Modern Psychopharmacology in Psychiatry

A man of thirty-one arrives labelled treatment-resistant after four antidepressants. Two were stopped at three weeks for side effects, one never passed the starting dose, and the fourth he took irregularly. He has never had therapy.

Nothing has failed yet. This book teaches you to see that before you write the fifth prescription, and does the same for the other decisions that quietly decide how treatment turns out.

What you will be able to do

• Tell a failed drug from a failed trial. Establish the dose reached, the time spent at it, and what was actually swallowed, before anyone writes resistant.
• Explain the delay so your patient does not quit in week two. The drug acts within hours; the benefit comes from slower change. Saying so plainly is what keeps people on treatment.
• Switch agents without losing the patient mid-switch. Plan the cross-taper on half-lives and say in advance what the hardest week will feel like.
• Calculate a washout that is genuinely safe. From the longest-lived active moiety rather than the parent drug, counted from the last dose actually taken.
• Build monitoring that still happens six months later. Booked when you prescribe, owned by a named person, with the response to an abnormal result agreed up front.
• Separate serotonin toxicity from neuroleptic malignant syndrome by examining the patient, not the drug list.
• Reduce a regimen that has piled up without the withdrawal being mistaken for relapse.
• Find the words for the hard conversations. Model explanations for starting lithium, proposing a switch, prescribing in pregnancy, and answering someone who feels well and wants to stop.

How it teaches

Who it is for