Psychoactive Drugs: Getting the Whole Support Team on Board

Pharmaceutical Commerce, Pharmaceutical Commerce - May 2009,

More so than other classes of drugs, making choices about drugs for mental health conditions require everyone around the patient to be well informed

While researching the story on central nervous-system (CNS) drugs, I had the unhappy and stressful experience of having a close family member enter intensive care for a series of medical conditions that in turn led to the development of transient mental-health issues. It’s rare for a reporter following a business topic to become so personally immersed in it as I have over the past few weeks, but the experience has highlighted some unexpected realizations.

The first realization has been that, to a surprising degree, many medical doctors seem to be “making it up as they go along” when it comes to prescribing CNS drugs. Put another way, it’s become clear to me that there is a LOT more art than science when it comes to prescribing powerful psychoactive drugs. While the initial hospitalization was related to a pulmonary condition, over the course of several months, the liberal use of sedatives and anti-anxiety drugs was followed by the introduction of antidepressants, and then antipsychotics were added to counter some of the side effects (transient delusions and such) that accompanied the antidepressants (and all of these drugs were added to a system that was already overloaded with a bevy of cardiovascular meds; this gets one thinking pretty quickly about the impact of unavoidable drug-drug interactions).

Dosages have been ramped up and down and different types tried, even before the medical situation (and its mental health consequences) had had a chance to stabilize. Through numerous and lengthy consultations with the multiple physicians involved, the usual logic expressed was, “Let’s try this and see how it goes.”

On the one hand, there’s some reassurance that a variety of drugs are available to try to meet a specific need while minimizing the (many) side effects that crop up. On the other, there’s cold comfort that “personalized medicine” of a sort is already well established when it comes to CNS drugs, given our experience with how rapidly regimens have been changed.

Another key realization has been the profound influence, at least in hospital and long-term acute care settings, of the attendant nurses. It is they who are observing waxing and waning mental conditions day in and day out, who are consulting with family members and then filtering their own observations based on the detailed, patient-specific backstory we are able to provide. In our experience, it was these nurses who would so often make drug- and dosage-specific recommendations to the attending physicians.

Even though they are not prescribers per se, nurses and other non-physician care providers play a critical role in the proper use of powerful mood-management drugs. The biopharma industry spends a lot of time focusing their educational and marketing outreach efforts on physicians, but my sense is that, at least in clinical settings, nurses and caretakers are the front line in managing the mood and other mental health conditions that so often arise during a patient’s long-term hospitalization or convalescence.

Biopharma could and should do more in terms of providing evidence-based information, and branded and unbranded educational outreach, to strengthen the ability of these medical professionals in managing patients’ mental health.