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Outliers on the Dose-Response Curve: If the Problem Is Not Concentration, Then What?


Journal of Psychiatric Practice®: November 2013 - Volume 19 - Issue 6 - p 490–494
doi: 10.1097/01.pra.0000438188.66735.68
COLUMNS: Psychopharmacology

This column addresses the two primary reasons some patients do not respond as usual to a medication. Such patients may not benefit either because they are uniquely sensitive to the adverse effects of the drug and/or because the drug does not work on the correct mechanism of action to treat the illness. This column explains and reviews these concepts and provides a rationale for using such information prospectively to increase the likelihood of an optimal outcome with the prescribed treatment. (Journal of Psychiatric Practice 2013;19:490–494)

SHELDON H. PRESKORN, MD, is Professor, Department of Psychiatry, University of Kansas School of Medicine-Wichita; Chief Science Officer and Medical Director, Kansas University-Wichita Clinical Trials Unit (KU-W CTU), Wichita, Kansas; and research psychiatrist, Laureate Institute for Brain Research, Tulsa, Oklahoma. He has more than 35 years of drug development research experience at all levels (i.e., preclinical through Phase IV) and has been a principal investigator on over 350 clinical trials—funded by industry, the federal government, or private foundations—including trials of every antidepressant and antipsychotic medication marketed in the United States over a period of 25 years. Dr. Preskorn maintains a website at where readers can access previous columns and other publications.

This column is adapted from Preskorn SH. If lack of concentration didn’t cause the fall, what did? Journal of Practical Psychiatry and Behavioral Health 1996;2:364–7.

Disclosure statement: Over his career, Dr. Preskorn has worked with over 100 pharmaceutical companies in the United States and throughout the world. Over the past year, Dr. Preskorn has received grants/research support from or has served as a consultant, on the advisory board, or on the speakers bureau for the following: Abbott, Assurex Health, AstraZeneca, Envivo, Johnson & Johnson, Merck, National Institute of Mental Health, Naurex, Novartis, Pfizer, Stanley Medical Research Institute, Sunovion, and Taisho.

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