Book Review
Psychopharmacology
Handbook of Female Psychopharmacology. Meir Steiner, Gideon Koren, editors. Scarborough (ON): Taylor and Francis; 2003. 160 p. US$43.95.
Reviewer
rating*: Excellent
Review by: Laura Calhoun, FRCPC
Winnipeg, Manitoba
The primary objective of Dr Steiner and Dr Koren, to “ raise the awareness and understanding of sex and gender differences in the etiology, presentation, prevention, and treatment of mental disorders in woman” (p xiii) is ably met in this new and timely text.
Although mood and anxiety disorders are twice as common among women in the reproductive years, compared with men, little research has been done thus far to determine whether there are differential responses to specific treatments. Further, despite the knowledge that 50% of pregnancies are unplanned, with the result that most women do not have a chance to withdraw from medication gradually prior to conceiving, little research exists on the effects of psychotropic medication on infant brain development.
This is an excellent book for all clinicians who treat women with mental illness. Knowledge about sex differences in pharmacokinetics and pharmacodynamics is tremendously important, and research studies are finally starting to report differential responses based on sex. To have this information compiled in one concise, practical volume is enormously helpful both clinically and in teaching residents and medical students.
The first 4 chapters of this handbook discuss the use of antidepressants, mood stabilizers, anxiolytics, and antipsychotics in women at various stages of their reproductive lives. There are also sections in these chapters about the interactions between hormones and these medications.
Other chapters discuss the treatment of disorders that occur exclusively in women, such as premenstrual dysphoric disorder, depression during pregnancy, and depression in menopause. These chapters provide information about etiology and diagnosis , as well as treatment suggestions. They include sections about herbal therapies, dietary supplementation, and psychosocial therapies, all of which serve to teach us in a holistic fashion.
The chapter on antidepressant medication and breast-feeding reviews the conflict that often arises for women who feel pressured to breast-feed on the one hand and to take medications on the other hand. Clinicians treating these women experience a parallel process when they try to balance the infant’s safety, the woman’s wishes, and the knowledge that the longer they wait to treat, the less likely they are to get women well. As is emphasized throughout the book, each treatment decision is unique, and no decision is risk-free.
Two further chapters on herbal remedies and substance abuse round out the book. The latter chapter details what is known about substance abuse at various reproductive stages, together with treatment information. The former chapter reviews St John’s wort, black cohosh, ginkgo biloba, and valerian root. This information is invaluable, as these herbs are being used extensively by women with mental illness.
Only the chapter on drug interactions with oral contraceptives was disappointing, owing both to its brevity and to the lack of available information about the effects of oral contraceptives and depot provera on mood and anxiety.
Under the superb editorship of Dr Steiner and Dr Koren (both Canadians), this book is well written, well laid-out, concise, and well referenced. I am proud to note that most of the contributors are also Canadian; I look forward to reading further works by many of these authors. At the price, this handbook is a terrific reference for clinicians.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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