The release of the web tool, the Psymatik Treatment Optimizer, has been accompanied by the publication of an umbrella review in Lancet Psychiatry. Researchers reviewed all available data on 69 medications – 32 antipsychotics and 37 antidepressants – which was then used to create a database of side effects and effectiveness of each one.

The National Institute for Health and Care Excellence (NICE) prescribing guidelines for antidepressants and antipsychotics recommend that patient and doctor have a conversation about the effectiveness and side effects of different medications before prescribing. However, due to the number of drugs available, and the wide array of potential side effects, meaningful conversations about the medications on offer are difficult and often limited to only a few options.

Prior to making a choice about which drug to prescribe, doctor and patient sit down to discuss the various potential side effects that the patient is most concerned about. The doctor inputs this information into the Optimizer, which then provides a clear table on which antidepressant is least likely to cause that side effect, balanced against its effectiveness as a medication.

Dr Toby Pillinger, a Clinical Lecturer at King’s IoPPN and the study’s first author explains, “A patient might, for example, feel reluctant to engage with a course of medication due to the significant amount of weight they gained the last time that type of medication was prescribed. Our database takes that information and plots out a series of alternatives, setting the groundwork for a much more transparent conversation about the prescribing process.”

In the United States of America (USA) and United Kingdom (UK), approximately 13-17% of the adult population are prescribed antidepressants and 1-2% are prescribed antipsychotics. While they have proven to be an effective means of managing symptoms for many people, about 75% of users experience side effects, such as weight gain, sedation and loss of libido, that can impair quality of life and functioning.

Dr Robert McCutcheon, Wellcome Clinical Career Development Fellow at the University of Oxford and the study’s senior author said, “Helping an individual choose a medication that is right for them is absolutely crucial, and optimising the balance of side effects is key to helping people stick with treatments than help their symptoms. We have compiled that most comprehensive side effect database for antidepressants and antipsychotics that streamlines the prescribing process while also empowering patients to make the decisions that are right for them.”

This research is supported by funding from the National Institute for Health and Care Research (NIHR) and Maudsley Charity.

 

Antidepressant and antipsychotic side-effects: a systematic review and digital tool to facilitate personalized prescribing (DOI10.1016/S2215-0366(23)00262-6 ) (Toby Pillinger, Professor Oliver D. Howes, Professor Christoph U. Correll, Professor Stefan Leucht, Maximilian Huhn, Johannes Schneider-Thoma, Professor Fiona Gaughran, Sameer Jauhar, Professor Philip K. McGuire, Professor David M. Taylor, Professor Allan H. Young, Robert A. McCutcheon) was published in the Lancet Psychiatry.

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