Carl Salzman

 by Paul J. Perry, Chris Alexander, Barry I. Liskow, and C. Lindsay DeVane;

Philadelphia: Lippincott Williams & Wilkins, 2006 736 pages • $55.95 (spiral-bound)

There are numerous handbooks that are available to practitioners on psychotropic drug treatments. The virtues of these handbooks include concise guidelines and practical advice, often in a spiral-bound format. After all, a busy clinician does not have time to wade through the endless references, citations, and dense (sometimes impenetrable) neurobiologic theories about a drug's effect that characterize many textbooks.

However, there are problems with these handbooks as well. Often they do not provide adequate background information on the drugs and the disorders for which they are being used, they have too few references, they are multiauthored, and--in an attempt to be concise--they are rather poorly written. It is with these comments in mind that I am introducing the 8th edition of the

a very useful clinical guide that has all of the virtues and none of the drawbacks of other handbooks.

The 8th edition, like its previous successful editions, is not multi- authored but is written by 3 pharmacologists and 1 psychiatrist so that there is a uniformity and consistent style throughout the book that make it a pleasure to read. The handbook is arranged according to classes of psychotropic drugs. Antipsychotic, antidepressant, mood-stabilizing, anti-anxiety, and hypnotic medications are each discussed in their own chapters. There are also chapters on treatment of alcohol dependence and drug dependence; drug interactions; management of acute drug withdrawal; and electroconvulsive therapy, as well as new chapters on the management of childhood and adolescent disorders and the treatment of disorders in geriatric patients.

Each chapter is organized in a similar fashion. Indications for the drug are presented first, followed by sections on efficacy, mechanism of drug action, starting dosage and dosage ranges, pharmacokinetics, and a discussion of adverse effects. Each chapter concludes with a helpful section on rational use of the drug in the clinical setting. This section is summarized as a list of pharmacologic information in order to guide clinical use. Numerous graphs and tables, along with an extensive bibliography, support the excellent text, which gives the impression that one is actually reading a textbook in spiral-bound format.

As one might expect from authors who are pharmacologists, there is a wealth of information regarding pharmacokinetics and pharmacodynamics of psychotropic medications; drug interactions; and mechanisms of therapeutic effects and side effects, as well as clinical prescribing advice. For example, here is the second of 10 recommendations concerning the use of tricyclic antidepressants (TCAs): "A rational method for selecting a TCA is to narrow the choice to a dimethylated TCA (eg, imipramine) and a monomethylated TCA (eg, nortriptyline), and make the choice between them on the basis of the patient's sedation requirements and ability to tolerate orthostatic hypotension, weight gain, and anticholinergic adverse effects." This model of accurate descriptive pharmacology and concise clinical recommendation about the use of a class of drugs is an example of the pithy advice that extends throughout the book to the delight of this reader.

The appendixes are also a model of clarity and accessibility and are alone worth the price of the book. They include psychotropic drug product lists; drug effects on pregnancy and lactation; pharmacokinetic drug parameters (metabolic pathways, oral availability, protein binding, clearance, volume of distribution, and elimination half-life); and a wonderful appendix on drug interactions, including their significance and clinical recommendations.

I strongly recommend the 8th edition of the 

for the psychiatrist's daily use. Clinicians, academics, and students will find the information accessible, comprehensive, and practical.

Dr Salzman is a professor of psychiatry at Harvard Medical School in Boston.  

Author | Carl Salzman

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