Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, April 1, 2015


A little while back, I wrote a post, Virtual Care Physician, about HealthTap, the app that lets you post a medical question and get rapid answers from doctors. The way I checked out Healthtap was by signing up under a false name as a patient, and posting a question about club soda. So now I get occasional email updates from them, and they've come up with an interesting feature called, RateRx, in which, "67,000 top U.S. doctors share their experience and expertise to guide millions toward the best indications."

RateRx is a study that surveyed thousands of US doctors about the clinical utility of medications for specified conditions. Doctors are not permitted to see other doctors' ratings and comments until they've submitted their own, although I'm not sure how they could stop me from viewing ratings as a patient, and then signing on as a doctor and submitting my own ratings. Doctors can also comment on other doctors' comments. The study is ongoing, and contributing doctors can also add ratings for new medications not already on the list.

The way you look up ratings is alphabetically, by condition:

Then you click on the number of treatments or the condition, and you'll get a dropdown list of individual drugs, with ratings and a link to reviews:

The drugs are listed from highest to lowest rated. So it turns out, Prozac is the most highly rated antidepressant, with 4.0 out of 5 stars. The lowest rated is Liothyronine or T3, with 2.2 stars.

Prozac seems to be the only SSRI on the list, which also includes, in descending number of stars:

Effexor                      3.9
Wellbutrin                3.9
Remeron                   3.3
Imipramine               3.0
Desipramine             3.0
Nortriptyline             3.0
Tranylcypromine      2.9
Isocarboxazid           2.8
Phenelzine                2.8
Protriptyline             2.8
Trazadone                 2.7
Trimipramine           2.6
Amoxapine               2.5
Maprotiline              2.5
Chlordiazepoxide     2.2
   & Amitriptyline
Liothyronine            2.2

One nice feature is that when you click on the reviews, you can see each doctor who submitted a rating, and link to his or her profile. Not everyone comments. For instance, in the case of Prozac, there were three comments up at the top, and none below. These are the comments, and all three commenters are psychiatrists:

Actually, I counted, and 23 of the 47 raters of Prozac are psychiatrists. A bunch of the others are neurologists. Then there are a few family medicine docs, as well as some internists. A couple of OB/Gyns, a pediatrician, a couple nephrologists, 1 pharmacologist, 3 clinical psychologists, and 1 labeled, "American Board of Phlebology". Personally, I'm not comfortable having people who can't prescribe or don't see patients comment on how patients respond to medications.

The drug that was most frequently rated, 103 to be exact, was desipramine. The comments were mainly about side effects. One comment I thought was useful was, "If the side effects can be tolerated, it can work. Usually, the prescribed dose is too low."

Most of the comments about Phenelzine were about dietary concerns, with some good general descriptions:

Phenelzine or Nardil is an antidepressant in the group called MAO Inhibitors. These older medications have the highest response rate, which is about 80%. They also require dietary restrictions to prevent a high blood pressire reaction to foods containing tyramine (cheese, processed meat, red wine, soy and some others). Other side effects: insomnia, dizziness.


Useful for atypical depression. People with atypical depression tend to feel better during enjoyable activities, have increased appetite and sleep a couple hours more each day than when not depressed, have a feeling that their arms & legs are heavy, & have an ongoing fear of rejection. Problem with this med: dangerous interactions with MULTIPLE other meds and SEVERAL foods.

So here's my assessment:

It's not a bad idea to have a large survey of doctor ratings and comments. The comments are probably more useful than the ratings, and can be very informative for patients.

It would be helpful to have more statistics listed, like how many of the raters of cardiac medications are cardiologists. I mean, it's not like I know nothing about cardiology, but I wouldn't presume to comment on how well those meds work in the clinical setting, because that's not what I do. By the way, the American Board of Phlebologist also put in his two cents about Amlodipine/HCTZ/Valsartan. I suspect he pops up in most ratings, and gets his name out there that way.

The main drawback is that the setup can be misleading. It seems like a gross oversight to have ratings for lots of MAOI's and Tricyclics, but only one SSRI. I think that would confuse a patient who is looking for advice about commonly prescribed antidepressants. I don't know if RateRx just expects doctors to add the most commonly prescribed meds, but it seems to me the people running the survey should encourage ratings of those drugs. It's not like it's hard to get prescribing information. Drug companies certainly know which meds are most popular.

So check out RateRx, and let me know what you think.


  1. ike how many of the raters of cardiac medications are cardiologists. I mean, it's not like I know nothing about cardiology, but I wouldn't presume to comment on how well those meds work in the clinical setting,

    Just to play devil's advocate here, it might be useful, however, to have cardiologist comment on the side-effects of certain psychiatric drugs, e.g. Geodon.

    1. Fair point. I guess I would feel comfortable commenting on the psychiatric side effects of cardiac meds. But not on the cardiac effects of cardiac meds. I think it has to do with what I consider to be my clinical experience. I can certainly paraphrase the PDR and call that a comment, but it wouldn't be based on what I see when prescribing a particular drug, and anyone can look up what the PDR says. They don't need me for that.

  2. Of course. But a multi-disciplinary perspective can often be helpful, and I was just being difficult. It wouldn't however be totally useless to have a physical therapist even comment if they had had to treat someone who had a weird muscle issue that was triggered by a psych med. (This happened to a friend of mine. It was way down in the bottom of the PDR, and his doctor had never heard of it, but then she called him back and said she thought it might be this freaky, rare side-effect.)

  3. No opportunity to comment on combination treatment....and enormous percentage of patients require combination of meds to successfully treat depressions. To take your example of desipramine being useful except often too low, I have seen success with treatment resistant depression using desipramine + paxil or celexa dozens of times.

    1. I think it has the potential to be a really good resource. Maybe it's like Waze. the more people use it, the more information it has, and the more helpful it is.