In a new article in the journal BMJ, an expert argues that the benefits of psychiatric drugs have been exaggerated and the negatives downplayed due to poor trial design, while another expert and psychiatric patient defend the use of these drugs.
Every year in the West, more than half a million people over age 65 die from the use of psychiatric drugs and the benefits would need to be “colossal” to justify these “immensely harmful” treatments, said Peter Gøtzsche, M.D., professor and director of the Nordic Cochrane Centre, Denmark.
But their benefits are “minimal,” he explains, adding that these drugs should “almost exclusively be used in acute situations.” New guidelines should support this change and there should be widespread access to withdrawal clinics to help many patients gradually come off these medications.
The benefits of these drugs have been exaggerated and their harms understated, he said, because randomized controlled trials have been biased, not blinded appropriately. He also notes that the effects of these drugs have not been fully evaluated and that deaths have been underreported.
For example, the majority of studies have included participants who had already been taking a psychiatric drug and such patients may undergo abstinence and be suffering from withdrawal symptoms from the first drug. As a result, this study design exaggerates the benefits of treatment and increases the harms in the placebo group.
Industry-funded trials have also underreported deaths, he said, estimating that there have probably been 15 times more suicides among people taking antidepressants than reported by the U.S. Food and Drug Administration (FDA).
Gøtzsche calculates that deaths from three classes of drugs — antipsychotics, benzodiazepines and similar drugs, and antidepressants — were responsible for 3,693 deaths every year in Denmark. This number corresponds to 539,000 deaths in the U.S. and European Union combined.
The benefits of these medications are so small, he adds, that it would be possible to stop current use almost completely without causing harm. He suggests stopping the use of all antidepressant, ADHD, and dementia drugs, and prescribing only a small fraction of currently used antipsychotics and benzodiazepines.
But Dr. Allan H. Young, a professor of mood disorders at King’s College London, and John Crace, a psychiatric patient, contend with Gøtzsche’s stance, arguing that research supports the use of psychiatric drugs. They believe that these drugs are just as beneficial and effective as the drugs used to treat other common, complex conditions.
They believe that these medications are needed to lower the long term harms of psychiatric conditions, which are the fifth leading cause of disability worldwide. Most psychiatric patients suffer from co-existing health conditions, they add, a primary cause of death among this group.
They note that psychiatric drugs are rigorously examined for safety and effectiveness and while the evidence base is “imperfect,” they say, research shows that psychiatric drugs do more help than harm.