A debate that questions benefits of psychiatric drugs and their harmfulness in the long run is currently raging on between international experts with the one against the use of such drugs claiming that the benefits have been exaggerated and the harms underplayed due to poor trial designs recommending that treatments involving such meds should ‘almost exclusively be used in acute situations’.
Peter Gøtzsche, professor and director of the Nordic Cochrane Centre, Denmark argues in The BMJ that the benefits of psychiatric drugs is minimal and they should only be recommended in acute situations. Advocating the need for new guidelines that incorporate this change, Gøtzsche suggests that withdrawal clinics should be used as a medium to help patients get off these medications.
Benefits have been overemphasised 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.
Gøtzsche aruges that more than half a million people aged above 65 years die from the use of psychiatric drugs annually in the Western world and the benefits would need to be “colossal” to justify these “immensely harmful” treatments.
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 the benefits of treatment and increases the harms in the placebo group.
The professor goes onto claim that industry funded trials have under reported deaths, 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 – were responsible for 3693 deaths every year in Denmark. This number corresponds to 539,000 deaths in the United States and European Union combined.
The beneficial effects of psychiatric drugs are so small, he says, that it would be possible to stop current use almost completely without causing harm. He recommends stopping the use of all antidepressant, ADHD and dementia drugs, and prescribing only a small fraction of currently used antipsychotics and benzodiazepines.
But another expert Allan H Young, a professor of mood disorders at King’s College London and John Crace, a psychiatric patient contend that the evidence supports the use of these drugs as they are 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.
