Book Review

Better Than Prozac: Creating the Next Generation of Psychiatric Drugs

N Engl J Med 2003; 349:2369December 11, 2003

Article

Better Than Prozac: Creating the Next Generation of Psychiatric Drugs
By Samuel H. Barondes. 219 pp. New York, Oxford University Press, 2003. $26. ISBN: 0-19-515130-5

The only thing missing from this book is a question mark in the title. Better Than Prozac is about the long road that neuropsychopharmacology has traveled and about hopes for its future, particularly with respect to creating better drugs. Drugs that treat psychiatric conditions are inherently fascinating. In the 1950s, when effective agents became available for use by psychiatric patients, many doctors thought that drugs with a simple pharmacologic action could not solve human problems. Of course, this is true, but what the drugs can help are psychiatric illnesses, which now seem to be caused by abnormal brain function. Many years of consolidation and refinement of the basic concept and of the drugs that were introduced during the 1950s have followed that golden decade. Much of the early “out of the box” thinking occurred in Europe, particularly in France. However, the action seems to have moved across the Atlantic, and the field is now dominated by North America, albeit with some important contributions from various centers around the world.

These are interesting times for the field of neuropsychopharmacology. Our understanding of the pathophysiological mechanisms that give rise to psychiatric disorders and of the contributions of genetic, metabolic, and indeed psychosocial factors still remains frustratingly provisional. Added to this is a growing distrust of the pharmaceutical industry and its role in developing and marketing new drugs. With this background, it is easy for those involved in biologic psychiatry and psychopharmacology to feel beleaguered. Barondes's excellent book provides an antidote.

Better Than Prozac is one of the few books I have found that is relevant not only to experts in the field and trainee psychiatrists but also to patients and their families. It is accessible to all and accomplishes the seemingly impossible task of making complex issues in psychopharmacology understandable and clear. Barondes's technique is essentially that of a storyteller recounting the history of the development of psychiatric drugs in an elegant and lucid style. He enriches this historical account with real-world clinical examples and brings the reader from the dawn of psychopharmacology, through all the important developments in the field, and right up to date with breaking research and the potential implications for the future.

Barondes's perspective is particularly valuable because he shows not only a wisdom derived from long and varied clinical practice but also an understanding of fundamental neurobiology. I found myself reinvigorated by this book and refreshed to tackle the tough problems it outlines. In particular, it is clear that the achievements of the field in the past 50 years have been so valuable, and recent advances in neurobiology so great, that new and exciting developments are highly likely to happen in the second half of psychopharmacology's first century. Barondes is to be complimented on an excellent book.

Allan H. Young, M.D., Ph.D.
University of Newcastle, Newcastle upon Tyne NE1 4LP, United Kingdom
a.h.young@ncl.ac.uk