Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
Overview of Treatment
Benefits and Risks
Throughout this report, currently accepted treatments for
mental disorders will be described. Except where otherwise indicated, the
efficacy of these interventions has been documented in multiple controlled,
clinical trials published in the peer-reviewed literature. In some cases, these
have been supplemented by expert consensus reports or practice guidelines.
Most studies of efficacy of specific treatments for mental disorders have been
highly structured clinical trials, performed on individuals with a single
disorder, in good physical health. While necessary and important, these trials
do not always generalize easily to the wider population, which includes many
individuals whose mental disorder is accompanied by another mental or somatic
disorder and/or alcohol or substance abuse, and who may be taking other
medications. Moreover, children, adolescents, and the elderly are excluded from
many clinical trials,17 as are those in certain settings, such as nursing homes.
Newer, more generalizable studies are being undertaken to address these
shortcomings of the scientific literature (Lebowitz & Rudorfer, 1998).
Pending the results of these newer studies, it is important for clinical
decisionmakers to review the current best evidence for the efficacy of
treatments. People with mental disorders and their health providers should
consider all possible options and carefully weigh the pros and cons of each, as
well as the possibility of no treatment at all, before deciding upon a course of
action. Such an informed consent process entails the calculation of a
benefit-to-risk ratio" for each available treatment option. Most medications or
somatic treatments have side effects, for example, but a likelihood of
significant clinical benefit often overrides side effects in support of a
treatment recommendation.
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