Use of Evidence in Bipolar Treatment: ECNP
An article resulting from a speech given at the annual ECNP congress by psychiatrist Dr. Andrew A. Nierenberg was published today in Clinical Psychiatry News. Dr. Nierenberg is the medical director of the bipolar clinic and research program at Massachusetts General Hospital. In the speech, Dr. Nierenberg discusses the ways in which many psychiatrists treat evidence that is published in medical journals. Specifically, he gives a number of examples of when psychiatrists don’t follow what studies suggest is the best treatment in a hypothetical patient. For example, quetiapine (Seroquel) has been shown to be very effective. However, side effects of sedation and weight gain have made it unpopular. For another example, the evidence for using antidepressants is unconvincing, but he still prescribes them in some cases because he has himself observed improvement, as have many other psychiatrists.
Commentary
It is very encouraging to hear that psychiatrists don’t simply blindly follow the conclusions of the abstracts of scientific journals (Dr. Nierenberg actually accuses a 2004 Meta-anlysis in the American Journal of Psychiatry of being “terrible”), but make decisions based on their own experiences with individual patients. This means a) taking into account which side effect patients don’t want, b) taking into account that individual patients are not hypothetical “average” patients and c) taking the author’s opinions about his or her findings in a study with the appropriate grain of salt. I know after reading about this speech, I have some more confidence in psychiatry as a whole.
Related posts:
Leave a Reply
