Stahl's Essential Psychopharmacology is an excellent,informative tome on current medications.
That being said, the book utterly lacks any information on the differences in responses to these drugs along ethnic diversity lines, or gender differences, or interactions with commonly used herbs or supplements.
The topic of diversity and supplement usage is extremely relevant in today's world and knowledge of the these subjects will only increase our clients' comfort.

The new edition of Stahl's... is amazing. It keeps the same friendly and easy-to-read texts and figures, but is much more complete in its subjects.
I'm very glad to had adquired this book, no doubt its going to improve my understanding about neurobiology/psychopharmacology. For sure, an outstanding masterpiece!

Excellent book and most helpful. I really appreciate my amazon connection. I have never had any difficulties or disappointments.

Would highly recommend this text to anyone who is interested in neurological or psychiatric disorders. Very good illustrations and explanations.

It's nowadays a very important tool for one who studies psychiatry, psychopharmacoly, the author made a very easy way to understand this important issue.

The biochemical illustrations are excellent but the text is lacking in nuance. (Maybe that book would require another thousand pages.) The author, in my opinion, is far too keen on a strict medical model and acceptance of DSM IV TR "disorders" and outlier conditions as diseases for which there is a pill lying in wait. The text glosses over these controversies the way that Powerpoint does at a pharma sponsored CME conference.

Nevertheless the chapter on antidepressant augmentation was excellent, though in practice I think it is foolish to use lithium for unipolar depression augmentation because it is the easiest drug to overdose on (and of course one of the big selling points of the SSRIs over TCAs to begin with was the safety factor in a suicide attempt.) One treatment that I was not aware of, and I will definitely start using in refractory cases, is MTHF supplementation which appears very safe and effective. I also learned quite a bit about alpha-2-delta ligands in the excellent chapter on ion channel blockers.

One chapter I had a lot of problems with was sleep disorders. In my opinion, the author is too cavalier about using benzo hypnotics, despite the fact that most evidence based treatment guidelines (i.e ACOEM) specifically warn against this except as a very short-term solution. I am disappointed that he failed to mention that these a history of alcohol or drug dependence changes the whole treatment paradigm. He seems enthusiastic about the "Z" hypnotics despite the scandalous promotion of Ambien as nonaddictive, a claim the manufacturer Aventis was forced to rescind. Not to mention the literature on sleepwalking and sleep driving with this drug (the Patrick Kennedy incident may have been related to this). I was also surprised to see Ambien CR (zolpidem CR) listed as a first line drug in the "hypnotic pharmacy" on page 849, under the premise of being nonaddictive. I say, fool me once, shame on you, fool me twice shame on me. In actual practice, the best move is to ditch all forms of Ambien, and go with Lunesta or even better yet, Rozerem, and only after trying a sedative antidepressant. The avoidance of these issues was curious to me, because the author did not flinch from addressing the problems and controversies with antispsychotics in that excellent chapter.

I also believe that the TCAs were given too little attention for their effectiveness in pain syndromes.

The following complaint is mostly about DSM-IV-TR which is obviously not the author's fault, but I wish he hadn't gotten so drunk on Bob Spitzer's Kool-Aid. Garbage in, garbage out, and if you are medicating a questionable diagnosis you will get questionable results or the condition will get better on its own, as it would have anyway. Many would argue that the lowering of the bar for psychiatric diagnosis in DSM (i.e. autism, ADD, Major Depression, PTSD) has been a benefit as these conditions are now more reliably diagnosed and more people are getting help. That may be true, but this has come at the expense of phenomenological validity. If you and I have dysphoria and 4 other completely different symptoms, guess what, we have the same diagnosis, so what are we really dealing with? If I "hear about" a tragic event and have some anxiety symptoms I can qualify for PTSD according to the DSM. I guess Mohammed Atta caused mental disorder in 300 million Americans. Does anyone believe that? Thirty years ago, if someone told me their kid had ADD or autism, I knew exactly what to expect. Today that child may be a moderately misbehaving child with poor social skills. As Tony Soprano once sarcastically asked a school psychologist diagnosing ADD, "What constitutes a fidget?"

All of this inclusiveness, whether the motive is compassionate or monetary, creates enormous problems in psychopharmacological comparisons. Older antidepressant and other psychopharm studies were done with severely ill patients with pure pathology. Today, the subjects may have a self-limited condition thanks to the changes in DSM. The success numbers for most of the SSRI studies are as inflated as today's home run totals in baseball and cannot be compared to the data from 25-30 years ago on TCAs and MAOIs. In other words, I don't buy a lot of the head to head comparisons and ratings in the text based on incomparable studies. Data is emerging that these are actually much more efficacious than the SSRI's which the author considers (along with the majority of psychiatrists) to be first line treatment. But let's be honest--the reason for this is defensive medicine, not because the new drugs are better. In fact, every senior psychopharmacologist knows that short of ECT, nothing works for refractory cases like Parnate, which is hardly ever used anymore. However, I do give the author of coming to the defense of MAOIs with some great illustrations about how the dietary problems with this group are completely overblown.

Despite these problems, I credit the author for a monumental undertaking. Obviously anything this prolific and robust will contain material with which some practitioners disagree. That would be no different if I had written it myself.

James O'Brien, M.D.

Essential Pharmacology is comprehensive and most informative. Diagnostic subjects range from mood disorders to ADHD to Fibromyalgia. The text elucidates genetics and mechanism of action through the liberal use of cartoons which are for the most part illuminating but are at times trivial. My only complaint is the lack of information on eating disorders. Which has more to do with the general ignorance of the subject vs. an editorial neglect.

The biochemical illustrations are excellent but the text is lacking in nuance. (Maybe that book would require another thousand pages.) The author, in my opinion, is far too keen on a strict medical model and acceptance of DSM IV TR "disorders" and outlier conditions as diseases for which there is a pill lying in wait. The text glosses over these controversies the way that Powerpoint does at a pharma sponsored CME conference.

Nevertheless the chapter on antidepressant augmentation was excellent, though in practice I think it is foolish to use lithium for unipolar depression augmentation because it is the easiest drug to overdose on (and of course one of the big selling points of the SSRIs over TCAs to begin with was the safety factor in a suicide attempt.) One treatment that I was not aware of, and I will definitely start using in refractory cases, is MTHF supplementation which appears very safe and effective.

One chapter I had a lot of problems with was sleep disorders. In my opinion, the author is too cavalier about using benzo hypnotics, despite the fact that most evidence based treatment guidelines (i.e ACOEM) specifically warn against this except as a very short-term solution. I am disappointed that he failed to mention that these a history of alcohol or drug dependence changes the whole treatment paradigm. He seems enthusiastic about the "Z" hypnotics despite the scandalous promotion of Ambien as nonaddictive, a claim the manufacturer Aventis was forced to rescind. Not to mention the literature on sleepwalking and sleep driving with this drug (the Patrick Kennedy incident may have been related to this). I was also surprised to see Ambien CR (zolpidem CR) listed as a first line drug in the "hypnotic pharmacy" on page 849, under the premise of being nonaddictive. I say, fool me once, shame on me, fool me twice shame on you. In actual practice, the best move is to ditch all forms of Ambien, and go with Lunesta or even better yet, Rozerem, and only after trying a sedative antidepressant.

I also believe that the TCAs were given too little attention for their effectiveness in pain syndromes.

The following complaint is mostly about DSM-IV-TR which is obviously not the author's fault, but I wish he hadn't gotten so drunk on Bob Spitzer's Kool-Aid. Garbage in, garbage out, and if you are medicating a questionable diagnosis you will get questionable results or the condition will get better on its own, as it would have anyway. Many would argue that the lowering of the bar for psychiatric diagnosis in DSM (i.e. autism, ADD, Major Depression, PTSD) has been a benefit as these conditions are now more reliably diagnosed and more people are getting help. That may be true, but this has come at the expense of phenomenological validity. If you and I have dysphoria and 4 other completely different symptoms, guess what, we have the same diagnosis, so what are we really dealing with? If I "hear about" a tragic event and have some anxiety symptoms I can qualify for PTSD according to the DSM. I guess Mohammed Atta caused mental disorder in 300 million Americans. Does anyone believe that? Thirty years ago, if someone told me their kid had ADD or autism, I knew exactly what to expect. Today that child may be a moderately misbehaving child with poor social skills. As Tony Soprano once sarcastically asked a school psychologist diagnosing ADD, "What constitutes a fidget?"

All of this inclusiveness, whether the motive is compassionate or monetary, creates enormous problems in psychopharmacological comparisons. Older antidepressant and other psychopharm studies were done with severely ill patients with pure pathology. Today, the subjects may have a self-limited condition thanks to the changes in DSM. The success numbers for most of the SSRI studies are as inflated as today's home run totals in baseball and cannot be compared to the data from 25-30 years ago on TCAs and MAOIs. In other words, I don't buy a lot of the head to head comparisons and ratings in the text based on incomparable studies. Data is emerging that these are actually much more efficacious than the SSRI's which the author considers (along with the majority of psychiatrists) to be first line treatment. But let's be honest--the reason for this is defensive medicine, not because the new drugs are better. In fact, every senior psychopharmacologist knows that short of ECT, nothing works for refractory cases like Parnate, which is hardly ever used anymore. However, I do give the author of coming to the defense of MAOIs with some great illustrations about how the dietary problems with this group are completely overblown.

Despite these problems, I credit the author for a monumental undertaking. Obviously anything this prolific and robust will contain material with which some practitioners disagree. That would be no different if I had written it myself.

James O'Brien, M.D.

Útil: La cantidad de información resumida, sistematizada y esquematizada, de fácil y amena lectura.

Cuestionable: Para empezar, no tanto el grado de simplificación, como el grado de parcialización, fragmentación y reducción de los contenidos referentes al funcionamiento normal y anormal del Sistema Nervioso Central, con un sesgo explícito hacia aquellos aspectos que ayudarían a entender mejor el supuesto funcionamiento de los psicofármacos, y con un sesgo implícito hacia la altamente cuestionable premisa de que los psicofármacos que hoy conocemos actuán verdaderamente sobre los fenómenos fundamentales de la "fisiopatología" neuro-psiquiátrica (suposición cada vez más cuestionable). Stahl parece querer explicarnos por qué y cómo es que funcionan los psicofármacos (con esquematismos que a menudo llegan a ser no sólo inaceptablemente sobresimplificados, sino también francamente inverosímiles), sin la menor intención de explicarnos por qué y cómo -si todo lo que nos explica es cierto- es que funcionan tan modestamente y en un porcentaje a veces tan reducido de pacientes. Como resultado, el aprendiz se verá tentado a basar sus prescripciones en el supuesto conocimiento de por qué tal o cual fármaco DEBIERA funcionar en tal o cual paciente (o en tal o cual síntoma!), sin preguntarse más bien por la evidencia acerca de si dicho fármaco funciona o no funciona realmente, y hasta qué punto... El posible riesgo de todo esto, es una peligrosa tendencia a la sobreprescripción y a la malprescripción (el posible beneficio, el mantenido enriquecimiento de la industria farmacéutica).

También parece cuestionable el enfoque akiskaliano de los trastornos del ánimo (que conduce a una mayor prescripción de profilácticos de fase, antipsicóticos atípicos y otros), y la presunción (a la DSM) de que todos los trastornos del ánimo merecen el estatuto implícito de enfermedad (en el sentido de la medicina científica), y deben ser tratados por lo tanto con medicamentos. El resultado, nuevamente: la sobreprescripción, incluyendo aquí la indicación de fármacos para el tratamiento de crisis vitales, reacciones vivenciales, dificultades de adaptación, cuadros de estrés laboral, disfunciones conyugales y familiares, y un larguísimo etcétera; todos casos que, cumpliendo los criterios diagnósticos de un 'episodio depresivo mayor' u otros, cabrían también (o 'en vez') en la categoría de reacciones depresivas, depresiones neuróticas / neurosis depresivas, disforias histeroides, depresiones caracterológicas, cuadros de ajuste, etc. Ningún clínico honesto y experimentado puede creer que esta distinción -esfumada como por arte de magia por el DSM- haya dejado de ser fundamental en la práctica.

Por último, la cantidad de afirmaciones del tipo 'pudiera ser que', 'es probable que', 'hipotéticamente' o 'teóricamente', no hacen más que alimentar todas nuestras dudas, si bien trasuntan un loable matiz de honestidad de parte del autor (hasta el punto de que en algunos pasajes nos advierte algo así como: las cosas son mucho más complejas y bien distintas en la realidad, pero bueno, vamos a hacer como que son así como se las estoy mostrando en estas laminitas tan lindas y explicativas, para que no nos compliquemos la existencia...). No deja de ser interesante, en todo caso, que la así llamada 'psiquiatría biológica' (supuestamente, la más 'científica' de 'las psiquiatrías') termine aglutinando tantas conjeturas, supuestos y especulaciones como cualquier corriente psicológica de los últimos cien años (y quizás más...)

En suma: Un libro digno de ser leído y estudiado, PERO con el sentido crítico bien despierto...

Útil: La cantidad de información resumida, sistematizada y esquematizada, de fácil y amena lectura.

Cuestionable: Para empezar, no tanto el grado de simplificación, como el grado de parcialización, fragmentación y reducción de los contenidos referentes al funcionamiento normal y anormal del Sistema Nervioso Central, con un sesgo explícito hacia aquellos aspectos que ayudarían a entender mejor el supuesto funcionamiento de los psicofármacos, y con un sesgo implícito hacia la altamente cuestionable premisa de que los psicofármacos que hoy conocemos actuán verdaderamente sobre los fenómenos fundamentales de la "fisiopatología" neuro-psiquiátrica (suposición cada vez más cuestionable). Stahl parece querer explicarnos por qué y cómo es que funcionan los psicofármacos (con esquematismos que a menudo llegan a ser no sólo inaceptablemente sobresimplificados, sino también francamente inversímiles), sin la menor intención de explicarnos por qué y cómo -si todo lo que nos explica es cierto- es que funcionan tan modestamente y en un porcentaje a veces tan reducido de pacientes. Como resultado, el aprendiz se verá tentado a basar sus prescripciones en el supuesto conocimiento de por qué tal o cual fármaco DEBIERA funcionar en tal o cual paciente (o en tal o cual síntoma!), sin preguntarse más bien por la evidencia acerca de si dicho fármaco funciona o no funciona realmente, y hasta qué punto... El posible riesgo de todo esto, es una peligrosa tendencia a la sobreprescripción y a la malprescripción (el posible beneficio, el mantenido enriquecimiento de la industria farmacéutica).

También parece cuestionable el enfoque akiskaliano de los trastornos del ánimo (que conduce a una mayor prescripción de profilácticos de fase, antipsicóticos atípicos y otros), y la presunción (a la DSM) de que todos los trastornos del ánimo merecen el estatuto implícito de enfermedad (en el sentido de la medicina científica), y deben ser tratados por lo tanto con medicamentos. El resultado, nuevamente: la sobreprescripción, incluyendo aquí la indicación de fármacos para el tratamiento de crisis vitales, reacciones vivenciales, dificultades de adaptación, cuadros de estrés laboral, disfunciones conyugales y familiares, y un larguísimo etcétera; todos casos que, cumpliendo los criterios diagnósticos de un 'episodio depresivo mayor' u otros, cabrían también (o 'en vez') en la categoría de reacciones depresivas, depresiones neuróticas / neurosis depresivas, disforias histeroides, depresiones caracterológicas, cuadros de ajuste, etc. Ningún clínico honesto y experimentado puede creer que esta distinción -esfumada como por arte de magia por el DSM- haya dejado de ser fundamental en la práctica.

La cantidad de afirmaciones del tipo 'pudiera ser que', 'es probable que', 'hipotéticamente' o 'teóricamente', no hacen más que alimentar todas nuestras dudas, si bien trasuntan un loable matiz de honestidad de parte del autor (hasta el punto de que en algunos pasajes nos advierte algo así como: las cosas son mucho más complejas y bien distintas en la realidad, pero bueno, vamos a hacer como que son así como se las estoy mostrando en estas laminitas tan lindas y explicativas, para que no nos compliquemos la existencia...). No deja de ser interesante, en todo caso, que la así llamada 'psiquiatría biológica' (supuestamente, la más 'científica' de 'las psiquiatrías') termine aglutinando tantas conjeturas, supuestos y especulaciones como cualquier corriente psicológica de los últimos cien años (y quizás más...)

En suma: Un libro digno de ser leído y estudiado, PERO con el sentido crítico bien despierto...

Buy this book instead: The Maudsley Prescribing Guidelines, Ninth Edition!

Stahl's bood would have been better titled "The PDR Companion for Psychiatrists." Listing each medicaiton in alphabetical order is a good idea but only as far as it goes, which is not very far.

The MAUDSLEY PRESCRIBING GUIDELIENS give more guidance about chosing and using medications. The MPG covers alot of material and is easy to read. The sections I use most include a table about timimg the cross tapering or time between using one antidepressant and another, the 1st, 2nd and 3rd line medications for treating treatment resistant depression. Examples of the many other great sections include monitoring for metabolic sysdrome and QTc, for example.

Of course, the best idea is to have the MPG and have Stalh for when your other books with alphabetical lists of drugs are insufficinet. Stahl can console himself that California Rocket Fuel is now in the list of first line interventions for treatment resistant depression. (In the previous edition it was not). It is a pity the MPG does not refer to California Rocket fuel by name but just refers to "SSRI or venlafaxine + mianserin or mirtazapine" - how the hell will you get maximum placebo effect if you don't know the name of the combination?

Stahl's bood would have been better titled "The PDR Companion for Psychiatrists." Listing each medicaiton in alphabetical order is a good idea but only as far as it goes, which is not very far.

The MAUDSLEY PRESCRIBING GUIDELIENS give more guidance about chosing and using medications. The MPG covers alot of material and is easy to read. The sections I use most include a table about timimg the cross tapering or time between using one antidepressant and another, the 1st, 2nd and 3rd line medications for treating treatment resistant depression. Examples of the many other great sections include monitoring for metabolic sysdrome and QTc, for example.

Of course, the best idea is to have the MPG and have Stalh for when your other books with alphabetical lists of drugs are insufficinet. Stahl can console himself that California Rocket Fuel is now in the list of first line interventions for treatment resistant depression. (In the previous edition it was not). It is a pity the MPG does not refer to California Rocket fuel by name but just refers to "SSRI or venlafaxine + mianserin or mirtazapine" - how the hell will you get maximum placebo effect if you don't know the name of the combination?

Dr. Stahl and Nancy Munter have outdone themselves once again. While the bar they have set is always high, this is the best book they have produced to date. Details are rich and easily understood - they even include tyramine content by brand. Everyone involved in treating patients needs to have this book in their library AND read it.

This new edition of Stahl's easy and delicious "Essential" surprises me. Some people who doen't like this book argues that the book is too superficial in some issues. I desagreee. The very title of the book already shows their propose. It's a book about ESSENTIAL psychopharmacology, make it easy and beaultiful. Thanks, Stahl, for bring us, again, with this piece of joy.
Wilson Conte de Las Villas Rodrigues
Psychiatric Enfermary
Assis Regional Hospital
São Paulo, Brasil.

Psychopharmocology easy to do badly and very difficult to do well. As a second year psychiatry resident in 1999 I thought this book was awesome - psych meds made easy, with neat pictures, and cool names like "California Rocket Fuel." Now that I practice general psychiatry in the community I realize that this book is misleading and potentially dangerous. One, it oversimplifies the neurobiology of psychotropics - although that is not all that serious a problem. More importantly, it encourages approaching real treatment decisions by thinking about neurotransmitters, not the REAL source of any actual knowledge we have about how these meds work - clinical trials. The result is that I have seen many prescribers think about tweaking chemical or treating each symptom with a different med, frequently leading to expensive and often dangerous polypharmacy. For a cartoon-like overview for a non prescribing practitioner, this is an entertaining but inaccurate introduction to psychopharm; for someone who will actually use this to guide their prescribing - your patients deserve better.