Psychiatric medications are commonly prescribed to treat serious issues such as attention disorders, major depression and schizophrenia. But the benefits of long-term use are "exaggerated" and would need “to be colossal” to counter the known harms associated with their use, suggests a Danish researcher in a candid debate posted Wednesday on the website of the BMJ, the journal of the British Medical Association.
Dr. Peter Gøtzsche, director of the Nordic Cochrane Centre—a group that provides systematic reviews of research—offered rather controversial suggestions about how the drugs should be handled. “Given their lack of benefit, I estimate we could stop almost all psychotropic drugs without causing harm,” he opined.
Short-term relief is eventually replaced by long term harm, he added. The medications “should almost exclusively be used in acute situations and always with a firm plan for tapering off.”
The overuse of psychiatric drugs has continued to be a widely debated topic in the United States, with many researchers suggesting the drugs are overprescribed. A 2012 study in JAMA Psychiatry found the rates of patients visiting their doctors for a prescription for antipsychotics more than doubled for most age groups between 1993 and 2009.
Use of the medications for the elderly in nursing homes has become the topic of much concern. Both federal health officials and trade groups have boosted efforts to curtail a practice in which the drugs are commonly used, off-label, to manage challenging behaviors in elderly dementia patients.
Last month, Medicare unleashed new data on drug spending within its prescription drug plan, Medicare Part D.
Notably among the top drugs by cost were the antidepressants Cymbalta (duloxetine) and Abilify (aripiprazole), also used to treat bipolar disorder and schizophrenia. Spending on Cymbalta topped $1.9 billion and accounted for nearly 7 million claims; Abilify topped $2.1 billion for nearly 3 million claims.
The data sources included physicians and healthcare organizations who submitted drug claims to Medicare's prescription drug plan in fiscal 2013.
A March report from the Government Accountability Office found the problem with overuse among the elderly is not exclusive to nursing homes. Internists, family medicine physicians, psychiatrists and neurologists wrote more than 80% of the prescriptions for antipsychotics for older adults with dementia in 2012.
The GAO report also estimated that the Medicare prescription drug program paid roughly $363 million in 2012 for antipsychotic drugs in elderly patients with dementia.
The BMJ debate included comments about the benefits of psychiatric drugs from Allan Young, director of the Centre for Affective Disorders at King's College London, and British journalist John Crace. They argue there is a clear need to treat psychiatric disorders to reduce the dangers patients may pose to themselves and others. They counter arguments about the harms, saying, “Over time, many of the concerns have been found to be over-inflated.”
In response to the debate, Dr. Doug Brown, director of research and development for the Alzheimer's Society in the U.K. said, "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."
Still, reports have noted that long-term use of typical antipsychotic medications may lead to the development of a condition marked by uncontrollable muscle movements.
And a study released in September in JAMA Psychiatry found an estimated 90,000 emergency department visits annually result from adverse events such as overdose, excessive sleepiness and head injuries. About 19% of the visits resulted in the patient being hospitalized.
Among the elderly, specifically, the high rates of the drugs being used off-label prompted additional precautions. A 2005 alert from the U.S. Food and Drug Administration warned about the increased risk of heart failure, sudden death and pneumonia among elderly patients taking the drugs.
