On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

Any evidence that PAXIL (or other SSRIs) provoke manic episodes (reveal bipolar disorder).

1     Bipolar disorder/ci,pa,pc,de,ph,dh,dt,th,ge,hi,me    results= 8296      
[Chemically Induced, Pathology, Prevention & Control, Drug
Effects, Physiology, Diet Therapy, Drug Therapy, Therapy,
Genetics, History, Metabolism]
2     Antidepressive    results= 12328   
agents/ad,ae,ai,me,an,pd,ph,pk,po,ct,to,du,tu
[Administration & Dosage, Adverse Effects, Antagonists &
Inhibitors, Metabolism, Analysis, Pharmacology, Physiology,
Pharmacokinetics, Poisoning, Contraindications, Toxicity,
Diagnostic Use, Therapeutic Use]
3     1 and 2    results= 648   
4     Eating disorders/    results= 3982   
5     3 and 4    results= 1   
6     Paroxetine/ or Piperidines/ or Serotonin uptake inhibitors/    results= 15752   
7     1 and 6    results= 87   
8     from 7 keep 3    results= 1   
9     from 7 keep 3    results= 1   
10     from 7 keep 3,5,13,16,25,37    results= 6   
11    Bipolar disorder/ or Serotonin uptake inhibitors/    results= 16765   
12     2 and 4    results= 50   
13     from 12 keep 3    results= 1   
14     Serotonin uptake inhibitors/ae,pd,pk,po,ch,sd,to,tu,du    results= 2977   
[Adverse Effects, Pharmacology, Pharmacokinetics,
Poisoning, Chemistry, Supply & Distribution, Toxicity,
Therapeutic Use, Diagnostic Use]
15     1 and 14    results= 51   
16     from 15 keep 11    results= 1   
17     "PAXIL".mp.    results= 15   
18     Paroxetine/ae,po [Adverse Effects, Poisoning]    results= 291   
19     1 and 18    results= 12   
20     from 19 keep 6-7,9-10    results= 4   
21     10 and 13 and 16 and 20    results= 0   
22     10 and 13 and 16 and 20    results= 0   
23     10 or 13 or 16 or 20    results= 10   

Reference Librarian comments

It's a nice long search you did, and I don't want to analyze it "line by line," but in general let me say this: usually you'll want to "explode" the medical subject headings, and frequently you should check the "focus" check-box, to get fewer but more "on target" references. Taking the time to "play" a lot with MEDLINE is important. Thanks for participating in the assignment.

I had a little time to play with the question myself. I thought I'd take a simple approach, like this:

a) i want all the articles where any sort of bad effect of any of the many SSRIs are involved. that will be set #1

b) in set #2, I want any reference discussing bipolar disorders where etiological factors are discussed

c) in set #3, I'll "combine" the two sets I've made, and we'll see what we get.

Answer = 67. I'm willing to bop thru those and see what I like.

For a subject like this, I like to also go to PSYCINFO. A fancy search in that database LOOKS very different.

I went to the advanced mode and did something like this:

(ssri$ or (serotonin adj uptake) or (serotonin reuptake)) and (bipolar or manic$ or mania)

I got 77 references with that strategy.

Here below is my MEDLINE strategy.

Medline 1966 to January 2000

#
Search History
Results
1
exp *serotonin uptake inhibitors/ae,po,to,co
1764
2
exp *Bipolar disorder/ci,et [Chemically Induced, Etiology]
685
3
1 and 2
67