Doctors may miss side effects

PROVIDENCE – Patients report side effects from drugs used to treat depression 20 times more often than psychiatrists record in their charts, raising questions about how often doctors miss problems that have been shown to lead people to stop taking their medications.
That is the finding of a study led by Dr. Mark Zimmerman, director of outpatient psychiatry at Rhode Island Hospital, which is published in the latest issue of the Journal of Clinical Psychiatry, available online ahead of print.
Zimmerman and colleagues asked 300 patients in ongoing treatment for depression to take a survey, using the Toronto Side Effects Scale (TSES), that rated the frequency of the 31 side effects and the degree of trouble that patients experienced.
The researchers then compared the survey responses to what their psychiatrists had noted on their charts.
On average, the number of side effects reported by patients was 20 times higher than the number recorded by the doctors, and even for side effects described as “frequently occurring” or “very bothersome,” the rate was still two to three times higher.
“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,” said Zimmerman, an associate professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University.
The only side effect that doctors consistently asked about, Zimmerman said, was sexual dysfunction, “presumably because of concerns that some patients may be too embarrassed to spontaneously report that without prompting.”
At least some of the side effects the doctors missed may not have been reported by patients because they’d grown accustomed to them, the study suggests, which is why the survey, by asking directly about them, was likelier to catch them.
The researchers also question whether side effect frequencies reported in industry-sponsored studies might underestimate problems, which could also lead doctors to be less likely to warn patients about potential side effects.
Based on their findings, Zimmerman and his colleagues suggest that doctors use more surveys to identify side effects.
“We believe that ongoing dialogue about side effects during treatment will help to reduce premature medication discontinuation and would help reduce depression relapse rates,” Zimmerman said. “Incorporating a self-report questionnaire like the TSES may be helpful to adopt into clinical practice for the treatment of depression.”