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Health See other Health Articles Title: An Important Look at Mortality in Mental Illness Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. I would like to comment on an article that recently appeared in JAMA Psychiatry,[1] formerly known as the Archives of General Psychiatry. This article appeared online at the end of August. The authors were a group of investigators led by Dr. Arifulla Khan of the Clinical Research Center in Bellevue, Washington, who, through a Freedom of Information Act request, obtained data from the US Food and Drug Administration (FDA) about psychotropic drugs that were evaluated from 1991 to 2011. The psychotropic drugs of interest were those used to treat schizophrenia; bipolar disorder; depression; and other conditions, such as anxiety disorders and attention-deficit/hyperactivity disorder. The focus of my comments will be on the very interesting results pertaining to schizophrenia, bipolar disorder, and depression. After obtaining these data, the investigators asked the question of whether mortality was increased in patients with these disorders relative to the general population, and whether there were differences in mortality rates in patients who received psychotropic medications compared with those who received placebo. They found, as has been previously reported many times, that individuals who have psychiatric disorders, and particularly schizophrenia, bipolar disorder, and depression, have lower overall survival (increased mortality). Of interest, being on a psychotropic medication (antipsychotic, mood stabilizer, bipolar medication or a combination of drugs) was associated with increased survival and lower mortality in patients with schizophrenia or bipolar disorder. This is important, because it has previously been suggested (and this fact has been used by critics of psychotropic medications) that psychotropic drugs, particularly the second-generation antipsychotic medications or mood-stabilizing drugs, contribute to side effects and medical comorbid conditions that shorten survival and increase mortality. These findings suggest that the opposite is true. Being on the medication in no way increased mortality; in fact, it actually reduced mortality, despite the fact that the studies that were obtained and analyzed were largely acute treatment studies of short duration, not the long df it. Treatment Enhances (not Diminishes) Survival These findings are consistent with earlier published reports that suggested that survival is enhanced by treatment as opposed to being diminished by treatment. The importance of this finding is that it suggests that although medications may have side effects, overall survival is affected more adversely by the illness or associated lifestyle factors, such as engaging in high-risk behaviors that could result in violent death or suicide. The illness itself is more injurious to survival than the medications that are used to treat it. With respect to depression, mortality was higher, but in the comparison between people on serotonin reuptake or serotonin norepinephrine reuptake antidepressants and those on placebo, there was no difference in survival rates. No benefit or disadvantage was associated with taking the medication. However, when death by suicide was examined, it was found that being on medication as opposed to being on placebo was associated with greater longevity and lower mortality, suggesting that antidepressants were helpful in reducing suicide rates and mortality from suicide. The bottom line from this very good and important study, which was carried out with a large amount of data obtained from the administrative database of the FDA, is that psychotropic drugs are in the aggregate very beneficial -- not just in suppressing patients' symptoms, but in extending their overall survival and reducing mortality. In the ongoing debate in the literature as well as in the media about whether psychotropic drugs are overprescribed or are potentially detrimental to health, as physicians we must always be aware that medications should be used only when indicated and very judiciously in all people, particularly in children and the elderly -- but we should never withhold them when they are needed, because they are very beneficial in terms of therapeutic effects. They should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans. Take a closer look at this study. It clearly illustrates the benefit of using medications when medications are warranted for treating mental illnesses, such as schizophrenia, bipolar disorder, and depression. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape. Post Comment Private Reply Ignore Thread
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