Long-term risks of psychiatric drugs: more prescriptions could lead to more people suffering serious side effects.
The issue raises concerns especially because sales of all types of psychiatric drugs, and the durations for which patients take them, have both risen markedly in recent years.
As of 2009, Great Britain's doctors were issuing twice as many prescriptions for SSRIs (selective serotonin reuptake inhibitors, a category of antidepressants and ADHD medications that includes Prozac, Paxil, and Strattera) as they were in the mid-1990s, according to studies published in ACS Chemical Neuroscience. Prescriptions for all antidepressants further rose by 9.6% in Great Britain in 2011, with around 2 million Britons taking antidepressants for several years or more.
In the United States, prescriptions for the antianxiety medications Xanax, Ativan, and Valium saw respective increases of 29%, 36%, and 16% from 2005 through 2009, according to IMS health. Prescriptions for Risperdal, a medication for bipolar disorder and schizophrenia, grew by 45%, and prescriptions for the antidepressant Cymbalta skyrocketed 237%. As of 2011, one out of every eight Americans, including children and infants, was on a psychiatric medication.
"Serious mental disorders have long been underrecognized and undertreated, so part of the trend reflects improved capture and treatment," says Richard Friedman, a Cornell University psychiatrist and New York Times columnist. "We don't know, though, to what extent people with nothing more than everyday sadness or anxiety are unnecessarily receiving them."
Friedman is concerned that many doctors might be overprescribing the drugs. Also, doctors are increasingly substituting more potent drugs for milder, safer ones. Friedman notes with alarm that more doctors are prescribing Xanax, Valium, and powerful antipsychotic medications for moderate insomnia and anxiety.
"That's a bit like killing a fly with a cannon," he says, adding that doctors are also not making enough use of behavioral approaches. "Various relaxation techniques, particularly transcendental meditation--for which there is good empirical evidence of efficacy--can be very effective."
Meanwhile, overprescribing medications might be putting more patients at risk of harmful effects. Some studies of patients who regularly use antipsychotic medications have found higher-than-normal occurrences of brain-tissue shrinkage and tardive dyskinesia, a disorder characterized by physical tremors. Antidepressants may also raise risks of tardive dyskinesia. Some studies suggest that adults over 50 who take SSRIs have double the risk of bone fractures, and that women of all ages who take antidepressants increase their risks for cardiac death.
Friedman cautions against making firm conclusions just yet. Many symptoms might have resulted not from the medications, but from the initial conditions. Schizophrenia and depression, for instance, can both damage brain tissues over time. He strongly favors more study.
"In the United States, we have essentially a voluntary system of post-marketing surveillance that relies on individual practitioners to report adverse events. That means we are probably not capturing important data that could answer these questions," he says.
Peter Breggin disagrees. A psychiatrist who has helped many patients withdraw from medications and who has publicly denounced medications' potential harms through a series of books and news-media appearances, he argues that we have plenty of data to act.
"We've known from the beginning that psychiatric drugs would be damaging to the brain and mind. That evidence has been accumulating from year to year," he says. "But that evidence is suppressed by the pharmaceutical industry, which has a firm grip on psychiatric practice."
Part of the drugs' problem is that they work by impairing brain functions, Breggin argues. SSRIs, for example, obstruct brain cells' absorption of serotonin, a neurotransmitter critical to regulating mood. This improves the patient's mood in the short term, since more serotonin stays present at high enough concentrations to be active.
Over time, however, the brain can "compensate" by slowing or stopping production of new serotonin. Eventually, nerve synapses themselves die. Then the patient needs a stronger medication and is at risk for even worse depression.
"This probably contributes to the long-term apathy that these drugs produce, with a general decline in quality of life," Breggin says. "All psychiatric treatments impair brain function directly as a part of their action. just like with shock treatment and lobotomy, the damage is the treatment. When you give an antipsychotic drug to someone who is disturbed, you lobotomize them, in part. What you get is a chemical lobotomy."
Nor do these effects necessarily go away once the patients wean off the drugs. Someone who is on a drug for a few years--or, in some cases, just a few months--can suffer biochemical disruptions and "chronic brain impairment" long after he or she has ceased taking it.
"In the case where you have damage that is clearly demonstrable--that is, it's the mind or the neurological system or the metabolic system--these things develop within months or less, and then it just becomes more frequent or worse as time goes on," says Breggin.
He warns that the numbers of patients who eventually come down with these symptoms are likely to increase in the years ahead, due simply to the sheer growth in the numbers of people who are on medications in the first place. As the numbers grow further, health-care systems everywhere will strain to help them.
"So we're talking about a massive problem, millions of people permanently injured by the drugs, there's no doubt about that," says Breggin, adding this grim caveat: "We can't even begin to estimate the overall effect, because we don't study for it."
Still, the risks of taking a medication are often far less than the risks of not taking it, cautions Ian Reid, a professor of psychiatry and mental health at the University of Aberdeen in Scotland. Depression and other such disorders are potentially debilitating, and a prescription drug is often the only reliable treatment option.
"Depressive disorder is a painful and disabling condition that can kill. It ruins many lives, and while antidepressants most certainly have side effects and can do harm, just like any other treatment--including talking therapies, for that matter--properly used they can and do help many," says Reid. "Folks who have never experienced serious mood disorder, or met sufferers, often have little conception of just awful the illness can be."
Side effects will not appear in every patient, he notes, and when they do, they are often manageable. Every patient should evaluate his or her health situation and the treatment options with a doctor and weigh all the pros and cons of treatment accordingly.
Additionally, any patient can reduce the chances of suffering serious side effects by having a checkup with his or her doctor regularly--Reid recommends every six months. Further safety comes from maintaining an overall healthy lifestyle: eating properly, getting enough sleep, and minimizing alcohol consumption, or avoiding alcohol if the medications carry warnings against alcohol consumption.
"All effective drugs are associated with side effects, of course, and the issue here is balancing benefit versus harm," says Reid. "This is by no means straightforward, and careful consideration is required in best matching medicines to individual circumstances, preferences, and experiences."
Drug safety might improve much in years to come, in any case, as communications technology improves, suggests Jay Herson, futurist and consultant on biostatistics and data monitoring who designed and analyzed clinical trials for pharmaceutical companies for more than 40 years. He says that digital communications networks make it easier for researchers to note new evidence on drug-related health effects and then relay it to the pharmaceutical company and to watchdog groups, news media, and government regulators. In fact, we might even be at risk of overreacting to alleged drug dangers that turn out later to be false.
"We will have data being constantly streamed from physicians to drug companies to the government, and we'll know about these things," Herson says. "Regulators are going to have more data than ever before, and all the data could create an overzealousness. There will be false alarms."
But another, more positive trend could also emerge: a more cautious public. As consumers read more about medications and their potential harms, more of them might opt for nonchemical, lifestyle strategies to boost their health naturally and safely. Increased participation in yoga and meditation in recent years are examples of this, Herson explains.
"We're learning more about yoga and meditation every year. More and more people are directed, and the Internet helps a lot, to these alternatives. People learn that that may be all they need," he says. "So there may be fewer people taking medicine."
The pharmaceutical companies will be more vigilant, as well, Herson hopes. They know that they lose financially if their drugs cause demonstrable physical harms to the consumers who take them. Companies that want to steer clear of lawsuits are finding ways to improve clinical trials, such as by using larger groups of people.
"Once the word is out that there are these effects, the doctors don't prescribe it anymore. And the pharmaceutical company will say 'we don't want a class action suit.' When all of that is happening, the sales of the drug go down," he says. "It doesn't go on forever."
Sources: Richard Friedman, Cornell University, www.cornell.edu.
Peter Breggin, Center for the Study of Empathic Therapy, www.breggin.com.
Ian Reid, University of Aberdeen School of Medicine and Dentistry, www.abdn.ac.uk.
Jay Herson, Johns Hopkins University Bloomberg School of Public Health, www.biostat.jhsph.edu.
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|Date:||May 1, 2013|
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