Do psychotropic drugs help over the long haul?

Participants at U of Haifa psychiatric conference split on issue.

By JUDY SIEGEL-ITZKOVICH
Updated: DECEMBER 24, 2017 09:41
Ecstasy monogram (photo credit: Wikimedia Commons)
Ecstasy monogram
(photo credit: Wikimedia Commons)
Psychiatrists at a University of Haifa conference reached a consensus that psychiatric drugs have a positive effect in the short term – but they split into two camps regarding the long-term effect.
One group argued at the conference on Wednesday that there is no convincing evidence in the medical literature that supports the claim that psychotropic drugs achieve long-term results – and there is even evidence that longterm administration of these drugs can cause harm in a significant proportion of patients.
But the proponents maintained that a delay in taking medications is linked to worse effects, so there is a risk from not taking the medications in the long run or discontinuing them.
The conference was run by the university’s community mental department, in cooperation with the Israeli Society for Psychiatric Rehabilitation, the Israel Psychiatric Association and the Israel Community Mental Health Association.
Robert Whitaker, a respected American investigative journalist who has written two books on psychiatry, declared, “There is currently no research evidence that psychotropic drugs have a long-term beneficial effect, and in fact, a long list of scientific studies over decades shows evidence that those who did not take drugs performed better over time.”
New York University psychiatry Prof. Donald Goff also agreed that there is no long-term evidence of a positive effect of the drugs, but argued that the main reason for this is that it is not ethically possible to prevent psychiatric patients from getting drugs for 10 years to serve as a placebo group and prove efficacy in the study group.
The two sides agreed on many “black holes” in psychiatrists’ understanding of mental illness and especially on the effectiveness of the prescribed drugs.
Goff said that statistically, drugs reduce the level of violence and severe symptoms in a large proportion of people suffering from psychosis, at least in the early stages of the disease. He noted that psychosis can cause great suffering and be very dangerous – both for the patient and for his environment – so most patients eventually choose to take drugs. “Some people are treated without medication, but to date, we do not have the ability to say or predict who these people are and how much it will help them,” he said.
WHITAKER PRESENTED a series of studies that questioned the effectiveness of psychiatric drugs in the long term. They started with studies from the 1950s and 1960s that examined the rate of rehabilitation, quality of life and recurrent hospitalizations compared with the period prior to the introduction of psychiatric drugs (around 1955) and afterward; they showed that the success rates in the period before the drugs were introduced were much higher. “We have thought that until the advent of the drugs, people who suffered from mental disorders entered the hospital and were not discharged because there were no medications, but that is not the case at all,” he said.
Whitaker continued to review a series of studies over the years that showed how the group of people who took psychiatric drugs over the years showed the lowest rehabilitation results.
Goff’s argument against these and similar studies was that it is not possible to conclude from existing clinical research whether the changes occurring at the biological level in the brain are related to the drugs or the disease itself. “It’s impossible to know whether the disease itself is ‘toxic’ to the brain or the drugs are.”
Whitaker agreed but argued that these studies reinforce the argument that non-drug therapy may be more helpful in some cases, saying that in his view, the default for a person with a first psychotic onset is to try non-drug therapy.
“There is no doubt that this is a very complex field; for ethical and methodological reasons it is very difficult to gather evidence from which conclusive conclusions can be drawn, [because of] the heterogeneity of the diagnoses of the people taking the drugs and the way they respond,” he said.
Prof. David Roeh of the University of Haifa’s community mental health department, who led the panel, said professionals should be aware of the great complexity of the subject and that there must be team decision- making by all those involved in the matter to provide the most effective treatment.