Tuesday, April 19, 2005

Proposal for a Rational Formulary for Antipsychotic Medications Drug Benefit Trends article at Medscape - "Most formulary decisions are based on similarities or differences among competing medicines—the pros and cons of olanzapine versus risperidone or haloperidol, for example—along with cost considerations. Instead, what if formulary decision makers focused on prescriber and patient variables? Perhaps if formulary committees also took into account who does the prescribing for different patient populations, a properly constructed formulary for antipsychotic medicines, particularly the more expensive but very useful atypical agents (clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole), would emerge. In considering the range of choices available, the relative benefits of medications, and the impact of medication costs on prescribing decisions, an important consideration is the type of insurance coverage a patient has. Thus, patients can be divided into 2 population domains—those who have private-sector insurance and those with public-sector insurance, typically Medicaid..." [Viewing Medscape resources requires registration, which is free].  
  

There's Nothing Deep About Depression New York Times Magazine article by Peter Cramer - "Shortly after the publication of my book Listening to Prozac, 12 years ago, I became immersed in depression. Not my own. I was contented enough in the slog through midlife. But mood disorder surrounded me, in my contacts with patients and readers. To my mind, my book was never really about depression. Taking the new antidepressants, some of my patients said they found themselves more confident and decisive. I used these claims as a jumping-off point for speculation: what if future medications had the potential to modify personality traits in people who had never experienced mood disorder? If doctors were given access to such drugs, how should they prescribe them? The inquiry moved from medical ethics to social criticism: what does our culture demand of us, in the way of assertiveness? It was the medications' extra effects -- on personality, not on the symptoms of depression -- that provoked this line of thought..." "nyt"