Are antipsychotics safe? International panel of experts reveal that benefits outweigh potential risks.
By Dr. Minal Mistry, Psychiatrist
My first blog on the Beautiful Space was about depot (injection) antipsychotics in young people. I wrote about the benefits of these medications, but did not raise the question regarding the safety of them. This is a highly relevant question because there have been concerns over the years about the side effects and long term safety of psychotropic medication such as antipsychotics.
Today we will focus on antipsychotics, medications that are commonly prescribed for people with conditions in Schizophrenia, but also used to treat Bipolar Disorder and as an add-on therapy in those who are depressed. The prevalent use of these drugs in a range of conditions begs the question: Are antipsychotics safe?
Antipsychotics, also known as “neuroleptics” or “major tranquilizers” are the cornerstone of treatment for Schizophrenia. Antipsychotics are divided into two main classes:
Are antipsychotics safe?
The safety of antipsychotics, even with the second-generation ones, have often been questioned. It should be noted that these concerns are valid. As shown by a 2006 paper by Dr John Newcomer and Dr Dan Haupt in the Canadian Journal of Psychiatry, metabolic effects (weight gain, insulin resistance, hyperglycemia, dyslipidemia, and type 2 diabetes mellitus) have been well established for over 10 years, and known about for much longer. Other concerns relate to questions about other potential adverse effects including impact on brain volume.
Question: So, what do we really know about the long-term effects of these drugs now in 2017?
Answer: Enter this month, a study published in the American Journal of Psychiatry.
Study into long-term effects of antipsychotics
Professor Donald Goff, based in New York, is a psychiatrist who has published 100’s of papers in the past 30 years. His research focus has been on Schizophrenia and antipsychotics. His most recent instalment in this impressive research portfolio is that he is first author of a review involving other experts around the world. This has led to a May 2017 publication in The American Journal of Psychiatry: The Long-Term Effects of Antipsychotic Medication on Clinical Course in Schizophrenia.
This study involved the merging of an international group of experts (from various sub-disciplines) in order to answer, once and for all, questions about the long-term effects of antipsychotics by examining theoretical and clinical research in this area. These experts concluded: “Little evidence was found to support a negative long-term effect of initial or maintenance antipsychotic treatment on outcomes, compared with withholding treatment”. In other words, the latest expert advice has reached a consensus that the benefits of these medications outweigh any potential side effects.
Although they acknowledge that stopping antipsychotic treatment or using non-drug treatments may benefit some patients with Schizophrenia, the experts also concluded that “early intervention” to reduce the time of untreated psychosis may improve long-term outcomes. This fits in well with my earlier blog on the Beautiful Space (“Schizophrenia: starting depot medication early may help”) where I described research reporting the benefits of starting treatment early.
There has been much scepticism in recent years regarding the effectiveness of drugs in psychiatry. For instance, antidepressants have been heavily criticised for their lack of benefits and potential for side effects. Another class of drugs is the antipsychotics, which may be slightly more convincing in their benefits compared with antidepressants, but there has been considerable debate regarding their potential toxic effects. Hopefully this latest research involving worldwide experts can allow doctors, and their patients, to have a more informed discussion as to whether these medications should be used or not.
Cite this article as:
Minal Mistry (2017). Are antipsychotics safe? International panel of experts reveal that benefits outweigh potential risks. The Beautiful Space-A journal of Mind, Art and Poetry. June 2017: TBSB119
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