When I found myself reaching for the Prescriber’s Guide, instead of The Compendium of Pharmaceuticals and Specialities (the large blue CPS that we all know), then I knew Stephen Stahl did something right. It has become my first source to check on the myriad of facts and questions that can arise in the course of a physician’s day.
The author has a number of other publications in the Essential Psychopharmacology series, in particular the book Neuroscientific Basis and Practical Applications that functions as a basic psychopharmacology text book outlining the hypotheses, science and clinical application of medications for the broad variety of mental disorders and treating medications used in psychiatry. It offers a clearly written text and diagrams that are complete and interesting enough to understand the concepts even without reading the text. While this latter book provides the basic science, the Prescriber’s Guide is the practical CPS for clinician psychiatrists.
The format for the 101 drugs (alprazolam to zuclopenthixol) is consistent throughout, allocating about four pages per drug. The class-of-drug icons are the same as in the basic science text. All drugs are presented under five major headings with colour-coded backgrounds that add to the ease of use. In each of the five, the same sub-headings are used and are slanted to the direct interest of psychiatrists:
Therapeutics: Brands, Generic?, Class, Commonly Prescribed For, How the Drug Works, How Long Until It Works, If It Works, If It Doesn’t Work, Best Augmenting Combos for Partial Response or Treatment-Resistance, Tests.
Side Effects: How Drug Causes Side Effects, Notable Side Effects, Life Threatening or Dangerous Side Effects, Weight Gain, Sedation, What to Do About Side Effects, Best Augmenting Agents for Side Effects.
Dosing and Use: Usual Dosage Range, Dosage Forms, How To Dose, Dosing Tips, Overdose, Long Term Use, Habit Forming, How to Stop, Pharmacokinetics, Drug Interactions, Other Warnings/Precautions, Do Not Use.
Special Populations: Renal Impairment, Hepatic Impairment, Cardiac Impairment, Elderly, Children and Adolescents, Pregnancy, Breast Feeding.
The Art of Psychopharmacology: Potential Advantages, Potential Disadvantages, Primary Target Symptoms, Pearls. There are 2–5 references for each drug that is indexed by Generic and Brand name, by Use and by Class. Abbreviations and FDA Use in pregnancy ratings are provided.
The information in each sub-heading is bullet style, short, direct and an easy read compared to the CPS. The use of colour for text background, icons, stars and headings complemented the ease of use. The use of the bullet style also allows a feature similar to the DSM-IV. In the latter, criteria are described using the same words and phrases found in a number of disorders. In The Prescriber’s Guide, a similar format is used, thus looking at a number of the Selective Serotonin Reuptake Inhibitors (SSRIs) revealed as identical bullets, when appropriate, yet each was still differentiated by unique bullets and some with stars for particular information about the drug in question.
The Special Populations sub-heading of Children and Adolescents is of interest to Academy members. While it includes the well-known phrases of ‘Safety and efficacy not well established etc.’ for many medications, it still includes comments on usage, recognizing that off-label use is very common. When known, extensive additional information and dosing practices are outlined. The activation effect with possible suicidal ideation is noted for the SSRIs. This is a section of the book that would benefit from more feedback from child and adolescent psychiatrists for future editions but is not so weak as to constitute a serious deficit of the book.
I am not going to make particular comment about the details of content (and I did review this for a number of the commonly used drugs for Attention-Deficit/Hyperactivity Disorder, depression and psychotic disorders) but I would like to make two points. First, I did not find any information that raised a red flag of warning about serious deficiencies. Second, the author’s helpful introduction specifically requested (including e-mail address) feedback that meant, when a second edition arrives, it would be even more accurate and useful.
The reasons I grab it off my shelf before the CPS are only partially explained above. The key reasons are that when I want information, it is easy to find, stands out because of the effective use of formatting and stars, and I like the clinical ‘pearls’ that give me the unique guides unlikely to appear in the CPS (or may be hidden in paragraphs of 8 font text).
This book shows the benefits of having an author whose scientific credentials are well known, whose clinical experience is broad and above all, whose communication style is elegantly direct and clear. It is a reference and teaching guidebook that I have no hesitation in recommending to experienced psychiatrists and to residents beginning their career.