Review - Successful Psychopharmacology
Evidence-Based Treatment Solutions for Achieving Remission
by Stephen V. Sobel
W. W. Norton, 2012
Review by Richard Skaff
Dec 10th 2013 (Volume 17, Issue 50)

Achieving remission with psychiatric disorders is a crucial task considering the complicated diagnostic system with its overlapping criteria, speculative and ambiguous etiology of the disorders, and the various responses that a patient might encounter with these medications. In addition, the lack of their general efficacy combined with the horrific side effects that a patient might experience when taking these drugs might present a major challenge to the prescriber. 

The one silver bullet approach when using psychotropic drugs is inadequate. Therefore, it becomes essential to use a constellation of approaches to achieve the desired goal of remission with the least harm to the patient. Stephen V. Sobel, MD, is a clinical instructor in psychiatry at the University of California, San Diego School of Medicine attempts to address some of these issues in his new book titled “Successful psychopharmacology: Evidence-based treatment solutions for achieved remission.”

Sobel undertakes the mission of putting medication treatment into context. He articulates in his volume the significance of understanding what medications mean to patients and that the goal of treatment should not be simply limited to writing prescriptions. Moreover, the author elucidates the basics to successful psychopharmacology. Per example, He reminds the readers of the multifactorial causes of disorders and begins his volume by discussing the gravity of targeting neurotransmitters instead of symptoms. Then, he moves on to recommend the use of medications assertively. Subsequently, he accentuates the importance of treating patients to remission, and encourages clinicians to combine medications based on mechanisms of action, and treatment for the appropriate duration. He also suggests that clinicians are encouraged to watch for saboteurs, and to always consider the half-life of the drug, and prompts the treating clinicians to combine psychotherapy with medicine and to view patients as teammates. He also underscores the necessity of communicating and collaborating with the treatment team. Furthermore, he illustrates the importance of understanding the meaning of consultation. Then, he goes on to discuss the geometry of psychiatry like triangulation and what medications mean to patients. Finally, Sobel encourages clinicians to combine evidenced-based medicine with their clinical experience.

Interestingly, this book attempts to approach mental illness as a bio-psycho-social process rather than a medical one, which is encouraging considering the incessant efforts by psychiatry to medicalize behavior.    The author gracefully combines his everyday clinical experience with treatment guidelines. He endeavors to maximize functional recovery by actively seeking total symptom control. He also provides templates and configurations of pharmacological interventions supported by evidence-based justifications, and lists summaries as a helpful and quick reference point.  

The book covers the treatment of various mental conditions ranging from major depression to psychotic disorders. It consists of thirteen chapters beginning with goal of treatment and ending with the treatment of psychosis. The author writing style is lucid and succinct, as he attempts to infuse useful information on psychopharmacology and provides practical tips that might benefit prescribers. Most of the author’s suggestions and modus operandi for successful psychopharmacology appear to be commonsensical and banal. However, this book can be a useful refresher for prescribing and non-prescribing clinicians of the essentials of the process.  This volume might also serve as an adequate reference for psychiatrists, pharmacists, general practitioners, and other health care professionals.

© 2013 Richard Skaff,

Richard Skaff, Rancho Palos Verdes, California