by Stephen M. Stahl
Cambridge University Press, 2005
Review by Christian Perring, Ph.D. on Jun 9th 2005
Like Stephen Stahl, I want to start
with a disclaimer. He and his publisher
want to insist that his is just providing a guide for clinicians, and they can
provide no warranties that the information is accurate. They don't want to get sued for any harm
that might come to people using the book.
My disclaimer is not motivated by a fear of being sued, but rather
because I do not want to pretend to be more qualified than I am. I am not a psychiatrist nor do I have any
scientific background in psychopharmacology.
I am not an pharmacological expert and so if there are mistakes in the
book, I would be unlikely to notice them.
The Prescriber's Guide is a
guide to the most common psychotropic drugs.
It lists 101 medications, and for each, it has sections on
Dosing and Use
The Art of Psychopharmacology
The alphabetical listing of the drugs takes 543 pages, and
then there is a table of contents, an introduction, and indices for drugs by
name, by use and by class, as well as a list of abbreviations. The sections for each drug are color coded
and they use icons to illustrate repeated points, such as a skull and
crossbones in a green circle for life threatening or dangerous side effects, an
exclamation point in a yellow triangle for other warnings/precautions, and a
pearl necklace for Stahl's pearls of information about how to use the
The different sections have
subsections, and within each, the essential facts are listed using bullet
point. For example, for haloperidol,
the Therapeutics section says it has the brand name Haldol, and refers the reader
to the index for additional brand names.
It is available in generic form, and is a conventional
antipsychotic. Then under
"Commonly Prescribed For," 7 classes of disorder are listed. The first five are in bold, indicted that
they are FDA approved. "How The
Drug Works" gives a very brief neurobiological explanation, saying that it
blocks dopamine 2 receptors. "How
Long Until It Works" says that psychotic symptoms can improve within a
week, but it may take several weeks to reach full effect. "If It Works" explains what
symptoms the drug can reduce or eliminate if treatment should be considered
successful. "If It Doesn't
Work" suggests what supplemental or alternative approaches to use, and
this is followed by a more specific section called "Best Augmenting Combos
for Partial-Response or Treatment-Resistance." "Tests" list what medical tests should be performed
before or while prescribing the drug.
The next section, on side effects,
does not give numerical lists, bur rather just lists notable side effects, the
dangerous ones, the frequency of weight gain and sedation, what to do about
side effects, and the best augmenting agents for side effects. As with nearly every drug, the main
recommendations about what to do about side effects are
followed by some more active suggestions.
The dosing section is full of
useful information, including the usual dosing range, dosage forms, how to
dose, dosing tips, overdose, long-term use, whether the drug is habit forming,
how to stop, pharmacokinetics, drug interactions, other warnings/precautions,
and conditions where the drugs should not be used. The special populations section has subsections for renal,
hepatic and cardiac impairment, the elderly,
children and adolescents, pregnancy and breast feeding.
The most distinctive feature of the
book is the section on the art of psychopharmacology. The four subsections here are "Potential Advantages,"
"Potential Disadvantages," "Primary Target Symptoms," and
"Pearls." It is here that
Stahl mostly inserts his own opinions formed from his own clinical
experience. He sets out the pros and
cons of the medication compared with others, some of the history of its use, or
any distinct features of the medication that have not been covered in other
sections. For example, for Haldol, he
explains that it was one of the most preferred antipsychotics prior to the
introduction of the atypicals, and it may still be useful at low doses for
patients who need a conventional antipsychotic or who can't afford an atypical. He gives 11 other points about the
medication, all of which could be useful for prescribers.
Stahl does not indicate if this
book is aimed at a particular subsection of prescribers. Presumably psychiatrists who already
specialize in psychopharmacology will have little to learn from the book,
because most of the information will already be familiar. It will probably be more appropriate for
general psychiatrists, training psychiatrists, general practitioners, and
others with prescribing privileges. It
might also be useful to psychologists who want to know more about psychiatric
medications and patients and their families who want to learn more about what
medications they are taking. While some
of the language of the book is highly technical, most is not, and those with a
moderate knowledge of the language of psychiatry should be able to understand
the central facts.
Presumably physicians already have
access to the scientific information about medications, through information
supplied by the manufacturers and works such as Physician's Desk Reference. The attraction of The Prescriber's Guide
is that it presents the information in a form that is much quicker to access
and decode. It is an easy book to
handle and navigate.
I still prefer Psychotropic
Drugs Fast Facts (reviewed in Metapsychology August 2003)as a resource because it is more quantitative and groups
the drugs by their type, giving more direct comparisons between different drugs
of similar types, and contains more detailed information. But that book is not color-coded and does
not have attractive icons, so readers who care about those things may prefer to
use The Prescriber's Guide.
© 2005 Christian
Perring. All rights reserved.
Perring, Ph.D., is Academic Chair of the Arts & Humanities
Division and Chair of the Philosophy Department at Dowling College, Long
Island. He is also editor of Metapsychology Online Review. His
main research is on philosophical issues in medicine, psychiatry and