Psychology Today Blog
by Jonathan Rotenberg, Ph.D.
April 20, 2010

A rich scientific study raises more questions than it answers.

This point is exempified by new work conducted at Rhode Island Hospital and published in the Journal of Clinical Psychiatry.

The investigators followed 300 patients who were in ongoing outpatient treatment for depression over six weeks. The authors compared what the patient reported on a standardized scale of 31 different side effects (Toronto Side Effects Scale; TSES) with the information recorded by the treating psychiatrist on each patient’s chart. The main finding: A stunning disconnect between psychiatrists and their patients. The average number of side effects reported by the patients on the TSES was 20 times (!) higher than the number recorded by the psychiatris. When the investigators concentrated on those side effects that were most troubling to the patient, patients still reported 2 to 3 times more side effects than were recorded by the treating psychiatrist.

The authors summarize their provocative findings in mild language, “The findings of the present study indicate that clinicians do not record in their progress notes most side effects reported on a side effects questionnaire by psychiatric outpatients receiving ongoing pharmacological treatment for depression.”

Obviously all is not well in the state of Demark. Although the findings concern the treatment of depression, they raise broader questions about the doctor-patient relationship.

Why is there such a massive disconnect between what psychiatrists and patients report, on something so basic as whether prescribed medications are having untoward effects? Do psychiatrists not ask enough questions about side effects? Do psychiatrists not dig deep enough into patients’ responses? Are psychiatrists hearing what patients say, but not documenting it in their notes? Or is the problem more on the patient side? Are patients reluctant to speak candidly to their doctors about side effects (i.e., yes, I am having problems with sexual functioning)? Or do patients freeze up and forget their experiences when asked in the heat of the moment (it is easier to respond to a standardized list of side effects using pencil and paper)? Or is it the situation that is to blame for this disconnect? Are patient-doctor interactions in this day and age simply too rushed to insure efficient or effective transfer of information?

Whatever the explanation, psychiatrists appear to believe that patients are having fewer problems with medications than they truly are. It is hard to see how psychiatrists can act in the best interest of their patients if they do not know what their patients are experiencing!!!!

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. This study reveals a chasm of misunderstanding between doctors and patients. This recommendation is a sensible, but baby, step towards narrowing it…

The study:
Underrecognition of Clinically Significant Side Effects in Depressed Outpatients
Mark Zimmerman, MD; Janine N. Galione, BS; Naureen Attiullah, MD; Michael Friedman, MD; Cristina Toba, MD; Daniela A. Boerescu, MD; and Moataz Ragheb, MD
J Clin Psychiatry 2010;71(4):484–490
© Copyright 2010 Physicians Postgraduate Press, Inc.