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Stahl′s Essential Psychopharmacology:

Neuroscientific Basis and Practical Applications

Article  in  Mens Sana Monographs · January 2010

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146 Mens Sana Monographs, Vol. 8(1), Jan - Dec 2010

MSM Book Review

CITATION: Andrade C., (2009), Stahl’s Essential Psychopharmacology: Neuroscientific Basis

and Practical Applications. In: Psychopharmacology Today: Some Issues (A.R. Singh and S.A.
Singh eds.), MSM, 8, Jan - Dec 2010, p146-150.

Stahl’s Essential Psychopharmacology:

Neuroscientific Basis and Practical Applications

Stephen M. Stahl
Cambridge University Press, 2008;
3rd edition, Paperback; Color; 1117 + xv pp.
ISBN-13: 978-0-521-74578-9. $75.

Chittaranjan Andrade*

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

*M.D. Professor.
Address correspondence to: Chittaranjan Andrade, Department of Psychopharmacology, National
Institute of Mental Health and Neurosciences, Bangalore 560 029, India. E-mail: andradec@gmail.com
Received 25 Sept 2009. Revised 29, 30 Sept 2009. Accepted 30 Sept 2009

MSM : www.msmonographs.org
DOI: **********
C. Andrade, (2010), Book Review 147

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.

MSM : www.msmonographs.org
148 Mens Sana Monographs, Vol. 8(1), Jan - Dec 2010

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

MSM : www.msmonographs.org
C. Andrade, (2010), Book Review 149

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 *****.

Conflict of interest

None declared

[Book reviewer’s ratings: ***** Excellent; **** Very Good; *** Good; ** Average; *Avoidable.]

MSM : www.msmonographs.org
150 Mens Sana Monographs, Vol. 8(1), Jan - Dec 2010

Declaration

This is an original unpublished article, not submitted for publication

elsewhere.

References
1. Seeman P., (2009), Glutamate and dopamine components in schizophrenia. J Psychiatry
Neurosci , 34, p143-149.
2. Stahl S. M., (2007), Essential Psychopharmacology: The Prescriber’s Guide. New Delhi: Cambridge
University Press.

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.

MSM : www.msmonographs.org

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