Abstract
The seventh edition of this volume attests to the rapid expansion in the number of medications available to treat psychiatric disorders, as well as the amount of clinically relevant literature about their use. None more so than in the area of drug interactions, in particular, knowledge of the cytochrome P450 oxidative hepatic isozymes and the effects of drugs on this system and vice versa. Chapter 8 of this volume is devoted to drug interactions, providing a description of a number of drug interactions of different potential clinical severity and some rather obscure examples (e.g. imipramine-labetalol interaction apparently based on a single study.) While it would clearly be possible to devote an entire volume to drug-drug interactions (e.g. [1]), this chapter seems strangely devoid of general principles and provides only one table of potential pharmacokinetic interactions, while pharmacodynamic interactions are not described in detail. An alternate approach would have been to describe drug interactions within each of the drug classes (Chapters 1–5) and make more extensive use of these. As this volume is designed as a ‘handy, rapid access reference’ it would seem that tabulated forms of data would be more appropriate to meet this goal.
The first five chapters of this volume contain standard material on indications, efficacy in each indication, dosage, mechanism of action (usually very brief summaries of contemporary views), pharmacokinetics, adverse effects and rational prescribing. This latter section is relatively brief and essentially consists of some general admonitions on polypharmacy, length of treatment, excessive doses and so on. There are extensive sections on newer agents such as olanzapine, sertindole, risperidone as well as clozapine in the antipsychotic chapter.
Among the antidepressants, nefazodone, venlafaxine, mirtazapine, trazodone, amoxapine and bupropion are singled out, but moclobemide (which is not available in the US) is a notable omission. In addition to lithium, carbamazepine and valproate the antimanics chapter includes sections on verapamil and clonazepam, while the use of gabapentin and lamotrigine are not discussed even though these drugs have been used as antimanic agents in the US, albeit experimentally. Among the anxiolytic agents, there are no compounds with which clinicians in Australasia would be unfamiliar. A separate chapter on hypnotic agents is included, which importantly describes non-pharmacological management of insomnia while at the same time including older, indeed outmoded drugs such as barbiturates and chloral hydrate. Two other agents mentioned are tryptophan and melatonin. The problems of eosinophilia myalgia syndrome with the use of tryptophan is discussed in detail. The use of melatonin as a sleeping agent remains controversial with the best evidence for its use being in sleep disorders associated with shifts in circadian rhythms (e.g. delayed phase sleep syndrome and perhaps ‘jet lag’). Doses, long-term safety and controlled clinical evaluations of melatonin in sleep disorders have not been established and evidence for its efficacy remains largely anecdotal.
The final ‘drug’ chapters examine the use of agents for extrapyramidal symptoms and drug and alcohol dependence, while the remaining chapters deal with drug overdose, withdrawal symptoms, nacro therapy (amobarbital interview) and the use of electroconvulsive therapy. There is an appendix of patient advice sheets to inform consumers and ‘their concerned others’ about individual medications. These could no doubt be useful in any clinical practice but require some modifications (most notably drug trade names) for use in Australasia. Each chapter is extensively referenced and the spiral binding ensures that the book remains open at the relevant page (a most useful practical feature). The book has much to recommend it to those who wanted a detailed source of information about psychotropic drugs. Notwith-standing the perceived deficiency of the drug interaction chapter both registrars and practising clinicians would do no better than to consider this volume for their personal library.