Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment
of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-
certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continu-
ing education program. An analytic hierarchy process was performed and participants were
asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and
in avoiding toxicity and adverse events. Of the 61 participants from the continuing education
program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more
important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, high-
est preference was given to avoidance of falls and drug interactions, followed by avoidance of
sedation, weight change, and impairment of sexual function. The most important preferences for
appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical
psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events
and toxicity. This raises the question for future research whether these preferences cause dif-
ferences in prescription patterns in clinical practice even though a multitude of antidepressants
are similarly effective when judged with instruments used in clinical trials.
Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment
of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-
certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continu-
ing education program. An analytic hierarchy process was performed and participants were
asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and
in avoiding toxicity and adverse events. Of the 61 participants from the continuing education
program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more
important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, high-
est preference was given to avoidance of falls and drug interactions, followed by avoidance of
sedation, weight change, and impairment of sexual function. The most important preferences for
appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical
psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events
and toxicity. This raises the question for future research whether these preferences cause dif-
ferences in prescription patterns in clinical practice even though a multitude of antidepressants
are similarly effective when judged with instruments used in clinical trials.
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