National Alliance on Mental Illness
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Adverse Effects of Psychotropic Drugs

By John M.Kane, MD, Jeffrey A. Lieberman, MD, and Oliver G. Cameron, MD, PhD

Reviewed by members of NAMI's Literature Committee

Adverse Effects of Psychotropic Drugs by John M. Kane, MD, Jeffrey A. Lieberman, MD, and Oliver G. Cameron, MD, PhD Published by Guiliford Press, 1993. 511 pp $60.00

Twenty years ago, Shader and DiMascio edited "Psychotropic Drug Side Effects." A great deal has happened in psychopharmacology in the intervening 20 years (for example, development of the specific serotonin re-uptake inhibitors,and recognition of the neuroleptic malignant syndrome and tardive dyskinesia), and a new book on side effects, adverse effects of psychopharmacological agents is very timely. Thus, the recently published edited volume by Drs. Kane, Lieberman, and Cameron is quite welcome.

This is a book written for and by physicians, mainly clinical psychopharmacologist; over 90 percent of the contributing authors are MDs or DOs.

The subject matter and level of detail are directed at practitioners who are specialists in the therapeutic use of psychotropic agents. Most of the authors are from the United States, especially from New York and Massachusetts, but a few are from the United Kingdom and Ireland.

There are 3 major sections in the book, titled "General Issues," "Side Effect Profiles of Psychotropic Drugs," and "Special Populations."

The general issues section focuses on pre- and post-marketing evaluations of drug safety, drug-drug interactions, abuse potential, and informed consent, while the section on special populations addresses problems primarily related to children and geriatric patients.

In the section on side effect profiles, there are 5 subsections:
(1) "Behavioral Effects,"
(2) "Neuromuscular Effects,"
(3) "Cardiovascular Effects,"
(4) "Convulsive Effects," and
(5) "Endocrine Effects."

The chapters in the subsection on behavioral effects are arranged around types of drugs--antidepressants and lithium, neuroleptics, benzodiazepines, and psychostimulants.

Most of the neuromuscular side effects of psychotropic are due to the antipsychotics; however, there is also a welcome chapter included on these effects due to antidepressants and lithium.

The cardiovascular effects subsection focuses on the effects of antidepressants -- heterocyclic and monoamine oxidase inhibitors, while the subsection on convulsive effects deals with several classes of drugs in a single chapter.

The subsection on endocrine effects actually deals with more than just endocrine issues, and is thus somewhat inappropriately named; in addition to chapters on endocrine, metabolic, and nutritional effects, and on reproductive and sexual, there are chapters on hematologic, immune system, gastrointestinal and hepatic and genitourinary.

The authors provide the reader with numerous useful tables, figures and references. The 15-page index is very helpful. Because of its focus, length and detail, the subsection on neuromuscular effects might be the best and most useful in the book, especially since these adverse effects are often very problematic and not as routinely recognized by clinicians as they should be.

The typical member of NAMI is likely to find this book not "all you wanted to know," but much more than that, and at a level of technical detail which is likely to make many parts of the volume not understandable to someone not clinically trained in this area.

But knowing that this information is now easily available in an up-to-date version is important to anyone who has an interest in the optimal care of individuals on psychotropic medications.

You might not read this book yourself, but you will want to know where you can find the wealth of knowledge contained in it, and you will want to be sure that the prescribing physician does too!