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Recent developments in psychopharmacoepidemiology

Wang, Philip S.; Schneeweiss, Sebastian; Avorn, Jerry

Clinical therapeutics

Purpose of review: Psychopharmacoepidemiology has grown from its origins investigating unanticipated hazards from psychiatric drugs and now includes a wide array of studies. This review covers recent developments in the field including the current sources of data being used, examples of studies published in the past year, and potential directions for the future.

Recent findings: Investigators now have several important sources of psychopharmacoepidemiological data at their disposal, each with its own unique strengths and limitations. With them, psychopharmacoepidemiologists have recently identified potential adverse metabolic, electrophysiological, and cancer outcomes associated with the use of antipsychotic medications. Underrecognized benefits have also been found, such as the protective effect of clozapine on suicidality, a finding recently confirmed in the InterSePT trial. Investigations have also documented the marked expansion over the past decade in the use of psychotropic medications for disorders such as depression and attention deficit hyperactivity disorder. However, sobering results have shown that in spite of these secular increases the quality of care is often poor. For this reason, psychopharmacoepidemiological studies continue to shed light on modifiable determinants of suboptimal prescribing and patient non-adherence. Interventions to enhance the use of psychiatric medications have recently been shown to be effective and cost-effective for an ever wider set of disorders, populations, and outcomes, giving new grounds for optimism.

Summary: Psychiatric medications are increasingly effective, costly, and widely consumed. Psychopharmacoepidemiological studies can be of central importance in ensuring that the use of these medications is safe, appropriate, and optimal.

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Philip S. Wang, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA Tel: +1 617 278 0930; fax: +1 617 232 8602; e-mail: pwang@rics.bwh.harvard.edu

Abbreviations APM: antipsychotic medication HMO: health maintenance organization NCS-R: National Comorbidity Survey Replication

© 2003 Lippincott Williams & Wilkins, Inc.