Decisions about when to pursue antidotes for adverse psychotropic drug effects versus when to choose alternative pharmacotherapies must be tailored to the needs and circumstances of an individual patient. Risk-benefit analyses usually favor drug retention with active management of adverse effects when efficacy is dramatic and few if any comparable alternatives exist, unless insurmountable hazards exceed potential benefits, or unless the true inability to manage benign but bothersome adverse events would likely cause treatment nonadherence. A goal of this book has been to afford readers a greater awareness of viable options and resources for managing adverse effects than they might have previously realized, and of the circumstances under which the active management of side effects can produce better treatment outcomes. One of the greatest challenges in practicing contemporary psychopharmacology involves recognizing the factors and contexts that comprise risk-benefit analyses while considering the gravity of psychiatric symptoms alongside the manageability and medical dangerousness of adverse psychotropic drug effects.
In some respects, psychiatry has only fairly recently joined the ranks of other medical specialties in which treatment risk-benefit analyses have long been routine. Excess morbidity and mortality attributable to untreated or undertreated psychopathology pose disease risks that have become recognized and quantified in just the past two decades. By contrast, patients and clinicians alike have for centuries been aware of the excess morbidity and mortality associated with primary medical problems such as arrhythmias, infectious diseases, and cancer, yet seldom if ever avoid effective treatments due to safety concerns or the need for careful end-organ monitoring. Drugs such as warfarin, digitalis, amphotericin B, interferon, prednisone, and most antineoplastics all entail substantial (and sometimes life-threatening) adverse effects, yet the potential life-saving benefit of such drugs is seldom accorded secondary importance to their tolerability.