Evidence Based Treatment

The mood disorders clinic at Gateway Psychiatric Services is very committed to the principles of “evidence-based treatment”.

What does this mean for you?

Evidence-based treatment is treatment that is based on the best quality scientific studies. [For a more complete discussion of this concept, please see the book “Users’ Guides to the Medical Literature: Essentials of Evidence-based Clinical Practice” AMA Press; 2002].

Evidence-based medicine doesn’t mean that there is not a vital role in selecting a treatment for the practitioner’s clinical judgment. Studies, however, consistently find that when pure “clinical judgment” is compared with pure “evidence-based” medicine, evidence-based medicine achieves better outcomes.

The scientific community has established a “gold standard” for clinical research. The best data is from multiple, randomized, controlled trials. Unfortunately, there are relatively few questions that have been evaluated in this way. Still, where this information is available we need to make full use of it, and yet, routine clinical care often does not do so. There are a number of reasons for this: one important one is that most clinicians get much of their information from sources that are funded by pharmaceutical companies. Clinical practice tends, as a result, to favor the “newest” and the most expensive treatments, even when they are less effective.

It is our philosophy that treatment decisions should begin by discussing those treatments that are the best that have been shown the most convincingly to be effective. This often means talking about treatments that are not “the latest and greatest.” This isn’t because we don’t keep up. Quite the contrary, we spend thousands of dollars a year on subscriptions and library resources to stay up to the minute on mood disorders research. But we know very well how much bias there is in the world of medication treatment.

Non-randomized controlled studies of gabapentin (Neurontin), for instance, for the treatment of bipolar disorder found that approximately 75% of patients improved. The controlled randomized trials found that patients treated with Neurontin actually did worse than the patients treated with placebo. An ongoing criminal and grand jury investigation is evaluating how it was that this medication became so widely used in the treatment of bipolar disorders.

Ultimately, of course, the decisions about treatment are made based on your values. Our belief is that our role is to consult with you and to provide you with the best information that we have about which medications work best. However, some of you are interested in trying new approaches and new medications and some of you are more cautious. In the end, the choice is yours, but we do our best to provide you with unbiased information to guide you.