For people with schizophrenia, antidepressant medications appear to reduce suicide rates, while treatment with benzodiazepines greatly increases it, according to new research.
But giving a patient several antipsychotics simultaneously seemed to have no effect at all on mortality.
“We weren’t aware that the beneficial effects of antidepressants were so powerful,” said Jari Tiihonen, professor of clinical psychiatry at Karolinska Institutet’s Department of Clinical Neuroscience, who led the study.
The study followed 2,588 Finns who had developed schizophrenia from the time of their initial admission to the hospital over an average of four years. The researchers were able to ascertain the effects of different drug combinations on the group’s mortality risk.
During the study, 160 people died. While external causes, such as drowning, poisoning or violent crime, claimed 57 people, 35 of the deaths were suicides, which made it and cardiovascular disease the two main causes of death.
The researchers found that when taking benzodiazepines, the participants ran a 91 percent higher risk of early death than when these drugs were not used. Most deaths occurred with patients who had been taking benzodiazepines for longer than four weeks.
“The increased suicide risk for patients with long-standing benzodiazepine use may be partly attributable to the possible development of withdrawal symptoms when the drugs run out,” said Tiihonen.
“These symptoms, which can be severe anxiety and insomnia, might have affected some of the patients’ decisions to commit suicide. It’s therefore extremely important that bensodiazepines are discontinued gradually rather than abruptly over a period of weeks or months and in consultation with a doctor.”
During the periods the participants took antidepressants, they ran a 43 percent lower mortality risk than when these drugs were not used. The decrease in suicide risk was 85 percent, the researcher notes. Antipsychotics had no effect on mortality if the patients were on multiple prescriptions simultaneously, he added.
“People think that it’s dangerous to treat patients with schizophrenia with more than one antipsychotic drug, but there is nothing to back that up,” Tiihonen said.
“I believe that most doctors prescribe several antipsychotics if their patients are not helped by just one kind, and our study finds no link between this and increased mortality during a four-year followup. But it does mean more adverse effects, such as the risk of weight gain, which also impacts the health in the long run, so the recommended attitude is still one of restraint.”
Source: Karolinska Institutet