

Does long term use of psychiatric drugs cause more harm than good? - itomatik
http://www.bmj.com/content/350/bmj.h2435

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neuro_imager
This article is unhelpful, typical of the BMJ.

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.

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mason55
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.

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fsk
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.

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bmj
_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.

~~~
fsk
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.

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tokenadult
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.

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pc2g4d
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.

~~~
pc2g4d
I'm curious about the downvote here---is pointing out financial and other
interests of authors unwelcome here?

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usmeteora
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...](http://projects.huffingtonpost.com/dying-to-be-free-heroin-
treatment)

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-...](http://www.huffingtonpost.com/johann-hari/the-real-cause-of-
addicti_b_6506936.html)

~~~
corin_
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.

~~~
techlibertarian
It definitely is relevant because psychiatric drugs are _how_ people get onto
heroin.

~~~
corin_
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.

~~~
techlibertarian
Yes that is what I meant. A confusion on my part.

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andy_ppp
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.

~~~
exit
the article is about psychiatric drugs, not psychedelics.

~~~
corin_
Not related to this article so you're right to call it out, but a side point:
psychedelics are a class of psychiatric drug.

