The American Psychiatric Publishing Textbook of Psychopharmacology, Fourth Edition

The fourth edition of the Schatzberg and Nemeroff textbook is over 1600 pages long, but it reads like a carefully written series of articles, much in the way that articles from a good encyclopedia read. The four major sections cover psychopharmacology in four different flavors—research methodology, a pharmacopeia of major drugs currently in use, the major psychiatric disorders that are treated with drugs, and finally, psychopharmacological treatment itself; a brief fifth section is devoted to ethical issues.

The section on research methodology is best read by someone who already has some familiarity with a particular area but wants to make sure that he or she has not overlooked any important considerations. One example is the excellent chapter by Kraemer and Schatzberg on statistical analysis, trial design, and the placebo response. The chapter is thoughtful and wide ranging. It well summarizes Kraemer's classic advice to eschew complicated analyses, particularly those involving stratification and covariates, which are tempting to investigators and their funding agencies but ultimately rob clinical trials of their power to detect differences between treatments. However, to implement such a strategy requires careful study of many of the chapter's references and a background in statistics and clinical trial design concepts, such as the Consolidated Standards of Reporting Trials (CONSORT).

Similarly, the chapter on the neurobiology of mood disorders by Gillespie, Garlow, Binder, Schatzberg, and Nemeroff in the section on major psychiatric disorders is an excellent overview of the neuroendocrine axes and neurotransmitter systems that make depression a fascinating combination of psychological, neurobiological, and somatic symptoms. But the chapter is actually a compact synthesis, and to understand fully the subject matter covered by the chapter would require an extensive background or careful reading of the references, which are comprehensive. Serious students of depression will want to read the chapter to make sure that they understand the full breadth of this research.

The pharmacopeia of individual drugs, which occupies over 600 pages, is the most unique feature of the book. The depth of information is considerable and will expand the knowledge base of most clinicians, even if they prescribe these drugs regularly to patients. The valproate chapter by Bowden, for example, covers pharmacokinetics, treatment response, and side effects in considerable helpful depth in its 17 pages.

The treatment section of the book is likely to be where many clinical readers will naturally turn first. The chapter on treatment of personality disorders by Simeon and Hollander combines perspective on the role of medication in the treatment of personality disorders with practical strategies for assessment and targeting of symptoms. It is a good guide and review for both residents and experienced clinicians who bridge psychotherapeutic and psychopharmacological approaches in their practices.

The fifth section of the book is a single chapter on ethical considerations. The chapter is well written and touches on every conceivable major issue, from the problems of prescribing for children and involuntary patients to the ubiquitous conflict of interest with the pharmaceutical industry. This section is a new feature of this edition, and it is a welcome addition. The authors—Hoop, Layde, and Roberts—have written prolifically on a wide range of ethical issues in psychiatry. There are still serious unresolved issues on how psychiatry should relate to the marketing efforts of the pharmaceutical industry. Major academic figures in psychopharmacology who have conducted pharmaceutical industry research, lectured to their colleagues at meetings as participants on industry speakers bureaus, and introduced new drugs to their patients as opinion leaders have a perspective on the management of relationships with industry that needs to be shared with others. An example of such sharing of perspective between a senior leader and his trainees can be found in this issue's Education in Psychiatry (1).