Drug Action in the Nervous System

Rarely do the authors of textbooks concede that the reader may want more than just easily accessible information—many, sadly, do not provide even that. Rarely can we say, “I like the way the author makes that point,” or the ultimate accolade, “That’s just what I would have written.” Much of this book, however, gave me that feeling. Paul Carvey is an able and effective teacher who enjoys his subject, and this comes across clearly in Drug Action in the Nervous System. He defines his standpoint in the preface, describing how pharmacodynamics has played a central role in developing our understanding of neurological and psychiatric disease. His enthusiasm for this approach is apparent throughout the text; here we see the influence of Carvey’s mentor, Harold L. Klawans, to whom the book is dedicated.

Following some introductory chapters addressing pharmacokinetics and receptor mechanisms, the majority of the book is given over to drug classes defined in terms of clinical mechanisms, going full circle from opioid analgesics to drugs of abuse and including anxiolytics, antipsychotics, and antidepressants. These chapters are well-balanced with useful outlines of the neural bases of the target diseases plus comprehensive descriptions of the mechanisms, side effects, and other important features of drug treatment.

It is almost inevitable that there will be some outdated information in any wide-ranging, single-author volume. I particularly noted the strong emphasis on the dopamine receptor up-regulation hypothesis of tardive dyskinesia, a proposal that positron emission tomography (PET) has shown to be incorrect. PET imaging has made an enormous contribution to our understanding of the receptor mechanisms underlying both antipsychotic action and extrapyramidal side effects, yet Carvey does not mention this work. Nevertheless, the majority of the book is written to a high standard, providing a useful source of information for students of the subject at all levels, from senior undergraduate upward.

This is one of several titles from Oxford University Press addressing aspects of central nervous system disease and its treatment; they include the classic text by Cooper et al., The Biochemical Basis of Neuropharmacology (1), and Philip Strange’s Brain Biochemistry and Brain Disorders (2). I would recommend each of these to any psychiatrist wishing to understand the biological background of psychiatry; they are well written and illustrated with clear and simple diagrams. The same could be said of Drug Action in the Central Nervous System, which provides a useful complement to these other two, were it not for two deficits. First, the index severely restricts access; I failed, for example, to find γ-aminobutyric acid_A (GABA_A) or benzodiazepine receptors in it. In addition, the figures are extraordinarily poor and show little attempt at consistency of style. Neuronal pathways are illustrated by barely distinguishable lines overlaid on a poorly reproduced brain diagram or by in-your-face boxes and arrows with an offensive mixture of font sizes. Every imaginable format for neurons and synapses is shown, varying from cells in the style of Miro to bloated neuronal terminals suffering from an excess of gray shades. The publisher cannot excuse allowing a well-written text to be so poorly supported.