Individual differences and evidence-based psychopharmacology
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Individual differences in response to pharmacologic treatment limits the usefulness of mean data obtained from randomized controlled trials. These individual differences exist even in genetically uniform inbred mouse strains. While stratification can be of value in large studies, the individual patient history is the most effective currently available guide for personalized medicine in psychopharmacology.
KeywordsVariance clinical trials individual differences replicability measurement error variability
The truth of course is more likely that most psychiatric disorders, like most medical disorders, are highly heterogeneous  and that the best tool we have for dissecting that heterogeneity today is to take a careful history . In the absence of a history, careful follow-up is necessary and often the best treatment for a particular patient will appear only over time. The illusion that what is needed is more head-to-head large trials without differentiating the diagnosis of bipolar depression into subtypes could lead to great expense but also to inappropriate treatment for individual patients. Medicine must return to understanding that individual differences are the essence of medicine as opposed to those sciences that are interested essentially in uncovering the grain of wheat from among all the chaff. We in medicine are interested in each bit of chaff or wheat, whoever and wherever he or she may be. Perhaps Bayes' Theorem might allow us to design more appropriate medical experiments based on this concept of individual differences. Recent papers on 'patient-centered evidence'  have emphasized this point as well as the need to report heterogeneity in clinical trials .
RHB is a clinical psychopharmacologist and director of a bipolar disorder treatment unit.
YB is a clinical psychiatrist, mood disorder psychopharmacologist and biostatistician.
GA is a biochemist and neuropharmacologist and director of a biochemistry and animal behavior research laboratory.
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