopharmacotherapy and its rationale. When it strays beyond this focus, I found some weaknesses. The discussion of suicidal and homicidal states is too superficial. The editorial hand has been remiss in occasionally failing to eliminate irrelevant paragraphs. Otherwise, the editing is exceptionally effective in minimizing internal inconsistency and repetitiveness. The editors have succeeded in providing a clear, systematic organization.

The book includes comments on experimental developments and novel psychopharmacologic agents introduced in Europe but not the United States. Thus, the authors have tried to defer the obsolescence that threatens any clinical textbook. All the same, sections of this book will soon become outdated. Perhaps it could be subdivided into several smaller books -- creating a kind of miniseries that could be revised and updated piece by piece. Alternatively, a computerized format -- on a CD-ROM, for instance -- might be marketable as a core text, and it could be updated annually.

Ole J. Thienhaus, M.D.
University of Cincinnati College of Medicine, Cincinnati, OH 45267