Journal of Clinical Psychiatry article

[Guest guest]

As seen in Eurekalert at

http://www.eurekalert.org/pub_releases/2010-04/l-adm041910.php

The money sentence: " The researchers also question whether side effect

frequencies reported in industry-sponsored studies may underestimate the

prevalence of side effects from medication "

--------------------------Eurekalert Post Follows---------------------

Are doctors missing depression medication side effects?

Study finds patients report 20 times more side effects than recorded in charts

PROVIDENCE, RI – A study from Rhode Island Hospital shows that patients report

side effects from medication for the treatment of depression 20 times more than

psychiatrists have recorded in the charts. The researchers recommend the use of

a self-administered patient questionnaire in clinical practice to improve the

recognition of side effects for patients in treatment. The study is published in

the Journal of Clinical Psychiatry, Volume 71, No. 4, now available online ahead

of print.

One of the most frequent reasons for the discontinuation of medication to treat

depression is the side effects that patients may experience. The premature

discontinuation of medication is also associated with poorer treatment outcomes.

In his recent study, lead researcher Mark Zimmerman, MD, director of outpatient

psychiatry at Rhode Island Hospital, notes that despite the clinical importance

of detecting side effects, few studies have examined the adequacy of the

detection and documentation methods currently in use among clinicians.

Zimmerman and his colleagues asked 300 patients in ongoing treatment for

depression to complete a self-administered version of the Toronto Side Effects

Scale (TSES). The patients rated the frequency of the 31 side effects and the

degree of trouble they experienced. Those patients' charts were then examined to

extract side effects information recorded by the treating psychiatrist.

The findings indicate that the mean number of side effects reported by the

patients on the TSES was 20 times higher than the number recorded by the

psychiatrist. When the self-reported side effects were limited to " frequently

occurring " or " very bothersome " the rate was still found to be two to three

times higher than recorded in their charts.

Zimmerman, who is also an associate professor of psychiatry and human behavior

at The Warren Alpert Medical School of Brown University, says, " Despite the

importance that side effects have on premature medication discontinuation, there

is some evidence that clinicians may not do a thorough job of eliciting

information regarding their presence. This study finds that clinicians do not

record in their progress notes most side effects reported on a side effects

questionnaire.. "

While there may be several explanations for this, Zimmerman says, " Our research

found that the only specific side effect that was regularly inquired about by

clinicians was on sexual dysfunction, presumably because of concerns that some

patients may be too embarrassed to spontaneously report that without prompting. "

The researchers also suggest that patients stop reporting to psychiatrists the

side effects that they have grown accustomed to, but patients reported these

side effects in the self-report scale because there were specific questions

about them. .

The researchers also question whether side effect frequencies reported in

industry-sponsored studies may underestimate the prevalence of side effects from

medication. As a result, clinicians may not be accurately informing patients of

the potential likelihood of such side effects, and that lack of adequate

preparation may result in patients prematurely discontinuing their medication.

Zimmerman says, " As a result of this study, we believe that ongoing dialogue

about side effects during treatment will help to reduce premature medication

discontinuation and would help reduce depression relapse rates. Incorporating a

self-report questionnaire like the TSES may be helpful to adopt into clinical

practice for the treatment of depression. "

###

Other researchers involved in the study along with Zimmerman include Janine

Galione, BS, Naureen Attiullah, MD, Friedman, MD, Cristina Toba, MD, and

Moataz Rahgeb, MD, all of Rhode Island Hospital the Alpert Medical School.

About Rhode Island Hospital:

Founded in 1863, Rhode Island Hospital in Providence, RI, is a private,

not-for-profit hospital and is the largest teaching hospital of The Warren

Alpert Medical School of Brown University. A major trauma center for

southeastern New England, the hospital is dedicated to being on the cutting edge

of medicine and research. Rhode Island Hospital receives nearly $50 million each

year in external research funding. For more information on Rhode Island

Hospital, visit www.rhodeislandhospital.org.