Many physicians choose insomnia meds based on habit

February 15, 2017

Clinical decision-making is a complex process, driven by multiple factors, including social and psychological dynamics, peer pressure and even exposure to drug advertising.

Now research from Harvard Medical School shows that when it comes to a physician's choice of insomnia medication, habit may trump all else.

The results suggest that many clinicians choose insomnia drugs somewhat reflexively, based on routine, rather than by taking into account a patient's symptoms and medical history. Indeed, the analysis showed that a physician's past prescribing pattern, rather than patient characteristics, was the more potent predictor of what insomnia medication a patient might get.

Findings of the research, based on analysis of 1,105 patients' medical records and the accompanying clinical notes, appear Feb. 9 in Scientific Reports.

"Our results illuminate the notion that just as everyone else, many physicians are creatures of habit who tend to rely on cognitive shortcuts in their decision-making," said study first author Andrew Beam, a postdoctoral research fellow in the Department of Biomedical Informatics at HMS. "Doctors are not always as rational as we'd like to believe."

Insomnia's economic burden is estimated to top $60 billion a year, a number that doesn't account for the physical toll of a condition believed to affect as many as 40 percent of Americans. Yet insomnia remains underdiagnosed and poorly treated.

As with any other condition, choosing the optimal medication based on individual patient characteristics is critical to successfully resolving symptoms and to averting the many physiologic, psychological and social consequences of insomnia, Beam added.

In their analysis, the researchers focused on the two most commonly prescribed drugs: zolpidem, a newer medication with a great efficacy record but associated with side effects such as next-day drowsiness and dizziness, and trazodone, an older drug typically used for depression that is less effective for insomnia but has a well-established safety profile. How and why physicians choose one drug over another remains unclear so the HMS team set out to untangle the factors that drive clinical choice.

Analyzing thousands of patient records and narrative clinical notes and comparing them against each physicians' prescribing records, the researchers found that a doctor who prescribed one medication in the past was three times as likely to continue prescribing the same drug subsequently.

Patients who had symptoms of depression in addition to their insomnia were somewhat more likely than those without depression to receive a prescription for trazodone, the analysis showed. The finding, researchers said, suggests that certain patient characteristics do play some, albeit smaller, role in clinical decision-making.

In addition to the specific findings of the research, the study underscores how electronic medical records--and the wealth of data they contain--can yield intriguing insights into the interplay between physician decision-making and patient characteristics in treatment choices.

"Electronic medical records provide an astounding richness of information at our fingertips that allows us to deconstruct clinical behavior and clinical decision-making in the context of the patient-physician encounter, rather than in isolation," said study senior author Zak Kohane, chair of the department of biomedical informatics at HMS. "This approach can be used in analyzing treatment decisions for other, more complex conditions."
Other investigators included Uri Kartoun, Jennifer Pai, Arnaub Chatterjee, Timothy Fitzgerald and Stanley Shaw.

The work was supported by the National Institutes of Health Common Fund's BD2K Center for Excellence grant U54 HG007963 with additional funding by Merck.

Harvard Medical School

Harvard Medical School has more than 11,000 faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.

Harvard Medical School

Related Depression Articles from Brightsurf:

Children with social anxiety, maternal history of depression more likely to develop depression
Although researchers have known for decades that depression runs in families, new research from Binghamton University, State University of New York, suggests that children suffering from social anxiety may be at particular risk for depression in the future.

Depression and use of marijuana among US adults
This study examined the association of depression with cannabis use among US adults and the trends for this association from 2005 to 2016.

Maternal depression increases odds of depression in offspring, study shows
Depression in mothers during and after pregnancy increased the odds of depression in offspring during adolescence and adulthood by 70%.

Targeting depression: Researchers ID symptom-specific targets for treatment of depression
For the first time, physician-scientists at Beth Israel Deaconess Medical Center have identified two clusters of depressive symptoms that responded to two distinct neuroanatomical treatment targets in patients who underwent transcranial magnetic brain stimulation (TMS) for treatment of depression.

A biological mechanism for depression
Researchers report that in depressed individuals there are increased amounts of an unmodified structural protein, called tubulin, in lipid rafts compared with non-depressed individuals.

Depression in adults who are overweight or obese
In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year.

Why stress doesn't always cause depression
Rats susceptible to anhedonia, a core symptom of depression, possess more serotonin neurons after being exposed to chronic stress, but the effect can be reversed through amygdala activation, according to new research in JNeurosci.

Which comes first: Smartphone dependency or depression?
New research suggests a person's reliance on his or her smartphone predicts greater loneliness and depressive symptoms, as opposed to the other way around.

Depression breakthrough
Major depressive disorder -- referred to colloquially as the 'black dog' -- has been identified as a genetic cause for 20 distinct diseases, providing vital information to help detect and manage high rates of physical illnesses in people diagnosed with depression.

CPAP provides relief from depression
Researchers have found that continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) can improve depression symptoms in patients suffering from cardiovascular diseases.

Read More: Depression News and Depression Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to