Book Reviews

The Complete Guide to Psychiatric Drugs: Straight Talk for Best Results, Drummond, Edward, M.D. New York: John Wiley & Sons, Inc., 2000. (Paperback, 314 pages, $17.95)

The Complete Guide to Psychiatric Drugs: Straight Talk for Best Results, by Edward Drummond, is a useful handbook for the layperson attempting to sort through the myriad of psychiatric drugs on the market. One section provides, in alphabetical order, a general description of each drug, its generic and brand names, and the condition it is used to treat. Included are precautions necessary when taking the drug, possible side effects, doses, interactions, how to monitor your use, and what to expect when you stop taking the drug. Other helpful information includes how to proceed when you have missed a dose and the effects of drinking alcohol while taking the drug. In a clear style, the author skillfully integrates this information without raising undue fear in the reader. The author addresses many questions that patients and family members may have about medication treatment.

The Complete Guide to Psychiatric Drugs deals with all psychiatric syndromes, not just affective disorders. It discusses disorders of anxiety, attention deficit, development (such as autism), drug dependence, Alzheimer’s, eating, and sleep.

The chapter that should be the most important in the book, “What to Discuss with Your Doctor before You Start Medication,” unfortunately does not live up to its title. The reader is left with the impression that it is up to the patient?not the expert, the doctor?to consider treatment plans and choose the best.

The Complete Guide to Psychiatric Drugs can probably be found in the self-help section of your library—a placement with which this reviewer finds fault. Despite the hype on the front and back covers, i.e., “How to decide if drugs can help you,” “How to start and stop drugs safely,” and “Your complete guide to choosing and using medication,” medication treatment for psychiatric disorders is not a self-help issue. The book is a good guide for educational purposes or for an intelligent discussion with the doctor. It is not, however, the definitive answer to medication treatment.

By Marion Ehrlich
Ed. note: Bruce Hershfield, M.D., and Sallie Mink contributed to this review.

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TREATING THE ILLNESS, excerpts from an article by Andrew Feinberg, M.D.,1 Smooth Sailing, Fall 1995, pp. 1, 2.

I've been directing my professional energy toward the diagnosis and treatment of mood disorders in teenagers, adults, and seniors for the past 10 years. . . . I think the single most important function of any psychiatrist who is treating a clinically depressed patient is to offer hope in a confident manner. I tell my patients that they are indeed fortunate to have available such a wide variety of effective antidepressants. I remind them that . . . not that long ago . . . we had only two groups of antidepressants from which to choose. Unfortunately, all available antidepressants have side effects, and a significant amount of my time is spent either reassuring patients that side effects are frequently only transient, or helping them try to cope with the longer-lasting side effects.

Often when I'm discussing treatment options with a depressed patient, I use a graphic mythological metaphor which may represent my five-year-old son's influence; he loves playing with plastic gargoyles, castles, and aliens. It seems to leave an impression on the patient when I describe the medical illness we call depression as a dragon—which we are fighting with a growing arsenal of effective weapons much like the swords, lances, and crossbows that my son's toy heroes wield in their battles with hostile zoological predators.

Now I'm sure that some will find this image overly dramatic or ripe with Freudian significance. It is, however, a useful metaphor. I think it encourages the patient to see his or her illness as a challenging foe, which together we can defeat with our hope and pharmacologic weapons.

My main regret in my clinical practice is the limited opportunity to conduct psychotherapy beyond the confines of a 15- to 30-minute appointment. Unfortunately, such time constraints are a frequent reality in our environment of increasingly managed care. I'm amazed, however, at the effective supportive psychotherapy that can be accomplished in a very brief contact with a patient. I've learned, and I continue to learn, which non-M.D. psychotherapists are most skilled at helping my mood-disorder patients who require more intensive psychotherapy. In fact, I encourage most of my new patients with depression and related conditions to consider the combination of medication, my brief supportive treatments, and fuller psychotherapy at the hands of an expert in that form of treatment.

I can't even guess at the vast number of patients I've referred to DRADA. . . . I'm impressed by the number of folks I see who already know about [it, and] I think DRADA does a wonderful job of encouraging the involvement of family and friends, who then assist in the patient's care.

. . . What are some other components of my work with patients? I'm an enthusiastic advocate of various forms of aerobic exercise. After approval from the patient's internist or family practitioner, I encourage exercise as a healthy, constructive, structured activity which can at least somewhat improve sleep and mood while the patient is waiting for medication to begin working.

Diet is another important consideration for some patients with mood disorders. When people come in with concerns about diet or weight, I frequently refer them to hospital based nutritionists for consultation. Of course, patients with both a mood disorder and an eating disorder may need more specialized treatment than can be provided by a general nutritionist.

. . . I've been reflecting on the potential benefit that organized religion can have for the mood disorder patient. I think the social support, moral direction, structure, sense of hope, and proscription against suicide common to most major religions can be immensely therapeutic.

[These are some of my] thoughts about the outpatient treatment of people with mood disorders. Hopefully, we will all continue to accumulate and share ideas as we progress in our ability to understand and control depressive illnesses.

_________________________

1 Assistant Professor of Psychiatry and Behavior, Johns Hopkins University School of Medicine.

VIRGINIA WOOLF a report on a presentation 1 by Kay Redfield Jamison, Ph.D., 2 Smooth Sailing, Spring 1997

Celebrated writer Virginia Woolf was born Adeline Virginia Stephen on January 25, 1882. She had manic depression, and the disease could be traced through three generations in her family. Her father, Sir Leslie Stephen, inherited manic depression from his father and had been hospitalized three times for it. Virginia Woolf wrote that being with her father was like "being shut up in a cage with a wild beast." Her two brothers and her sister had recurrent bouts of depression, and other members of her family had affective disorder. A cousin died of manic exhaustion and a refusal to eat.

The many pictures of Virginia Woolf shown during the presentation indicated that she had a very expressive face. She was described as "having laughter like a child's" and having a "great capacity for joy," although "an undertow of sadness" was also noticeable in her presence. Her father's death in 1904 triggered the first of several nervous breakdowns that darkened her adult life.

In 1912, she married Leonard Woolf, also a writer. This devoted man would take her temperature and weigh her in the attempt to predict her moods. During their marriage she would "pass from sanity to insanity" many times. While in her manic episodes, she became violent and had delusions (persistent false beliefs) and auditory hallucinations (she heard voices). Dr. Jamison mentioned that during one manic episode, Virginia Woolf talked for three days without stopping, and during another she believed she heard birds talking in Greek in the garden. When she was in a depressive state, she barely spoke or ate, and during several of these episodes, she tried to commit suicide. She felt she was a failure and ex-perienced overwhelming, irrational pain. She described her moods as "wild waves of emotions."

Virginia Woolf believed that her "madness" inspired her and made her a better writer. Her disease probably gave rise to the nontraditional narrative techniques and definitions of reality in her stream-of-consciousness style of writing. A friend said, "A dull moment in her company was not likely . . . her mind was a rich kingdom to itself and her going was the end of an age."

Virginia Woolf wrote two suicide notes telling of her certainty that she would become manic and that she "cannot fight it." In both notes she expressed gratitude to her husband. She believed she owed the happiness in her life to her husband and she did not want to spoil his life. She wrote that they "were happy until this disease came on." On March 28, 1941, sensing the beginning of another manic episode and a flight into madness, she drowned herself.

In 1949, only eight years after Virginia Woolf's suicide, lithium was found to be useful in treating manic depression.

1 Presented at the DRADA/Johns Hopkins symposium, Baltimore, Maryland, April 1997