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Thinking about psychiatric drugs: The risks

Psychiatric drug risks

We have looked at some of the risks associated with antidepressant drugs here, and when they are used with children and young people, here. We have also looked at some of the risks of stimulant drugs like Ritalin when used with so-called ADHD children here. We have observed here that mental health drugs are rough tools and limited in what they can do.

We also reflect on the social implications as these drugs can be disabling and disfiguring too, here. We now briefly touch on some of the possible (some might say "likely") damage of psychiatric drugs to the brain and to other areas of the body.

I am aware that much of what I am about to say here on the risks of mental health drugs is shocking. But the facts are stark and any attempt at toning down the risks would be a distortion of the facts and be doing others a serious disservice.

Having said that, you are likely to find that most doctors and psychiatrists have a very strong belief in the benefit of these drugs. From the research I have read and from a number of years working closely with people who take these drugs long-term, I am at best not impressed by what these drugs do. When I go to a doctor I like to be clearly told the risks, the benefits, how necessary the drugs really are, and whether or not there are safer options to consider. The risks I write about here are some of those I would like to be told about if I was considering taking these drugs. But please note that this is an over-view and is not intended as in-depth and all-inclusive.

A brief summary of psychiatric drug groups (more here)

Before we look at the risks, the different groups of psychiatric drug are summarised here for the benefit of those less familiar with them: antipsychotics - also known as neuroleptics divided into 2 groups (the division is primarily for marketing purposes, as explained here by Prof Kendall) 'typicals' (1st generation antipsychotics) and 'atypicals' (2nd generation antipsychotics); antidepressants; anti-anxiety (sedatives, including benzodiazepines such as Valium); so-called mood stabilisers (including lithium); anticholinergics (often used alongside antipsychotics to try to counter some of the drug ill-effects); psychostimulants (such as Ritalin); and sleeping tablets. Each group of drugs has its own particular risks, though there is some common ground.

We only get one brain and quite rightly we want to protect it

Skateboarder

These days we have become very cautious about protecting our heads. Cycle helmets are often worn and skateboarders and skiers also protect their heads. I see very small children wearing cycle helmets too. We do this because we know the dangers of head injury. We only get one brain and quite rightly we want to protect it. But when it comes to protecting our brains from toxic drugs we are often (perhaps inadvertently) far less cautious. Drugs (illicit and/or prescribed) can create desirable short-term effects but can also lead to unwanted long-term damage to our brains.

Drugs are made to breach the brains natural defence system

Our brains have a natural defence system in place to prevent toxins and infections reaching brain tissue: this is a very fine cellular mesh known as the “blood brain barrier1. Psychiatric drugs (and sometimes other drugs too) have to be pharmacologically engineered to trick the brain into allowing them to pass this “microscopic defence system” 2. To do this the drugs are structured, at the molecular level, in a way that helps them mimic the action of neurotransmitters (such as serotonin and dopamine) 3. They are then able to hijack their way through the safety barrier and into the brain. Not only do poisonous substances (including psychiatric drugs) enter the brain in this way, but the actual barrier can be weakened by the use of the psychiatric drugs 4. Furthermore, “substances that have difficulty entering the brain, in general, also have difficulty leaving it” 3. There is an added risk for the unborn child if the mother is taking psychiatric medications as the child’s blood brain barrier “is not completely formed until about 6 months after birth” 6 - the child is therefore vulnerable to toxins via the placenta and later through breastfeeding.

The drugs actually damage the brain (the seat of our personality)

That's not good news from the highly respected Dr Nancy Andeasen - that antipsychotic drugs actually cause the front part of the brain to slowly die. What's more, the loss of brain tissue is relative to the amount of drugs that have been used. See the quote below from the New York Times.

 
  What we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose…They [antipsychotic drugs] block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy [waste away]. Dr Nancy Andreasen (Neuroscientist/Psychiatrist)  

This is serious damage; in fact, a decrease in brain cells in the frontal lobes is found in patients with advanced Alzheimer’s disease and Parkinson’s disease. Damage to the frontal lobes is targeting the very seat of our personality. When the frontal lobes are damaged we may fail to regulate our own behaviour, our ability to make decisions is hampered, and our interactions with others are severely impaired as we then struggle to read social cues. It is no surprise that people who take these drugs sometimes describe feeling like a robot or "zombie".

Dr Andreasen’s conclusions are consistent with animal studies that “suggest that antipsychotics can affect neuronal structure and function”, lead to cell death in a number of areas of the brain, and that both the older and newer (so-called atypical) antipsychotic drugs are “associated with reductions in both grey and white matter” within the brain 8.

This is not just a problem with the antipsychotics. With regard to antidepressants and frontal lobe damage, Dr Breggin writes: "It is especially ominous, therefore, that young animals develop permanent changes in the frontal lobes of their brains after a brief exposure to Prozac." 7

The benzodiazepine drugs (such as Valium/diazepam) have been "associated with an approximately 50% increase in the risk of dementia" 5 and benzodiazepine use in conjunction with an antipsychotic drug has been "associated with a substantial increase in mortality" 11.

Risk of death associated with mental health drugs

I guess it is easy to say that the chance of sudden death by mental health drugs is statistically low. But in comparison to some other prescription drugs the rates are alarmingly high. Consider reports of death reported to the FDA for the period 1998-2005. The so-called newer atypical antipsychotics are high on the offender list: Clozapine 3,277; Risperidone 1,093; Olanzapine (US Zyprexa) 1,005. (You can view the full list here. We also need to bear in mind that the true figures are likely higher as only a fraction of adverse drug events are usually reported).

It is worth noting that drugs with fewer reports of death (such as the anti-inflammatory drug Vioxx/Rofecoxib, which is shown with 932 deaths) have been withdrawn from the market due to the risks, and yet mental health drugs remain on the market and extensively prescribed. You may have noticed that the antidepressant Paroxetine/Seroxat has 8095 reports of "disability or other serious outcome", for that period. (Full study available here).

 

Life example

I was working with a young man who was being advised by his psychiatrist to change his medication to clozapine. He was reluctant to do so and his social worker gave him a promotional video on this drug to try and convince him of the benefits. What the doctors, social worker and video did not tell him was that in a 10 year study seven people experienced heart attacks (five fatal) whilst prescribed this drug and that two of these were under 30 years of age (his age group)12.

He mentioned his concern to the psychiatrist and told me the psychiatrist's reply was: "Any of the drugs I prescribe you can cause sudden death". Honest but not reassuring! Surely the young man should have been told these and other facts (such as 34% developed diabetes in this study, in spite of safeguards to try and prevent this - though the figure would likely have been around 43% if everyone had continued with the drug) to help him in making an informed decision.

In passing, I would point out that his dentist noticed a marked reduction in bone density - a matter of concern for someone in his early 20s. Though not confirmed as causal in his case, it is worth noting that both antidepressants and antipsychotic drugs have been associated with causing reduced bone density. He had been on these drugs long-term.

The myth of 'new is better'

The newer antipsychotics (see glossary here) have been widely promoted by the drug companies as superior and safer than the older antipsychotic drugs. This is more spin than substance as they come with serious risks and clozapine/Clozaril is in fact an old drug (previously withdrawn for serious safety issues) and reintroduced through astute marketing. In fact, it was clear 10 years ago (and remains so today) that “No convincing evidence has ever been forthcoming that any of the new ‘atypical’ antipsychotics are superior to the older ‘typicals’ in either safety or efficacy 10” and they are associated with causing a metabolic syndrome (see glossary here) leading to increased risk of weight gain, diabetes and stroke.

Psychiatric drugs can damage and disable many parts of the body

The damage from psychiatric drugs can affect many parts of the body, even down to the structure and functioning of cells, including the microscopic mitochondria (which are within most of the cells in the body) and are the cells "power houses". “All classes of psychotropic [psychiatric] drugs have been documented to damage mitochondria…”9 and this can put high-energy organs, such as the heart and brain, at particular risk 4.

Dopamine, in one way or another, influences sexual behaviour, lactation, our emotions, thinking and memory, movement, bone density and even the regulation of blood pressure and heart rate. It should therefore come as little wonder that drugs that affect dopamine (such as the antipsychotic drugs) will have widespread effects across the body.  Not surprisingly, they play havoc with emotions, memory, sexual activity and are also a serious heart risk too. Sadly, due to hormonal disruptions by antipsychotics, we hear of children developing breasts (see here) and males lactating. We also hear of the disfiguring and disabling effects of tardive dyskinesia (TD), causing uncontrollable movements - arms, lips, tongue, and facial movements - that can also result from the newer so-called atypical antipsychotic drugs. The patient information by the makers of Risperdal/risperidole (one of the newer drugs) points out that TD can develop “after relatively brief treatment periods at low doses.” (see here).

The cure can also be poisonous

The antipsychotics, not unlike other psychiatric drugs, can slow down movement, impede thinking and memory and inhibit any zest, enthusiasm or spontaneity for life. This is even more pronounced when they bring about the symptoms of Parkinson’s disease.  When I hear doctors insist that these drugs are helpful I invariably think to myself: “But what about the permanent damage, especially with long-term use?” The shaking, slow faltering steps, and grave difficulty thinking and remembering are typical of Parkinson’s disease. As I think of a friend of mine who was so mentally and physically agile, but who is now being destroyed by Parkinson’s disease (not through mental health drugs), it seems that taking these drugs seems a perverse risk to take, and requires a very careful balancing of risks versus benefits.

Most drugs are toxic - there is always a need for caution and balancing benefits with risks

The cure can also be poisonous

Some of the psychiatric drugs are seriously toxic; consider the toxic metal Lithium, which is used for so-called mood disorders. As one former neuroscientist writes: "I hope that one day soon we will come to regard lithium given to children as a treatment with the same disbelief that we now consider mercury, white lead and arsenic.” Clearly, this applies to adults too.

Having said that, it is true that most drugs (those in general medicine too) are toxic in varying degrees and come with a measure of harm. Doctors aim to balance the risks by using only a “therapeutic dose” and by not prescribing the drugs for too long. In mental health, high doses are often prescribed [see this Healthcare Commission Report here] and with the use of a number of drugs in combination (sometimes referred to as polypharmacy) and for extended periods – often many years – thus increasing the risks of harm. Even though the practice of co-prescribing mental health drugs is common place, this raises serious additional concerns as the drugs are unlikely to have been safety-tested in combination.

The cure can also be poisonous

In deciding whether or not to take a drug, a risk-benefit analysis is made: weighing up the hoped for benefits against the known (and possibly unknown) risks. If the disease is life-threatening and the drugs are highly risky, a person may still opt for the treatment as there is little to lose; on the other hand, we are unlikely to risk taking a drug with the potential to seriously maim of kill us if we only have a headache or common cold. Hence, the risk taken is usually relative to the seriousness of the disease. This is one reason why people need to be told the breadth and depth of the risks associated with psychiatric drugs - so a reasoned choice can be made.

Damage limitation?

Doctors may consider different ways of reducing risk. With psychiatric drugs this could be by trying to avoid combinations of drugs (as the full risks of co-prescribing are not known); by reducing the dose to the minimum dose possible once a crisis has passed; and/or by exploring the possibility of periodic use - prescribing the drugs during times of crisis and gradually weaning the person off as the situation resolves and settles - though there is no guarantee that the drugs themselves will not exacerbate the problems and appear to necessitate their long-term use. The fact that the drugs are associated with adverse effects (including paradoxical effects) makes the concurrent use of additional drugs difficult to avoid and raises the risk stakes.

Being aware of the risks and respecting personal choice

Psychiatric drug warning

Whether or not to take these drugs should be a matter of personal choice (though this choice is sometimes overruled by the Mental Health Act here in England - more here). Hence, in practice I work with those people who choose to take these drugs in spite of the risks, as well as with those who choose to gradually reduce their doses and who may decide, over time, to stop them.

But if you are taking mental health medications and are considering making any changes please do not rush to stop taking them but take note of the SAFETY ADVICE to the right. This is very important. Thank you.

Take time to make carefully considered decisions with the support of those you trust

There are numerous other risk factors that are associated with mental health drugs, such as lowering the threshold for epileptic fits, and the fact that they can cause some people to be violent and/or to be suicidal. This is something of an overview. But I am also concerned that psychiatric drugs can disempower people by severely hampering thinking and decision making, and by the fact that they can create social problems by causing disfigurement and sexual dysfunctions. We take a closer look at these here.

Each person's circumstances are of course unique, and it is for each person, with the support of trusted friends and, where appropriate, the advice of trusted doctors too, to decide whether the risks are worth taking within the context of their life and circumstances. Ultimately it is a personal decision, and especially difficult to make if there is little alternative support available. As I say here, this website supports the freedom to choose (including to take or not to take these drugs) and the right to be fairly informed of the limitations, risks and alternatives. And for those thinking of reducing or even coming off their mental health drugs some day, I discuss some of the key issues here.

References - Bibliography

1 Abbott, N.J. et al (2010) Structure and function of the blood-brain barrier. Neurobiol Dis. 2010 Jan;37(1):13-25. Abstract here.

2 Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House

3 Cooper, J. et al. (2003 edition) The Biochemical Basis for Neuropharmacology. New York: Oxford University Press

4 Jackson, G. (2009) Drug-induced dementia - a perfect crime.  USA: Anchor House

5 Billioti, S. et al. (2012) Benzodiazepine use and risk of dementia: prospective population based study. BMJ 2012;345:e6231. Full study here.

6 Grandjean, P. et al (2006) Developmental neurotoxicity of industrial chemicals. The Lancet. November 8 2006

7 Breggin, P. (2001) The Antidepressant Fact Book. US: Da Capo Press

8 Navari, S. & Dazzan, P. (2009) Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings. Psychological Medicine (2009), 39, 1763-1777. Full study here.

9 Neustadt J, et al. (2008) Medication-induced mitochondrial damage and disease. Mol Nutr Food Res. 2008 Jul;52(7):780-8. Abstract here.

10 Dr D. Healy. House of Commons Health Committee: The influence of the Pharmaceutical Industry 2004. Quoted section available here.

11 Tiihonen, J. et al. (2012) Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia. Arch Gen Psychiatry. 2012;69(5):476-483.

12 I am of course not claiming that the apparent association proves the drug is culpable.

 

Further reading - Might be worth checking out

For a short and easy-to-read, but informative introduction to psychiatric drugs you might find this helpful:

Moncrieff, J. (2009) A Straight Talking Introduction to Psychiatric Drugs. UK: PCCS Books Ltd

 

The following are perhaps a more comprehensive read:

Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House

Healy, D. (2002) Psychiatric Drugs Explained. UK: Churchill Livingstone

Moncrieff, J. (2008) The Myth of the Chemical Cure. UK: Palgrave MacMillan

 

For those with a more in-depth interest in the physiological damage caused by psychiatric drugs:

Breggin, P. (2008) Brain-Disabling Treatments in Psychiatry. New York: Springer Books

Jackson, G. (2009) Drug-induced Dementia - A Perfect Crime.  USA: Anchor House

 

       
 
 
 
Drug withdrawal warning