Posted by Phillipa on April 27, 2010, at 19:59:45
Seems pdocs don't pick up on the side effects of meds for patients who are depressed. Proposal for check list for patients at visits. Phillipa
rom Medscape Medical News
Medication Side Effects in Depressed Outpatients Often Go Undetected
Jill Stein
April 26, 2010 Psychiatrists pick up only "a fraction" of the side effects experienced by psychiatric outpatients undergoing long-term drug treatment for depression, new research suggests.In fact, results in 300 depressed outpatients showed that the mean number of side effects reported by patients on a standardized checklist was 20 times as high as the number recorded by psychiatrists in patients' medical records.
"I was somewhat surprised at how little the psychiatrists were reporting, myself included," principal investigator Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital in Providence, told Medscape Psychiatry. "Or another way of saying it is I was surprised at how much we were missing. I wasn't expecting the differences to be that large."
The take-home message for psychiatrists, he added, is that increased vigilance about medication side effects in depressed patients is needed. "Just as there has been increasing discussion over the past few years about how we need to be more thorough when assessing symptoms in depressed patients, we need to be more thorough when assessing medication side effects in this population," he said.
Dr. Zimmerman pointed out that, to his knowledge, the study, which was published in the April issue of the Journal of Clinical Psychiatry, is the first to compare psychiatrists' clinical evaluation of side effects to a standardized side effects checklist in depressed outpatients.
The study is part of the ongoing Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.
Cause of Premature Treatment Cessation
On a positive note, Dr. Zimmerman said that the use of a simple, patient-completed questionnaire that includes a comprehensive list of side effects commonly associated with antidepressant medications is likely to boost side effect recognition.
Multiple studies have found that the development of side effects is the main reason cited by depressed patients for discontinuing use of their medication prematurely.
Research has also shown that although depressed patients are more likely to stop taking their medications within the first 3 months of starting therapy, side effects are still a common reason for treatment discontinuation several months later. Early treatment withdrawal is known to worsen outcomes in depressed patients.
Despite the obvious importance of identifying side effects, studies and anecdotal reports suggest that physicians do not routinely query patients about side effects related to antidepressant medications.
What's more, when they ask patients about side effects, they tend to use general, open-ended questions without referring to specific side effects.
Information Gap
Dr. Zimmerman and colleagues analyzed responses to a side effects questionnaire completed by consecutive psychiatric outpatients who were being treated for a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) major depressive episode.
The questionnaire was a self-administered version of the Toronto Side Effects Scale. The questionnaire was initially developed as a clinician-administered checklist of 31 side effects commonly reported by patients taking antidepressants but was modified by the investigators for self-administration.
Patients rated the frequency of each of the side effects during the past week and the degree to which it bothered them. A research assistant reviewed patients' medical records to extract side effects information recorded by the treating psychiatrist.
Results showed that the mean ± SD number of side effects reported by patients was 7.4 ± 5.9 vs 0.6 ± 1.2, t = 20.5, P ≤ .01. When self-reported side effects were limited to "frequently occurring" or "very bothersome" side effects, the side effect rate reported on the questionnaire remained 2 to 3 times higher (P = .01).
Dr. Zimmerman, who is also an associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, strongly advocates the routine use of a questionnaire like the one used in the study to improve the recognition of side effects in depressed outpatients.
"As for how often patients should complete a symptom questionnaire, there's currently a lot of discussion about this question," he said. "At this point, it's really a judgment call, and some will argue in favor of using a questionnaire after 3 months of treatment and again at 6 months and after a year. In my view, a questionnaire that is feasible to complete in a short period of time should be used on a routine basis.
"I have my patients fill out questionnaires at every visit, and I consider the questionnaire a regular part of the clinical evaluation process," he added. "Just as the hypertensive patient has his blood pressure checked every time he sees his primary care doctor, patients with mental health problems like depression should have their outcomes, including side effects, checked at every visit."
Commenting on the findings, Jonathan Stewart, MD, codirector of the Depression Evaluation Service at Columbia Psychiatry and the New York State Psychiatric Institute in New York City, said he agreed that well-structured questionnaires completed by patients may help identify side effects that may not be picked up by clinicians asking open-ended questions.
"The use of a questionnaire may also be especially helpful in the contemporary medical environment where doctors are required to do everything in less time than it is possible to do what they need to do," he said.
"Even if have a lot of time to spend with the patient, are you going to ask every possible question to elicit every possible side effect? I don't think you will," said Dr. Stewart.
Dr. Zimmerman and Dr. Stewart have disclosed no relevant financial relationships.
J Clin Psychiatry. 2010;71:484-490.
poster:Phillipa
thread:945336
URL: http://www.dr-bob.org/babble/20100425/msgs/945336.html