May 12, 2015

expert reaction to debate on harm of psychiatric drugs

The positive and negative effects of psychiatric drugs are the subject of a discussion in The BMJ, with two professors and a patient debating their merits.

Prof. Tom Burns, Professor Emeritus of Social Psychiatry, University of Oxford, said:

“Interpreting the varied findings from the available mountain of medical research requires discipline. A smash and grab raid can usually collect enough facts to support almost any proposition. Several of Gøtzsche’s quoted findings are from studies not designed to test the outcomes he cites, while others that are, are simply dismissed as ‘unreliable’.

“That psychiatric patients on medication have increased mortality compared to the general population is not disputed. They are, after all, ill. That they have higher mortality than psychiatric patients not receiving medication is far from the truth. Where it has been possible to carefully compare long term outcomes in patients with illnesses such as schizophrenia or severe depression without treatment (usually in the developing world) their outcomes are drastically poorer – and that includes early death.

“An unintended consequence of accessible universal healthcare is that we can lose sight of just how awful untreated illnesses are.”

Dr Doug Brown, Director of Research and Development, Alzheimer’s Society said:

“In his article, Professor Gotzsche suggests dropping all “dementia drugs”. In 2010, Alzheimer’s Society campaigned hard for NICE to approve drugs such as Aricept for people with Alzheimer’s disease. Since then, these drugs have been shown to provide real benefits for many people living with dementia, providing help with daily living.

“The use of anti-psychotic drugs on the other hand is an outdated way to treat symptoms of dementia like aggression. Although we appreciate these drugs are important for a minority of people with dementia, they can leave people heavily sedated, damage their quality of life and even lead to death and should only be used as a last resort.

“We welcome a debate on drugs, but we need to ensure that those drugs working well for people with dementia remain available to all who so desperately need them.”

Prof. Guy Goodwin, President of the European College of Neuropsychopharmacology (ECNP), said:

“Extraordinary claims require extraordinary evidence, and the claims made here that the benefits of psychiatric drugs are ‘minimal’ contradict the conclusions of responsible regulatory bodies like the FDA and EMA, and ignore the innumerable evidence-based guidelines written by clinicians who actually treat psychiatric patients. The data presented here and the concerns about risks/benefits should therefore be treated with due scepticism.”

Dr Michael Bloomfield, Academic Clinical Fellow in Psychiatry, Medical Research Council & University College London, said:

“The article published in the BMJ is deliberately thought-provoking in order to tie in with a long-running series of debates on controversial topics that have been held at the Maudsley Hospital in London.

“The size of the possible benefits and side-effects of psychiatric drugs is similar to other treatments used for common, complex medical conditions.  For many patients, psychiatric medicines will make an important part of their recovery journey, alongside psychological therapy and social interventions, in line with the contemporary medical “bio-psycho-social” model of the causes and treatments of mental illnesses.

“Professor Gøtzsche’s opinion that “we could stop almost all of psychotropic drugs without causing harm” is not supported by current scientific evidence and there is ongoing research taking place in the field into for how long psychiatric medicines should be continued after starting them.  In patients with schizophrenia, for example, long-term treatment with antipsychotic medicines is associated with lower mortality compared with no antipsychotic use.

“In practice, there need to be regular reviews of treatments between a patient and their psychiatrist in order to continually weigh up the pros and cons of any treatment.  Adequate funding needs to be in place to ensure patients with mental health problems have access to expert care and follow-up by a psychiatrist to enable these reviews to take place.  Any patient thinking of stopping a psychiatric medicine should always first discuss this with their GP or psychiatrist.”

Dr Simon Ridley, Head of Research, Alzheimer’s Research UK, said:

“This important debate focuses on a wide range of drugs used for numerous conditions, but it is very difficult to generalise about the relative benefits and drawbacks of such a large number of varied treatments.

“The dangers of long-term use of antipsychotic drugs for symptoms of aggression and agitation in dementia were highlighted in an Alzheimer’s Research UK-funded study in 2009, and since then moves have been made to reduce their use. Antipsychotics may be prescribed in the short term to help with agitation, an extremely challenging symptom of dementia, but these drugs should only be given when there is no other option for dealing with these symptoms, and their use should always be carefully monitored.

“The most commonly-used drugs for dementia, cholinesterase inhibitors, have been found in several studies to help some people cope with symptoms such as memory loss. Although these do not work for everyone and the effects for some people may be small, many people report significant benefits with these drugs offering relief from distressing symptoms. Alzheimer’s Research UK would not support the removal of these treatments from people who may benefit.

“All medicines carry side effects and it is important for the potential harms of any drug to be weighed against its possible benefits, and for treatments to be monitored closely. Ultimately, we still need treatments that can stop the diseases that cause dementia in their tracks, and these can only come through research. With 850,000 people living with dementia in the UK, the need for continued investment in research has never been more urgent.”

‘Does long term use of psychiatric drugs cause more harm than good’, a Head to Head debate article by Gotzsche, Young and Crace published in The BMJ on Tuesday 12^th May. 

Declared interests

Prof. Burns: “No conflict of interest.”

Dr Brown doesn’t have any conflicts of interest.

Prof. Goodwin: Prof. Guy Goodwin has acted as a consultant to most large pharmaceutical companies.

Dr Bloomfield: “I am a member of the Royal College of Psychiatrists, a trainee member of the British Association of Psychopharmacology and a young member of the European College of Neuropsychopharmacology. I conduct research funded by the Medical Research Council and the National Institute of Health Research. I work in medical research at the Medical Research Council and University College London.  I work clinically in the National Health Service. I have no other financial interests to declare.

Dr Ridley has no interests to declare.