REVIEW OF: Pillinger T et al, Lancet Psychiatry 2023;10:860–876

STUDY TYPE: Meta-analysis 

Advising patients about the usual antidepressant and antipsychotic side effects, like sedation with mirtazapine or quetiapine, is straightforward. Weighing multiple potential meds and their subtler side effects can get complicated quickly. This paper shows how the authors used a digital application to do that work—and how you can, too.

They began with a systematic review and meta-analysis that incorporated 68 other meta-analyses of RCTs and seven guidelines, the latter offering ordinal data from experts. Altogether, this covered 32 antipsychotics prescribed for schizophrenia and 37 antidepressants for major depression. Tabulating the evidence allowed the authors to calculate the effect sizes—the strength of the relationships—between these monotherapies and their potential side effects. Finally, the authors coded these findings into a digital tool they call the Psymatik Treatment Optimizer (www.psymatik.com). It allows users to select and weigh specific side effects (eg, more concern for QT prolongation and less for akathisia) to compare across medications.

Psymatik makes over 5,000 behind-the-scenes comparisons and outputs a heat map that shows which meds are more likely than others to match the concerns entered by the user. Psymatik offers a very bare-bones antidepressant-switching guide, as well as a blog. It is free but requires users to create a login. Like TCPR, there are no ads.

CARLAT TAKE
If you’re comparing multiple potential side effects and meds, Psymatik is free and fast. It’s not necessary to enter patient or provider side effect concerns. Note that the results do not include all medications (and do include some medications not used in the US). The results also are built from a database of monotherapy studies. It might be tempting to treat a computer-generated diagram as gospel, but as with all our tools, Psymatik should only inform, not dictate, your decision making.