Under Debate: Psychiatric Medications

Psychiatric medication health effects debated by experts

(RxWiki News) Medications are often prescribed to treat mental conditions, but are they all they’re cracked up to be? Some have raised concerns that psychiatric medications may have overstated benefits and underreported harms.

Two leading experts recently published their debate on the pros and cons of the long-term use of psychiatric medications. The argument on the con side claimed that the benefits of these medicines are exaggerated and deaths from psychiatric medicines are understated. The pro side underscored the effectiveness of these medicines and found that they were not tied to higher death rates in patients.

Doctors regularly prescribe medications that are designed to modify the behaviors and moods of those who have mental health problems, such as depression, bipolar disorder, anxiety and ADHD (attention deficit hyperactivity disorder). Global sales of antidepressant, stimulant, anti-anxiety and antipsychotic drugs have reached more than $76 billion a year, according to the Citizens Commission on Human Rights.

Peter C. Gøtzsche, MD, professor and director of the Nordic Cochrane Centre in Copenhagen, Denmark, claimed that psychiatric drugs do more harm than good in the long run. Allan H. Young, PhD, MBChB, a professor of mood disorders at King’s College London, and John Crace, a psychiatric patient and parliamentary sketch writer for The Guardian, offered the opposing view, defending the use of these drugs.

“Psychiatric drugs are responsible for the deaths of more than half a million people aged 65 and older each year in the Western world,” Dr. Gøtzsche wrote. “Their benefits would need to be colossal to justify this, but they are minimal.”

Dr. Gøtzsche said 3,693 deaths every year in Denmark were tied to antipsychotics, antidepressants, benzodiazepines (tranquilizers) and similar medicines. Dr. Gøtzsche estimated that this number translated to 539,000 deaths in the US and European Union combined.

Many of the studies showing the benefits of psychiatric drugs did not fully or accurately assess their effects, Dr. Gøtzsche said. He pointed to research regarding the depression drugs fluoxetine (brand name Prozac) and venlafaxine (Effexor). The effect of these medicines would be similar to a placebo (fake treatment) if the placebo evaluation had been carried out a few days longer in their studies, Dr. Gøtzsche said.

He concluded that patients received very few beneficial effects from psychiatric drugs. His recommendation was to stop the use of all antidepressant, ADHD, and dementia drugs and prescribe only a small fraction of the antipsychotics and benzodiazepines currently used.

Crace and Dr. Young defended these medicines, saying they were more beneficial than harmful. These therapies gained regulatory approval after being carefully tested, they said. They noted that these medicines decreased long-term health harms in patients, and that most patient deaths may be from other health conditions patients may have. According to one study in their report, long-term treatment with antipsychotic drugs was tied to a lower death risk compared to no antipsychotic use.

This paper was published May 12 in The BMJ. The arguments presented were part of the Maudsley Debates, which take place three times a year at the Institute of Psychiatry, Psychology & Neuroscience at King’s College.

The authors disclosed no funding sources. Dr. Young received funds from AstraZeneca, Eli Lilly, Lundbeck and Wyeth.

Review Date: 
May 13, 2015