Long-Term Drug Treatment for Schizophrenia Deemed Safer Than No Medication
In a new study, an international team of researchers investigated the safety of very long-term antipsychotic medication for patients with schizophrenia. They found that death rates were lower when patients were taking medication compared to when they were not.
The findings are published in the journal World Psychiatry.
People with schizophrenia have an average life expectancy 10 to 20 years less than the general population, and there has long been concern that one of the causes is the long-term use of antipsychotic drugs.
And while previous studies have indicated that the death rates for schizophrenia patients on antipsychotic drugs are 30 to 50 percent lower than those on placebo, most of these studies have been shorter than six months, which does not reflect the reality of treatment often being life-long.
Now, researchers at Karolinska Institutet in Sweden and their colleagues in Germany, the U.S. and Finland have conducted a long-term follow-up study, demonstrating that antipsychotic drugs are not linked to an increased risk of concurrent complications, such as cardiovascular disease. The study is the largest conducted in the field to date.
“It’s difficult to make comparisons between people on permanent medication and those who aren’t, as these groups differ in many ways,” said Dr. Heidi Taipale, assistant professor at the Department of Clinical Neuroscience at Karolinska Institutet.
“One common method of dealing with this has been to try to take account of such differences when making comparisons. However, we chose another method, in which each person was their own control, making it possible for us to make individual comparisons of hospitalisation during periods of antipsychotic medication and periods of no treatment.”
The study involved more than 62,000 Finns who had received a schizophrenia diagnosis at some point between 1972 and 2014. The researchers found that the likelihood of being hospitalized for a physical disease was just as high during the periods when the patients were on antipsychotic drugs as when they were not.
The differences in mortality, however, were notable. The cumulative death rate in the follow-up period during times of medication and non-medication was 26 and 46 percent respectively.
The researchers believe this shows that continual antipsychotic treatment is a safer option than no medication. At the same time, treatment brings the risk of adverse reactions, such as an increase in weight, which can raise the risk of cardiovascular disease.
The finding that treatment with antipsychotic drugs does not increase the likelihood of hospitalization for cardiovascular disease may be attributable, argue the researchers, to the fact that the drugs can also have an antihypertensive effect and can reduce anxiety and the risk of substance abuse. Antipsychotic treatment may also help patients adopt a healthier lifestyle and make them more likely to seek care when needed.
“Antipsychotics get something of a bad press, which can make it difficult to reach out to the patient group with information on how important they are,” said Dr. Jari Tiihonen, professor of psychiatry at the Department of Clinical Neuroscience, Karolinska Institutet.
“We know from previous studies that only half of those who have been discharged from hospital after their first psychotic episode with a schizophrenia diagnosis take antipsychotic drugs. Besides, there are many people with schizophrenia who are on long-term benzodiazepine medication, which is in breach of existing guidelines and is associated with increased mortality risk.”
“Building trust and understanding towards the efficacy and safety of antipsychotic drugs is important, and we hope that this study can contribute to this end.”
Source: Karolinska Institutet
Pedersen, T. (2020). Long-Term Drug Treatment for Schizophrenia Deemed Safer Than No Medication. Psych Central. Retrieved on February 28, 2020, from https://psychcentral.com/news/2020/01/20/long-term-drug-treatment-for-schizophrenia-deemed-safer-than-no-medication/153311.html