Depression and Bipolar Disorder: Stahl’s Essential Psychopharmacology, 3rd Edition

This text provides a specific and fully revised review of the pharmacological treatment of Depression and Bipolar Disorder, based on Stahl’s comprehensive Essential Psychopharmacology text. It is very readable and includes Stahl’s trademark informative and colourful diagrams. This book serves as a quick reference to the currently proposed mechanisms of drug action and interaction as well as serving as a helpful primary source of information regarding the state of knowledge about postulated drug targets. It is appropriate for medical students and residents, as well as for experienced physicians, given the number and complexity of existing pharmacological agents. Throughout, Stahl adopts an approach of optimizing treatment based on a “treat the symptom” model, as opposed to assuming that symptom complexes represent a common underlying disease entity – the “treat the underlying illness model”. The former model (used in Stahl’s text) may favour polypharmacy (adding agent 1 for symptom y and then adding agent 2 for symptom z), while the latter model favours a selective monotherapy approach (for this patient with this illness subtype, agent 1 should in the majority of cases resolve all related symptoms (y and z)). Which approach is actually the most effective (symptom-targeting polypharmacy vs. syndrome-based monotherapy) in the stabilization of bipolar disorder has not been directly tested, however accumulating evidence suggests that carefully selected monotherapy based on the patient’s clinical profile yields success in about 70–75% of cases, as compared to a success rate of 30% using treatment guidelines including combinations. Together with the STAR D study showing that only 50% of depressed patients benefit from current treatment approaches (switching and combining), we still have a long way to go in understanding and selecting effective treatments for patients with mood disorders. Despite these limitations, this textbook by Stahl is a useful summary of our current understanding of the field in an easy to digest format. It is arguably the best book in its class for illustrating conceptual mechanisms of action and is comprehensive, covering all existing agents.