Does long term use of psychiatric drugs cause more harm than good?(bmj.com)
bmj.com
Does long term use of psychiatric drugs cause more harm than good?
http://www.bmj.com/content/350/bmj.h2435
7 comments
There are so many problems with this article.
> A cohort study of patients older than 65 who were their own control found that all cause mortality was 3.6% higher when patients were taking the newer antidepressants for one year than when they did not take antidepressants.
This is a well known effect where depressed people previously didn't have the energy to follow through with suicides. Some antidepressants increase energy much sooner than they improve mood and so you have a depressed person who now has the energy to follow through with suicide.
Edit: I just realized this article presents both sides of the argument. This just seems like super clickbait for a hot button issue.
> A cohort study of patients older than 65 who were their own control found that all cause mortality was 3.6% higher when patients were taking the newer antidepressants for one year than when they did not take antidepressants.
This is a well known effect where depressed people previously didn't have the energy to follow through with suicides. Some antidepressants increase energy much sooner than they improve mood and so you have a depressed person who now has the energy to follow through with suicide.
Edit: I just realized this article presents both sides of the argument. This just seems like super clickbait for a hot button issue.
Maybe. There were several I tried that were horrible and only one I liked.
Most drug trials are 30-90 days. I haven't seen a study that tracked drug vs. placebo over years/decades.
In only 30-90 days, drug withdrawal can cause placebos to seem worse, if a patient switches from drug to placebo during the experiment.
Most drug trials are 30-90 days. I haven't seen a study that tracked drug vs. placebo over years/decades.
In only 30-90 days, drug withdrawal can cause placebos to seem worse, if a patient switches from drug to placebo during the experiment.
Most drug trials are 30-90 days.
Is this specific to psychiatric drugs? I write software for a company that facilitates patient report outcome/clinical outcome assessment trials for the pharmaceutical industry, and we have trials that run for years. I don't believe our products have been used in a psychiatric drug trial, though.
Is this specific to psychiatric drugs? I write software for a company that facilitates patient report outcome/clinical outcome assessment trials for the pharmaceutical industry, and we have trials that run for years. I don't believe our products have been used in a psychiatric drug trial, though.
For any drug trial, if a patient switches from drug X to placebo, compared to patients who switch from drug X to drug Y, that could cause the placebo to seem worse than it actually is, due to withdrawal.
All the drug research I read regarding psychiatric drugs had a 3-6 month timeframe max.
Another flaw is that "Is the patient doing well?" was based on the subjective opinion of the doctor. (Even if the doctor does not know which patients are taking placebo, a competent psychiatrist should be able to tell. "Compliance with medication" is one thing doctors are trained to look for.) I would have liked to see other objective metrics, such as "How high can the patient score at Tetris?"
A multiyear psychiatric study is very hard, because many patients will struggle to follow any treatment plan. Also, placebos might cause the patient to initially get worse before they get better, whereas a drug might cover up symptoms while hurting long-term recovery. It's hard to find patients who would follow through for years.
All the drug research I read regarding psychiatric drugs had a 3-6 month timeframe max.
Another flaw is that "Is the patient doing well?" was based on the subjective opinion of the doctor. (Even if the doctor does not know which patients are taking placebo, a competent psychiatrist should be able to tell. "Compliance with medication" is one thing doctors are trained to look for.) I would have liked to see other objective metrics, such as "How high can the patient score at Tetris?"
A multiyear psychiatric study is very hard, because many patients will struggle to follow any treatment plan. Also, placebos might cause the patient to initially get worse before they get better, whereas a drug might cover up symptoms while hurting long-term recovery. It's hard to find patients who would follow through for years.
The first few comments posted here didn't even describe the article, so I thought I should at least do that. You can, of course, read the whole article yourself to form your own opinion. The article is organized as a pro-con debate (with the "con" side first) on whether the broad classes of medicines prescribed for psychiatric conditions (mostly mood disorders and schizophrenia) are helpful or not.
The writer who says that the drugs' "benefits would need to be colossal to justify [patient deaths associated with their use], but they are minimal" is Peter C Gøtzsche, a professor at the Nordic Cochrane Centre in Copenhagen. I would ordinarily expect someone with an affiliation with the Cochrane centers to have an evidence-based perspective on evaluating treatments for human disease, and I think he makes some good criticisms of study designs about drug effectiveness for treating psychiatric disorders.
The writers who say that "Psychiatric drugs are as beneficial as other treatments used for common, complex medical conditions. Leucht and colleagues reviewed the efficacy of psychiatric and general medicine drugs by analysing meta-analyses: they found that psychiatric drugs were generally as efficacious as other drugs" are Allan H Young, professor of mood disorders at King’s College London and John Crace, psychiatric patient and a writer for The Guardian. They in turn make several thoughtful criticisms of the studies Gøtzsche relies on to infer harm. My personal impression is that they have the better of the argument, because the conditions treated with the drugs mentioned in this article are themselves fatal, and if left untreated greatly increase patient mortality.
I think everyone who follows this research closely (as I do, as part of my journal club participation with researchers on human behavior genetics) has settled on the conclusion that patients are genetically diverse even if they have the same diagnosis, and therefore a drug that works for one patient may not work for another. But a drug that works for an immediate family member of the patient probably will work for the patient, and "talk therapy" of a kind proven to be safe and effective is an important both-and to add to treatment of major psychiatric disorders. Patients with major psychiatric disorders ARE living longer and enjoying better day-by-day functioning than ever before in my lifetime, so the statistics trump the anecdotes in showing that something about current treatment is working to help patients.
The writer who says that the drugs' "benefits would need to be colossal to justify [patient deaths associated with their use], but they are minimal" is Peter C Gøtzsche, a professor at the Nordic Cochrane Centre in Copenhagen. I would ordinarily expect someone with an affiliation with the Cochrane centers to have an evidence-based perspective on evaluating treatments for human disease, and I think he makes some good criticisms of study designs about drug effectiveness for treating psychiatric disorders.
The writers who say that "Psychiatric drugs are as beneficial as other treatments used for common, complex medical conditions. Leucht and colleagues reviewed the efficacy of psychiatric and general medicine drugs by analysing meta-analyses: they found that psychiatric drugs were generally as efficacious as other drugs" are Allan H Young, professor of mood disorders at King’s College London and John Crace, psychiatric patient and a writer for The Guardian. They in turn make several thoughtful criticisms of the studies Gøtzsche relies on to infer harm. My personal impression is that they have the better of the argument, because the conditions treated with the drugs mentioned in this article are themselves fatal, and if left untreated greatly increase patient mortality.
I think everyone who follows this research closely (as I do, as part of my journal club participation with researchers on human behavior genetics) has settled on the conclusion that patients are genetically diverse even if they have the same diagnosis, and therefore a drug that works for one patient may not work for another. But a drug that works for an immediate family member of the patient probably will work for the patient, and "talk therapy" of a kind proven to be safe and effective is an important both-and to add to treatment of major psychiatric disorders. Patients with major psychiatric disorders ARE living longer and enjoying better day-by-day functioning than ever before in my lifetime, so the statistics trump the anecdotes in showing that something about current treatment is working to help patients.
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I haven't read the article. But I've done something just as important---sought to understand the interests of those who wrote it. Here goes:
The authors: "Peter C Gøtzsche, professor, Nordic Cochrane Centre, Rigshospitalet, DK-2100 Copenhagen, Denmark, Allan H Young, professor of mood disorders, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, UK, John Crace, psychiatric patient and parliamentary sketch writer, Guardian, London, UK"
Declaration of competing interests: "Competing interests: All authors have read and understood BMJ policy on declaration of interests and declare the following interest: AHY has done paid lectures or been on advisory boards for all major companies producing drugs used in affective and related disorders. He was the lead investigator for Embolden Study (AstraZeneca), BCI neuroplasticity study, and Aripiprazole Mania Study, and received funds for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck, Wyeth. He has received research grants from NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edinburgh); BMA; UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); and NIHR (UK)."
So Allan H Young has been bought and paid for by the pharmaceutical industry. Just keep that in mind.
John Crace would also seem to have an interest in justifying the status quo because he participates in it as a "psychiatric patient".
Gøtzsche would of course benefit from acceptance of his argument, because it would likely mean more book sales.
The authors: "Peter C Gøtzsche, professor, Nordic Cochrane Centre, Rigshospitalet, DK-2100 Copenhagen, Denmark, Allan H Young, professor of mood disorders, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, UK, John Crace, psychiatric patient and parliamentary sketch writer, Guardian, London, UK"
Declaration of competing interests: "Competing interests: All authors have read and understood BMJ policy on declaration of interests and declare the following interest: AHY has done paid lectures or been on advisory boards for all major companies producing drugs used in affective and related disorders. He was the lead investigator for Embolden Study (AstraZeneca), BCI neuroplasticity study, and Aripiprazole Mania Study, and received funds for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck, Wyeth. He has received research grants from NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edinburgh); BMA; UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); and NIHR (UK)."
So Allan H Young has been bought and paid for by the pharmaceutical industry. Just keep that in mind.
John Crace would also seem to have an interest in justifying the status quo because he participates in it as a "psychiatric patient".
Gøtzsche would of course benefit from acceptance of his argument, because it would likely mean more book sales.
I'm curious about the downvote here---is pointing out financial and other interests of authors unwelcome here?
The truth is that we need lots of well designed clinical trials to decide if psychedelics are helpful or not. It's really difficult to decide on efficacy of drugs. For example, we still aren't certain how much salt is bad for you, who knows if LSD and other drugs that react in mindblowingly complex ways in the brain can be good or bad.
We can only get somewhere with this by being as scientific as we can and refining our view of these drugs, be they prove to be good or bad. Prohibition of them definitely hasn't helped us decide. I'm willing to believe that they do help some people, some of the time.
We can only get somewhere with this by being as scientific as we can and refining our view of these drugs, be they prove to be good or bad. Prohibition of them definitely hasn't helped us decide. I'm willing to believe that they do help some people, some of the time.
That is totally amazing - I did skim the article pretty fast but still was 100% sure I read psychedelics. Strange how your mind works sometimes :-D
hmm Well considering heroine use has doubled in the passed 5 years, and doubled from 2012-2013, and that three-quarters of all heroine users now started out by getting addicted to their prescribed pharmaceutical equivalent, due to the delay in the administration cracking down on the pharmaceutical pill farms who incentivized the healthcare system to hand these out like candy with anyone who used the word "pain, back pain or anxiety", I would say, yes, psychiatric drugs and painkillers, are causing more harm than good. We are in the middle of the biggest heroine epidemic in U.S. History.
The Huffington Post has three articles in 2015 detailing this epidemic and providing the statistics on this for anyone interested. This one is the most in depth and compelling I have seen so far: http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...
The best part is there is a compelling treatment, but it is stigmatized in favor of abstinence/cold turkey teaching. Of course there is no data to support this is more effective (in fact a disturbing amount of data to show otherwise) but alot of politics of holier than thou to support the failing system. Read more about this tragedy here: http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
The Huffington Post has three articles in 2015 detailing this epidemic and providing the statistics on this for anyone interested. This one is the most in depth and compelling I have seen so far: http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...
The best part is there is a compelling treatment, but it is stigmatized in favor of abstinence/cold turkey teaching. Of course there is no data to support this is more effective (in fact a disturbing amount of data to show otherwise) but alot of politics of holier than thou to support the failing system. Read more about this tragedy here: http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
Heroin (and prescribed opioids) are not psychiatric drugs, so while yes they are a big problem, they're not really relevant to whether psychiatric drugs are positive or negative.
It definitely is relevant because psychiatric drugs are how people get onto heroin.
That's not the way my parent was talking about, nor something I'm aware of.
What's very common is people getting prescribed painkillers (oxycodone, etc.) and then moving onto heroin, because they are similar drugs. But those painkillers are not psychiatric drugs.
What's very common is people getting prescribed painkillers (oxycodone, etc.) and then moving onto heroin, because they are similar drugs. But those painkillers are not psychiatric drugs.
Yes that is what I meant. A confusion on my part.
People are generally prescribed opiates, which are not considered psychiatric but a pain reliever, and can become addicted that way. Perhaps you're thinking about benzos, like Valium or xanax, that are both psychiatric, addictive, and whose abuse/withdrawal can be extremely lethal (especially with alcohol for an overdose combination). They are similar but have different problems. Benzos are more deadly but less life-destroying. Opiates are probably prescribed too much/for too long without patient monitoring.
What? Opiates are not psychiatric drugs. You don’t get addicted to opiates by tasking other, unrelated drugs. That’s absurd.
Are you misreading psychiatric as psychedelic?
Even then, I vehemently disagree with you, but I at least can follow the logic.
Arguing that clozapine, diazepam, fluoxetine, etc., are gateway drugs for heroine is an argument I've never heard before. It sounds ridiculous to me, but if you have evidence to support the claim, please post.
Even then, I vehemently disagree with you, but I at least can follow the logic.
Arguing that clozapine, diazepam, fluoxetine, etc., are gateway drugs for heroine is an argument I've never heard before. It sounds ridiculous to me, but if you have evidence to support the claim, please post.
I'm pretty sure he's thinking painkillers are classed as psychiatric drugs, which if they were would mean he was correct.
But on your point, personally I think abuse of benzodiazepines is more likely to lead to a drug like Heroin than psychedelics are. The whole concept of "gateway drugs" hasn't been proven, but the effect of benzos is a lot closer to heroin than psychedelics (anyone who has actually tried heroin might correct me on this...), so would imagine a stronger cross-over (even if not due to a gateway effect, simply down to the fact that anyone who likes downers is likely to try other downers).
But on your point, personally I think abuse of benzodiazepines is more likely to lead to a drug like Heroin than psychedelics are. The whole concept of "gateway drugs" hasn't been proven, but the effect of benzos is a lot closer to heroin than psychedelics (anyone who has actually tried heroin might correct me on this...), so would imagine a stronger cross-over (even if not due to a gateway effect, simply down to the fact that anyone who likes downers is likely to try other downers).
> I'm pretty sure he's thinking painkillers are classed as psychiatric drugs, which if they were would mean he was correct.
Yes, you are correct. My bad.
Yes, you are correct. My bad.
I'm deeply confused by this comment. The main thesis of that first link you posted is that it's way too hard for psychiatrists to prescribe a drug that treats heroin addiction.
> incentivized the healthcare system to hand these out like candy with anyone who used the word "pain, back pain or anxiety"
It's all well and good to blame big pharma, but the problem isn't an incentivised healthcare scheme, the problem is there's a lack of awareness and follow up care associated with the people who are prescribed these drugs. In Ireland I was put through weeks of agony trying out various strengths of painkillers before they decided to give me Oxycodene, which had me back on my feet and in work. There's still people becoming addicted to these drugs who aren't given these drugs just because they are asked to.
The biggest problem I saw was that my GP decided that when my back pain was resolved after an operation he decided I was finished with the painkillers as of right now. No weaning off process, no care to ensure that I was coping without the tablets other than the pain.
furthermore, when I was put on them, my doctor mentioned in passing that they were addictive - Nobody mentioned to me that I could end up with a chronic addiction to them when they put me on them. As is always the case; education and information availability will solve a huge amount of the problems, along with better management when withdrawing from opioids (that doesn't require me to sign up to a rehab program)
It's all well and good to blame big pharma, but the problem isn't an incentivised healthcare scheme, the problem is there's a lack of awareness and follow up care associated with the people who are prescribed these drugs. In Ireland I was put through weeks of agony trying out various strengths of painkillers before they decided to give me Oxycodene, which had me back on my feet and in work. There's still people becoming addicted to these drugs who aren't given these drugs just because they are asked to.
The biggest problem I saw was that my GP decided that when my back pain was resolved after an operation he decided I was finished with the painkillers as of right now. No weaning off process, no care to ensure that I was coping without the tablets other than the pain.
furthermore, when I was put on them, my doctor mentioned in passing that they were addictive - Nobody mentioned to me that I could end up with a chronic addiction to them when they put me on them. As is always the case; education and information availability will solve a huge amount of the problems, along with better management when withdrawing from opioids (that doesn't require me to sign up to a rehab program)
Opioids and Benzos need to be much more carefully prescribed. They are addictive and expensive and people build a tolerance to them. Once you have are addicted and have a tolerance the logical decision to make is somethimes to start snorting heroin as it is much cheaper. I hear a lot of people starting on prescribed opioids then moving to heroin because it is more affordable.
That being said, these classes of drugs are not the ones being discussed in the article.
That being said, these classes of drugs are not the ones being discussed in the article.
There are so many different classes and types of psychiatric drugs that even attempting to make sweeping comments like this (one way or the other) are ludicrous.