Book Review

Drugs and the Brain

N Engl J Med 1996; 335:2003December 26, 1996

Article

Drugs and the Brain
By Solomon H. Snyder. 228 pp., illustrated. New York, Scientific American Books, 1996. $19.95. ISBN: 0-7167-6017-7

Many people say we have learned more about the brain in the past 20 years than in all of recorded history. Much of this explosive growth in knowledge emanates from the technological advances that are revolutionizing all of biomedical research. These include the new tools of cellular and molecular biology and the advanced imaging techniques that are allowing our first look at the structure and function of the brains of living, awake, and functioning people. In Drugs and the Brain, Solomon Snyder does an outstanding job of explaining what the research community has learned. He meticulously chronicles the unusual history of one of the most compelling questions of neuroscience: how exogenous chemical substances, psychoactive drugs, modify moods and other experiences.

Not only have advances in neuroscience transformed our understanding of how drugs affect behavior, but the reverse has also been dramatically true. As Snyder's own work on endogenous opiate receptors and their natural ligands, the endorphins and enkephalins, illustrates, advances in drug research have stimulated a thorough reconsideration of many aspects of neurotransmission.

This book approaches the study of drugs and the brain from many directions. Snyder carefully chronicles the interesting trends in societal attitudes about drugs that can be abused and “medicinal” drugs. The book is also filled with beautifully told stories of discovery. For example, his description of the discovery of antipsychotic agents and antidepressants as involving “large doses of serendipity coupled with occasional flashes of brilliant scientific insights” illustrates how science actually moves forward.

Drugs and the Brain also provides many interesting and informative clinical observations and insights. A particularly interesting discussion centers on whether antipsychotic medications work on the “core” or essence of psychosis or whether they deal with more superficial symptoms. Snyder gives the reader excellent, detailed clinical descriptions of depression and mania.

If I have any complaint about this book, it is that in some instances issues that would have benefited from expanded discussion are only touched on. One example is the complexity of addiction. The book speaks about tolerance, dependence, and withdrawal but focuses too little on the clinical features of addiction — compulsive, uncontrollable drug use — the aspect of addiction that for most people matters the most. This may be because the understanding of the neuroscience of addiction is quite thin. But it is a lost opportunity to move the debate from whether specific drugs produce physical dependence, which clinically is not very important, to their potential to produce unrelenting drug-seeking in the face of serious negative consequences and their capacity to overpower other motivations.

Another minor flaw occurs in the last chapter, on hallucinogens, which devotes too much time to anecdotal experiences and too little to the science of how these drugs might work. These minor imperfections aside, this book represents an outstanding education for readers at many levels. It is about much of what we know about the brain and the mind — a most complex and intriguing relation that has drawn so many to study the brain in the first place. It well reflects the author's broad understanding of both basic science and clinical issues.

Alan I. Leshner, Ph.D.
National Institute on Drug Abuse, Rockville, MD 20857