Introduction
Many books in medical literature have become so well-established over the years that they are known by the names of the founding author(s) or editor(s). Notable examples are Harrison for Medicine; Bailey and Love for Surgery; Nelson for Pediatrics; Parson for Ophthalmology; Guyton for Physiology; Goodman and Gilman for pharmacology; Kaplan for Psychiatry; Lishman for Organic Psychiatry; Fish for Phenomenology; and Stahl for Psychopharmacology.
These classics in medical literature are common names in medical halls because of a consistency in quality across editions that have spanned generations of teachers and students. In this context, Stahl’s Essential Psychopharmacology has become a brand name in only a little over 10 years. In fact, the brand is now reflected in the title of the third edition: not just Essential Psychopharmacology, but Stahl’s Essential Psychopharmacology. With this modification, the publishers make a clear statement that they intend to establish perpetuity of publication no matter who authors future editions of the text.
The Present Edition
The third edition of the book is a quantum advance over the second; with 19 chapters and 1117 [plus xv] pages, the third edition has five extra chapters and some five hundred more pages. What is important is that the new edition is not just updated with the extra bits stuck on; rather, it has been completely reorganized to almost double its previous volume and in smaller print, to boot. Readers familiar with the previous editions will, however, recognize many sections and pictures within.
The first edition was a chatty text which introduced readers to hitherto arcane discussions about neurotransmitters, receptors, and the actions of drugs on these and other molecular targets in different psychiatric disorders. The first edition quickly caught the attention of readers across the world because it simplified and popularized what was previously hard to understand; and because it did so not only through easy-to-read text but also through diagrams that vividly brought concepts to life. The diagrams, in fact, were so self-explanatory that readers could quickly refresh their memory by merely looking at the pictures in the book.
The third edition has travelled far; Stahl has now become a reference book. It no longer presents just the basics; it examines almost everything that an industrious student of the subject would like to know. Because of the substantially increased depth of discussion of almost all topics, the book is no longer chatty or easy to read; the graphics, however, remain to assist the reader on his path to knowledge.
The 19 chapters in the book discuss the structure and functions of neurons; the anatomical basis of neurotransmission and neuroplasticity; signal transduction from synaptic signaling through second messenger effects to intranuclear activation of genetic pathways; neurotransmitter transporters and receptors; ion channels and enzymes; psychiatric genetics; neuronal circuits and their clinical and psychopharmacological relevance; psychosis and antipsychotic drugs; mood disorders, antidepressants, and mood stabilizing agents; anxiety and anxiolytics; pain, attention deficit disorders, and disorders of reward and addiction; disorders of sleep and wakefulness; and dementia.
The book is emphatically not about drugs; a different book by Stahl (Stahl, 2007), The Prescriber’s Guide, provides drug-related information. This book is a one-stop shop for anybody who wishes to learn the fundamental principles of psychopharmacology through neuroanatomy, neurophysiology, neurochemistry, and psychiatry. In other words, this is a book of theoretical psychopharmacology, not practical psychopharmacology; it deals with mechanisms and not with treatment strategies; with pharmacodynamics, not pharmacokinetics.
The chapters are well-organized into easily digestible subsections and written with simplicity and clarity to the extent that the subject permits. The contents are comprehensive and up-to-date. The large number of tables and color figures make the book attractive and easy to read. A browser who scans through only the tables and figures will probably assimilate most of the message of the book.
Overall, the book presents a difficult subject in an intellectually and emotionally appealing manner. These assets place the book head and shoulders above other publications in the field.
Some quibbles
It’s hard to find fault with a book that is written by an author who commands international respect; a book that has become a classic. Nevertheless, here are a few quibbles. To start with, the third edition is neither essential nor (just) psychopharmacology; as already mentioned, it has become a formidable reference book with a depth of coverage that far exceeds what an average clinician will want to know; and it addresses fields ranging from neurohistology to neurochemistry; from psychopharmacology to psychiatric genetics.
The book has been lauded for its pictures. To be honest, in my opinion, the pictures do not really simplify the text; though, I acknowledge that this may be my idiosyncrasy, and that others may feel otherwise.
Finally, the contents are presented as facts. However, when one goes into details, as Stahl does, devils exist in the form of controversies. Unfortunately, Stahl does not address the controversies or the weaknesses of hypotheses; he merely presents the dominant view.
As an example, some 30 pages of the book are devoted to the glutamatergic hypothesis of schizophrenia. On the one hand, acute psychosis is conceptualized as a state of glutamatergic excitotoxicity but little evidence in support is presented, even though drugs which dampen glutamatergic neurotransmission (an mGlu2/3 receptor agonist; topiramate) have been shown to attenuate psychosis. On the other hand, positive, negative, and cognitive symptoms are forcefully and in extreme detail argued to result from a completely opposite state: NMDA receptor hypofunction. Stahl does not reconcile these opposing stances; however, to judge from the depth of his coverage, he favors the latter mechanism.
Critically, the NMDA hypofunction hypothesis is heavily dependent on the finding that NMDA receptor antagonists such as PCP and ketamine better model the spectrum of schizophrenia symptoms than dopaminergic drugs such as amphetamine, or serotonergic drugs such as LSD. However, Seeman (2009) points out that both PCP and ketamine have dopaminergic effects and may well induce psychosis through dopaminergic rather than glutamatergic mechanisms. If this is true, the entire NMDA hypofunction hypothesis falls flat on its face.
To do Stahl justice, he does acknowledge in his preface that his intention is to simplify at the expense of precision. Unfortunately, no reader would know what is a controversy and what is not.
Who should read it?
While this book is not meant for serious psychopharmacologists who require in-depth discussions and extensive reference materials, it will certainly suit the needs of almost all students and academicians, and will also help practising clinicians understand more about the molecular mechanisms involved in health, and in illness and the treatment thereof. Very importantly, this book is the springboard from which the advanced student can take off to a deeper exploration of the field.
This book is strongly recommended to all students and teachers of psychiatry and psychopharmacology. Clinicians who wish to understand the principles underlying their prescribing behavior will also benefit from a perusal of the book, particularly from the sections that deal with therapeutics and the differences between drugs for a particular indication. All in all, this is a phenomenal piece of work from a single author.
Book rating
I will rate the book ****.
About the Author
Dr. Chittaranjan Andrade, MD, is a psychiatrist with over 25 years of experience in his field. He is a Professor in the Department of Psychopharmacology at the National Institute of Mental Health and Neurosciences, Bangalore, India.
He has received three international awards, 10 national awards (including all the major awards of the Indian Psychiatric Society and the Indian Association of Private Psychiatrists) and 6 state and other awards in recognition of his research. He has published 11 books, nearly 40 chapters in various texts, and approximately 400 scientific papers in peer-reviewed journals.
His main research interests lie in the field of electroconvulsive therapy. He received the ECT Investigator of the Year Award at San Francisco in 2003 and will guest edit a special issue of The Journal of ECT on the practice of ECT in developing countries. He is a member of the World Federation of Societies of Biological Psychiatry Task Force on Brain Stimulation, a member of the editorial board of The Journal of ECT, and a member of the editorial board of Brain Stimulation.
He is also the Field Editor for Clinical Therapeutics for the journal Bipolar Disorders. He is also on the editorial board of several other overseas and national journals, including the Indian Journal of Psychiatry. He is a referee/reviewer for 25 international journals, five national journals, and two international scientific publishing houses.