Myths and facts in contemporary psychopharmacotherapy: evidence-based vs. evidence-biased treatment algorithms practice

Abstract

Evidence based psychiatry and treatment guidelines have a significant role in raising the quality of mental health care and treatment, as well as in providing order where chaos reigns. The purpose of treatment guidelines and algorithms is to provide psychiatrists, health authorities, patients and their families with best evidence for making treatment decisions. However, adherence to some guidelines may do more harm than good if they are not flexible enough to take into account individual patient preferences and circumstances. The paradox at the heart of algorithms-based practice is that gold standard treatments are predicated on statistical generalizations about patients, mental disorders and treatments. In contrast, the effectiveness of a treatment is based on the art and practice of learning organization, the uniqueness of the patient, the doctor-patient relationship and the willingness of the patient to change her/his mental model, life philosophy and the relationships in his family. Treatment guidelines are the lifelines of medical psychiatry and clinical psychopharmacology, without which psychiatry will never reach professional maturity and become fully accepted in medical circles.