bmj-mailer@alerts.stanford.edu Press releases: Monday 11 May to
Friday 15 May 2015
Debate: Is the long term use of psychiatric drugs harmful?
The controversial topic
will be discussed by leading experts at the Maudsey Debate, King’s College
London
The benefits of psychiatric
drugs have been exaggerated and the harms underplayed due to poor trial
designs, argues one expert in The BMJ. But another expert and a patient contend
that the evidence supports the use of these drugs. More than half a million
people aged above 65 years die from the use of psychiatric drugs every year in
the Western world and the benefits would need to be colossal to justify these
immensely
harmful
treatments, argues Peter Gotzsche, professor and director of the Nordic
Cochrane Centre, Denmark. But benefits are "minimal", he explains, adding that
these treatments should almost exclusively be used in acute situations".
New guidelines should support this change as well as widespread withdrawal
clinics to help many patients gradually come off these medications.
Benefits have been over emphasised and harms
understated, he says, because randomised controlled trials have been biased, not blinded
appropriately, have not fully evaluated the effects of these drugs and deaths
have gone under reported. For example,
the majority of studies have included patients already using a psychiatric drug
and such patients may undergo abstinence and suffer from withdrawal symptoms.
As a result, this study design exaggerates benefits and increases harms, and
has even driven some patients to suicide, he explains.
Industry funded trials have
under reported deaths, he adds, estimating that there have probably been 15 times more suicides among people taking antidepressants than
reported by the US Food and Drug Administration (FDA). He calculates that deaths
from three classes of drugs: antipsychotics,
benzodiazepines and similar drugs, and antidepressants. They were responsible for 3693
deaths every year in Denmark. This
number corresponds to 539,000 deaths in
the United
States and European Union combined. [Since the average age of suicide is about 40
years, this entails as measured by years lost a greater figure than cigarettes which
kill mostly those over the age of 60 through heart attacks and secondly by
cancer.]
The effects of psychiatric
drugs are so small, he says, and that it would be possible to lower current use
by 98%. He recommends stopping the use of all antidepressant, ADHD
and
dementia drugs, and prescribing only 6% of antipsychotics and benzodiazepines. But Allan H Young,
a
professor of mood disorders at King’s College London, and John Crace, a
psychiatric patient, argue that research supports the use of psychiatric drugs
which are just as beneficial and efficacious as treatments for other common,
complex conditions. These drugs
are
needed, they insist, to reduce the long term harms of psychiatric conditions,
which are the fifth leading cause of disability worldwide. Most patients suffer
from co-existing health conditions, they add, a primary cause of death among
this group.
They explain that
psychiatric drugs are rigorously examined for efficacy and safety and while the
evidence base is imperfect,
research shows that psychiatric drugs are more beneficial than harmful.
Careful evaluation of these drugs is
undertaken before and after regulatory approval, they explain, and that post
surveillance after a drug is licensed can include safety of a medication in the
general population, which unlike study populations, includes people with varied
medical conditions.
Yet concerns persist and
many are overinflated, they add, and list recent studies supporting the use of
lithium, once labelled a "toxic placebo", and antipsychotics, and
treatments for mood disorders. But as with any drug treatment, the harms and
benefits need to be evaluated from group data in trials, and be applied to
individual patients whose subjective experiences are important to consider,
they argue.
For
more information please contact:
Emma
Dickinson
Tel: +44 (0)20
7383 6529
Email:edickinson@bmjgroup.com
Press
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