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Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 5th ed

by Stephen M. Stahl, Cambridge Medicine, New York, NY, 2014, 802 pages, $90.00 (paper).

Trying to find clear, practical information about prescribing psychotropic medication can be exasperating. All too often, such information presents in the form of indigestible chunks of prose. Whoever writes the data about medications in the pallid pages of the PDR or the bright white sheets in our journals and newsletters does so with the clear intent of covering all the legal niceties. All well and good, but “Where,” I feel like asking, “can I find out how to how use the meds?”

Stephen Stahl consistently provides reliable answers to that question in the new (fifth) edition of his Prescriber’s Guide. It is a natural companion to Stahl’s Essential Psychopharmacology, which explains the mechanisms of actions of psychotropic drugs and the ways they impact brain. This volume takes the work to the logical next step, providing practitioners with practical information about how to use the medications in their work with patients.

Stahl lists the medications alphabetically. The fifth edition contains information on 16 added drugs, including 6 of the latest to appear, such as milnacipran and vortioxetine. He has reviewed the entries for familiar medications and, where necessary, has added to or changed his position as new data have become available. He crams a remarkable amount of concisely expressed, up-to-date information into his book.

Several features make it easy for the reader to use the book. Color-coding makes it possible to rapidly get the type of information wanted. Information on each medication is subdivided into 5 sections: Therapeutics, Side Effects, Dosing and Use, Special Populations, and the Art of Psychopharmacology. Particularly pertinent is the information in the Dosing and Use section, which points out Drug Interactions and Other Warnings/Precautions. Stahl notes that the Art of Psychopharmacology sections reflect his personal opinions. Each contains a subsection, “Pearls,” which are little pieces of information about the medication that can help the practitioner fine-tune its use.

A notable feature of Stahl’s work is his consistent use of symbols to identify topics. Interacting cogwheels, for example, indicate mechanisms of action. I find the little icons indicating the class of medication confusing; otherwise, they are useful and even witty. They are more evidence that a particular person has written the book with a view to making it easier for the reader to learn.

In his introduction, Dr Stahl asks readers for feedback on the book. What is useful, and what is not? Are there mistakes? Is there fresh information that needs to be included? He recommends that readers assess their own level of sophistication in choosing medications. He doesn’t pretend that his is the definitive or only information about these drugs, and he urges readers to consult the information provided by manufacturers.

The tone of his introduction is that of one clinician speaking to another. To a remarkable extent he sustains that tone throughout the book. The combination of up-to-date information with such a reader-friendly presentation is what makes Dr Stahl’s work so welcome.

Brian B. Doyle, MD, CM

Author affiliation: Georgetown University School of Medicine, Washington, DC.

Potential conflicts of interest: None reported.