Handbook of Psychiatric Drugs

June 1, 2007

The field of psychopharmacology is evolving rapidly. New research and medications appear, and practice changes. This book was up-to-date when it went to press; however, it does not include the most recent findings from the CATIE, STAR*D study, and CATIE-AD study. There is no mention of paliperidone, intramuscular aripiprazole, selegiline transdermal system, varenicline, or depot inject- able naltrexone. One wonders whether books are becoming obsolete as a medium for communicating the state of the art.

by Jeffrey A. Lieberman and Allan Tasman; Hoboken, NJ:
John Wiley & Sons, 2006
284 pages
$27.50 (softcover)

The field of psychopharmacology is evolving rapidly. New research and medications appear, and practice changes. This book was up-to-date when it went to press; however, it does not include the most recent findings from the CATIE, STAR*D study, and CATIE-AD study. There is no mention of paliperidone, intramuscular aripiprazole, selegiline transdermal system, varenicline, or depot injectable naltrexone. One wonders whether books are becoming obsolete as a medium for communicating the state of the art.

Another problem with print media is that errors creep in and there is no way of correcting them. For example, the typical dosage of fluoxetine when used as an antidepressant is 20 mg/d, not 60 mg/d; the dosage of aripiprazole in manic patients is 30 mg/d, not 10 to 15 mg/d; the usual dosage of olanzapine is not 10 to 15 mg 4 times daily; the benzodiazepine potency of clonazepam is twice that of alprazolam, not half; the starting dose of clozapine is 12.5 mg for the first dose, not 25 to 50 mg; cytochrome P-450 2D6 does have inhibitors; and nicotine does not induce P-450 enzymes-that comes from other components of cigarette smoke. I hope that readers will recognize these errors.

There is much valuable pharmacokinetic information throughout the book. Yet, who can remember all this after reading page after page of it? Also, the index is rather short and this sometimes makes it difficult to retrieve facts.

The book provides tables of medication costs. However, the pricing data are the wholesale prices available to one retailer. The cost differentials are much greater with the largest public sector purchasers, such as Medicaid and Veterans Affairs programs. In the latter, there is a 50-fold difference in the cost of generic versus brand SSRIs, whereas the source cited in the book showed only a 5-fold difference.

Why did AstraZeneca, the maker of quetiapine (Seroquel), purchase copies of this book and pass them out with a stamp saying it was a gift from them? Are favorable remarks made about quetiapine that go beyond the evidence? The book states that quetiapine and ziprasidone are the 2 atypicals with the least long-term weight gain, which differs from what was found in phase 1 of CATIE. There was mention of "recent reports of beneficial effects of quetiapine in treatment-resistant patients with schizophrenia" followed by the recommendation that quetiapine and all other second-generation antipsychotics be tried individually before clozapine. Some experts would disagree.

Despite these issues, this is an excellent little book. The sections on cognitive enhancers and treatment of drug dependence are gems. The writing style is consistently clear and easy to follow. There are many useful tables. The book is small enough that busy clinicians can easily read it cover to cover. If they do, they will acquire valuable information on diverse topics. Most of it will not, in fact, be out-of-date very soon.

However, Internet-based decision support is more easily updated and corrected. Computerized drug-ordering systems of the future may provide clinicians with fast access to accurate, patient-specific drug information, evidence-based prescribing suggestions, and sophisticated drug interaction predictions at the moment when it is most needed. Meanwhile, I recommend this handbook. It is incisive, thoughtful, and informative.