Essential Psychopharmacology: The Prescriber’s Guide: Antidepressants, 3rd ed

Essential Psychopharmacology: The Prescriber’s Guide: Antidepressants, 3rd ed

Stephen M. Stahl, MD, PhD. Cambridge University Press, New York, NY, 2009, 241 pages, $35.00 (paper).

The Prescriber’s Guide: Antidepressants, first published in 2006, came out in a third edition in 2009, reflecting the rapid development and ongoing changes in the field of psychopharmacology. I predict that before long the main venue for conveying the latest in pharmacotherapeutic skills will migrate entirely to the Internet. Today, the main competition for pocket guides like this one is not other books but constantly updated Web-based programs such as Epocrates. With all of this in mind, the current volume admirably fulfills the promise of a useful, practice-oriented, and evidence-based rapid reference. The Stephen M. Stahl brand leads us to expect excellence, and this book does not disappoint. It is meant to complement Stahl’s Essential Psychopharmacology.

This volume offers 241 pages of well-organized information on every antidepressant available in the United States as well as many others sold abroad. It is constructed with the user in mind. Ordered alphabetically by the nonproprietary names of the drugs, it summarizes all of the clinically relevant information for any given compound within no more than 5 pages. It lists off-label indications along with the FDA-approved ones (the latter clearly marked); this is, again, extremely useful for the practicing clinician, although it raises the question of inclusiveness. Surely, there are many other drugs used to treat depressive symptoms once we leave aside the FDA’s canon—methylphenidate and lithium come to mind. However, as a practicing psychiatrist, I found the book to hit the right balance between comprehensiveness and day-to-day utility.

Each drug has its own mini-chapter, and each of these is predictably divided into 5 color-coded themes: therapeutics, side effects, dosing and use, special populations, and the art of psychopharmacology. In all of these areas, following a nod to the underlying science, the content has a "how-to" emphasis. Even before the user gets accustomed to Stahl’s extensive system of icons, orientation is easy. Time and again, I tested the utility of the book by raising a question (How would I dose duloxetine in a geriatric patient? How do I go about terminating paroxetine treatment?) and looking for an answer. Provided that I knew the nonproprietary name of the compound, I had my answer in seconds.

The section on side effects is useful as a guide when initiating treatment with a drug one uses less commonly. For the informed consent discussion with the patient, Stahl helps by providing a quick overview of the most common and the most serious potential problems, saving the clinician the need to scroll through the pages of adverse events listed in the typical online resources. Another useful characteristic is the advice on how to stop treatment with a particular medication and what to do if the treatment does not work. In the latter section, the listing of psychotherapy as an alternative if an antidepressant does not achieve remission was a bit surprising. Many clinicians would argue that psychotherapy is a necessary accompaniment to pharmacotherapy.

One important feature of this handy guide takes the reader beyond simple utility. The final section in each drug summary is titled "The Art of Psychopharmacology." This section starts with a quick summary of advantages, disadvantages, and specific target symptoms, based on literature and the author’s clinical experience. It concludes with a number of "pearls" of wisdom derived from practical experience. While Stahl remains true to his evidence-based philosophy, he enriches the dogma with added clinical empirical insights. For instance, his pearls address the problem, commonly seen in clinical practice, of what he calls "SSRI poop-out"—how to proceed with treating the patient who, after a time on an SSRI, complains that "the medicine seems to wear out." In a few pithy sentences, never heard from the pharmaceutical representative in your office, Stahl helps the practitioner make a prescribing decision between, say, venlafaxine and desvenlafaxine, or between citalopram and escitalopram.

In summary, Stahl’s Prescriber’s Guide is an excellent aid in practical clinical work with psychiatric patients who need antidepressant pharmacotherapy. The organization of the book is user-friendly, the references are up to date through 2008, and the content is impeccable.

Ole J. Thienhaus, MD

othienhaus@unr.edu

Author affiliations: Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Las Vegas. Potential conflicts of interest: None reported.

doi:10.4088/JCP.10bk06407whi

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