Kalyna Z, Bezchlibnyk-Butler J, Joel Jeffries
Hogrefe & Huber Publishers, Seattle Office, PO Box 2487, Kirkland, WA
Readers require knowledge of psychotropic drugs
Numerous charts and tables compare dosages, adverse effects, drug interactions, and pharmacokinetics of psychotropic drugs of different classes
Residents in psychiatry, family physicians familiar with psychotropic drugs, and psychiatrists
This handbook is a guide in psychopharmacology intended essentially for American and Canadian physicians familiar with psychotropic drugs. The authors claim it might also serve other mental health professionals as well. However, the handbook is not intended for neophytes who wish to become familiar with concepts in psychopharmacology.
All chapters have been updated or expanded, and new chapters have been added that, unfortunately, make this handbook less user-friendly than former editions. Using numerous charts and tables, the authors have created a practical way to compare information on drugs within the same class. Charts and tables show adverse events; dosages; drug interactions; and pharmacokinetics of antidepressants, neuroleptics, antiparkinsonian agents, anxiolytics and hypnotics, mood stabilizers, and psychostimulants.
The book also effectively highlights precautions and specific considerations (drugs used during pregnancy or for children or the elderly) of which physicians should be aware. I have found previous editions of the handbook very convenient in my clinical practice and will continue to use this edition as a quick reference manual.
However, numerous sections of this edition are superfluous for use in my daily practice. The telegraphic approach of many of these chapters makes the reading arduous, and topics are covered in more interesting ways in textbooks. These sections include a description of the practice of electroconvulsive therapy (ECT), the use of sex drive depressants, drugs of abuse, anti-alcohol drugs, and new unapproved treatments with psychotropic drugs. The five-page section on ECT could have been limited to the description of drug interaction with ECT.
In the section of unapproved uses for psychotropic drugs, I think the alternative treatments that are proposed should be reserved for patients highly resistant to conventional therapy and managed by specialists. This section might encourage some physicians to use drugs based on single case reports (ie, flunarizine in bipolar disorders) before having gone through stepped care.
One should also be aware of medicolegal issues when using medications for unapproved indications. Although many psychotropic medications are being used for unapproved indications, they are used when enough scientific data supports the choice of the treatment (for example, carbamazepine is extensively used but not approved for treating bipolar disorders). The handbook does not clarify these nuances, and it would have been preferable if the authors had focused on well documented and accepted therapeutic strategies, including a stepwise approach to major psychiatric disorders.
Finally, many of the terms included in the glossary are not useful for most physicians (ie, dermatitis: inflammation of the skin; jaundice: yellow appearance of skin). However, this handbook is a good reference manual, although many sections might not be useful for most physicians.