Thomas A. M. Kramer, MD

In This Article


Psychopharmacology has truly been blessed with a booming pipeline of agents to bring to bear against the disorders that we treat. It can often feel as if the options that a clinician has in selecting a medication have increased exponentially in recent years. This is particularly important for our patients because even as we continue to improve upon previous generations of medications, we have yet to come up with a medication that works for all patients with a given disorder all of the time. For antidepressants, for example, a reasonably accurate rule of thumb is that a patient will get better on any given antidepressant, if given an adequate dose for an adequate length of time, 4 out of 5 times. Having more options makes it more likely that we will eventually find something that works for everybody.

Although we are quite good as a field at coming up with new medications, we are not as good at developing some kind of methodology for choosing between them. Although the marketing campaigns of all pharmaceutical companies are designed to convince us that one product is somehow superior to others, the fact remains that there is very little definitive data to guide us in the selection of a particular agent in any given class of psychotropic medications. Recently, a great deal has been written urging clinicians to practice "evidence-based medicine" in which clinical decision making is based on scientifically derived data. The problem with this, of course, is there is very little evidence upon which to practice evidence-based medicine. As such, making the decision can feel both arbitrary and speculative.


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