Antipsychotic Meds Have Proven Role

The Register Guard (Eugene, OR), March 25, 2008 | Go to article overview

Antipsychotic Meds Have Proven Role


Byline: GUEST VIEWPOINT By Richard Staggenborg

In a March 16 guest viewpoint, "Antipsychotic drugs are doing harm," Chuck Areford makes some highly debatable, if not flatly false, assertions about the risks vs. benefits of antipsychotic medications.

Of equal concern, he only perfunctorily acknowledges the risks of discontinuing these meds without medical supervision before going on to argue essentially that they should never be prescribed.

His entire thesis undermines the credibility of the doctors under whose supervision he states patients should adjust their medication. The effect is to encourage them instead to make decisions to stop their medications on their own or on the advice of well-meaning but misinformed nonmedical "experts" such as himself.

Areford asserts that "the life expectancy of those treated in mental health centers has plunged to an appalling 25 years less than average (since the introduction of atypical antipsychotics)." I challenge him to explain how he came up with this statistic.

Rispiridone, the oldest antipsychotic in widespread use, was not introduced until 1993. Clearly, this remarkable claim is based on extrapolation from highly questionable assumptions.

It is indisputably true that some of these medications have substantial risks of metabolic side effects, such as high cholesterol and increased risk of diabetes. But others have not been clearly linked to these problems, despite the mandatory Food and Drug Administration class warnings that all atypicals share.

These risks have to be balanced against the devastating consequences of schizophrenia and bipolar disorder, the illnesses for which they are most clearly indicated. One of these risks is a substantially increased chance of suicide in untreated mania, bipolar depression or schizophrenia. Treatment of these conditions has been shown to reduce suicidality and therefore would be expected to increase life expectancy.

For other indications, the risk-benefit analysis is not always so clear cut. For this reason, I would agree that aggressive marketing of these agents to primary care providers for routine depression and bipolar disorders is unethical, although some of my colleagues would disagree.

Many in the psychiatric community also share the alarm of the general pubic at the tremendous increase in the diagnosis of bipolar disorder, depression and attention deficit hyperactivity disorder in children and believe that there is a tendency to reach too quickly for medications to treat what may be psychological problems or simply variants of normal behavior.

It is also true that research findings are highly skewed by pharmaceutical industry funding, despite some improvements due to newer requirements to report negative results as well as those demonstrating positive drug effects. …

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