Psychopharmacology as a discipline burst on the scientific horizon as precipitously as the psychotropic drugs that gave rise to the field. At a time of frustration at how psychiatry had lagged behind other fields of medicine in major advances, there appeared in December 1952 a brief report describing the remarkable effects of chlorpromazine, soon appreciated as the first antischizophrenic drug and heralding the class of neuroleptic agents that have truly revolutionized psychiatry. A few years later, imipramine, developed as a "me too" chlorpromazine derivative, was discovered to have remarkable antidepressant actions. By the end of the 1950s, chlordiazepoxide (Librium) and diazepam (Valium) were recognized as genuine antianxiety agents. Thus, in less than 10 years, the clinical treatment of most psychiatric disabilities was radically altered. Besides learning how to administer these agents most effectively, psychiatrists and basic neuroscientists endeavored to elucidate how they act. The contemporaneous development of methods for measuring biogenic amines such as serotonin, norepinephrine, and dopamine led to the discoveries that antidepressants facilitate the actions of these neurotransmitters and that neuroleptic drugs block the selective effects of dopamine. The American College of Neuropsychopharmacology was established in the early 1960s as a unique scientific society, uniting clinicians with basic scientists studying drugs and the brain. In most scientific groups, one of two poles dominates, so that the organization is deemed either a "clinical" or a "basic science" enterprise. Remarkably, for roughly 40 years, the American College of Neuropsychopharmacology has successfully melded the two in roughly equal proportions. One of the products of this marriage has been the publication, about every five years, of a major compendium of advances in the field. Each of these compendiums has been successful, but the current offering, Neuropsychopharmacology: The Fifth Generation of Progress, may well be the finest. All the editors are psychiatrists with backgrounds in both basic and clinical research in psychopharmacology. The book comprises 134 chapters, organized into 13 sections focusing on various areas. The success of the book comes from the selection of distinguished editors for each section and from their selection of optimal chapter authors. The elegance of the book is evident from a review of a few of the sections. Neurotransmitters are the royal road to understanding how psychotropic drugs act, since every major psychoactive agent works through one neurotransmitter or another. Eric Nestler and Ron Duman, who have made substantial contributions themselves, have assembled 17 chapters on different aspects of neurotransmission. George Aghajanian, a leader in the study of how LSD (lysergic acid diethylamide) and other drugs act through biogenic amines, writes on serotonin. Jean-Charles Schwartz, a pioneer in histamine research, addresses this remarkable substance, which in diverse parts of the body modulates allergy, gastric acid secretion, and neurotransmission. Joseph Coyle, whose research links excitatory neurotransmission to Huntington's disease and schizophrenia, updates the status of the excitatory neurotransmitter glutamate. Fred Gage, an authority on neuronal growth, provides a chapter on neurogenesis in the adult brain, one of the hottest areas of modern neuroscience. An innovative section depicts how drugs are discovered, evaluated, and approved by the Food and Drug Administration. Chapter authors in this section detail the ways in which preclinical models mimic mental illness, examine ethical considerations in studying drugs in human subjects, and discuss the design of clinical trials. There is even a chapter on regulatory issues, authored by Paul Leber, formerly director of neuropharmacology at the Food and Drug Administration. Separate sections treat individual disease groups such as schizophrenia, anxiety, affective disorders, Alzheimer's disease, substance abuse, obsessive-compulsive behavior, movement disturbances, and sleep disorders. This last section, edited by David Kupfer, a leading sleep researcher, relates recent important advances. For instance, Emmanuel Mignot, who discovered how abnormalities of the neuropeptide hypocretin (orexin) cause narcolepsy, writes on this disorder. Seasonal affective disorder is reviewed by Alfred Lewy, who has published seminal findings on how light exposure can alleviate symptoms. Clear writing, coupled with rigor and depth of coverage, is evident in almost every chapter. Conveying up-to-date research in an accessible form, this book will be indispensable both for neophytes and for professional psychopharmacologists.
Solomon H. Snyder, M.D.Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
