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Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, Third Edition.
Stephen M. Stahl . Cambridge University Press: New York, NY, 2008. 1132 pages. $95 (US).
When I first started working as a clinical pharmacist in psychiatry, I was at a loss as to where to start in terms of expanding my knowledge of psychopharmacology. A wise colleague recommended that I pick up a copy of Essential Psychopharmacology by Stephen Stahl. Immediately I knew this was a different book; one that made abstract concepts practical and understandable, and dare I say, enjoyable to read.
The first two editions of Essential Psychopharmacology were about establishing a new teaching style. The books employed vibrant, intuitive diagrams, colloquial mentions of drug combinations such as “California Rocket Fuel” that were memorable and tapped into existing schemata, and this writer’s personal favourite: long-haired, tie-dyed T-shirt-wearing, placard-waving hippies in a diagram representing “free radicals”. Medical students, residents and allied professionals new to working with psychiatric medications have found this resource invaluable. Experienced teachers of psychopharmacology have benefitted from adopting some of the analogies Stahl used in these earlier editions to make concepts concrete and simple to understand (e.g. in explaining the actions of mirtazapine on serotonin and norepinephrine neurotransmission, he refers to this as simultaneously “stepping on the accelerator and cutting the brake cables”).
Thirteen years, and two editions later, this text has become the reference for a generation of health care professionals that work with psychiatric medications. Some precision and fine detail has been purposely sacrificed to make concepts and rules easier to understand. This book is purposefully written on a conceptual level, with hardly a sighting of a table of receptor dissociation constants or milligram dosages anywhere to be found. For those seeking this information, a companion book, Essential Psychopharmacology Prescriber’s Guide is available, and for the first time, a fully searchable companion website, essentialpsych.org has been launched (content available by subscription fee).
This third edition weighs in at a hefty 1117 pages (an 86% increase from the second edition) and builds on the teaching methods of the earlier versions, making the rapidly expanding body of psychopharmacology knowledge as easily understandable as possible. Added chapters in this edition include treatment of fibromyalgia and pain syndromes, and greatly expanded sections on fundamentals such as signal transduction and targets of psychopharmacological drug action. Additionally, the cognitive enhancers section from the second edition has been split into separate chapters (treatment of dementia, and treatment of ADHD) and the anxiolytics and sedative-hypnotics section has been split into respective chapters for each drug class.
The most noticeable change from the second edition is the shift towards focusing on brain circuits, neuroimaging, genetics, and signal transduction cascades rather than drugs and receptors in isolation. This is deliberate on the author’s part, and appropriately reflects the rapid advancement of knowledge about the brain, mental illness and its treatment. Clearly the expansion of the fundamental sections at the start of the book is needed to lay the groundwork for this shift in later chapters. Compared to previous editions, it may be of greater importance to read this book from start to finish in a linear fashion. Unfortunately, if you are familiar with the previous editions, you can’t help but get the sense that what was made relatively simple in past editions, has become somewhat more complicated again.
Another criticism which the author acknowledges, is that the material in the book is not referenced on a statement-by-statement basis, and often relies on tertiary sources such as textbooks. A suggested readings bibliography for each chapter is presented at the end of the book, but one would have trouble attributing a particular statement in the book to any one source. To be fair though, there is more primary literature cited than in previous editions.
Despite some minor issues, Stahl’s Essential Psychopharmacology is still one of the best resources available for learning about and understanding this complex field. Ownership of this text is highly recommended for those who prescribe, recommend, monitor, and work with psychiatric medications.