Most people who take antidepressants and other psychiatric drugs would be better off without them, a leading scientist has warned.
In a controversial opinion piece published in the British Medical Journal, clinical trials expert Professor Peter Gotzsche argues that industry-funded drug trials have overestimated the benefits and understated the deaths from antidepressants, tranquillisers and anti-psychotics.
Professor Gotzsche said given the lack of benefits, people could stop almost all psychotropic drugs without causing harm.
But the opinion has been strongly refuted by medical experts, who say that if people with mental illness acted on this advice it could be highly damaging.
Dr Joel King, a consultant psychiatrist at the Melbourne Clinic’s Professorial Unit, who is also an honorary senior lecturer at the Department of Psychiatry at the University of Melbourne, said psychiatric medications was just one part of the management of a patient’s mental illness, or perhaps not at all.
He said talking to a patient or psychological therapy was often a first-line treatment for mild to moderate cases.
“There are cases where patients continue to struggle despite these types of measures. Medication can sometimes be helpful in this situation,” Dr King said.
In his report, Professor Gotzsche said that drugs prescribed to patients for conditions such as depression, attention deficit disorder and dementia were responsible for the deaths of more than half a million people aged 65 and older in the western world every year.
Australian National University Medical School academic Jeffrey Looi said he had deep concerns for the public report which was not evidence-based, and could be harmful for patients.
Dr Looi said the suicide data in the report, that related to the use of antidepressants, was only cited in the professor’s own unpublished book and was unclear. He also said that clinical trials did not normally involve subjects over 65.
Professor Gotzsche’s report also said that clinical trials of several drugs, including fluoxetine (better known as Prozac) and venlafaxine (better known as Efexor-XR) demonstrated that the medication had little impact beyond a placebo effect after a few days.
Clinical trials of schizophrenia were “disappointing” and the benefits of drugs for attention deficit hyperactivity disorder were “uncertain”, he added.
“The short-term relief seems to be replaced by long-term harms. Animal studies strongly suggest that these drugs can produce brain damage, which is probably the case for all psychotropic drugs,” he wrote.
“Given their lack of benefit, I estimate we could stop almost all psychotropic drugs without causing harm. This would lead to healthier and more long-lived populations.
“Because psychotropic drugs are immensely harmful when used long-term, they should almost exclusively be used in acute situations and always with a firm plan for tapering off, which can be difficult for many patients.”
But Dr King said the evidence doesn’t support this.
“Most patients find a stable dose that works, they don’t get cravings for their antidepressants, and they can be weaned off the medication if they don’t want to be on it or it doesn’t work or agree with them,” he said.
“Regular review and relapse prevention are also important … all psychiatric medications have the potential to cause side-effects and patients should be properly advised about them.”
Dr King also said there was very little evidence that all psychiatric medications caused “brain damage”.
A group of UK-based medical experts responsible for the Cochrane Reviews that relate to mental health, agreed with some aspects of Professor Gotzsche’s report, but were highly concerned if his recommendations were acted on, could lead to patient harm.
“Treating them as a homogenous whole is not helpful within such a concise article, given that there will be very different benefits and harms in different populations and with different drugs,” the group said.
Untreated mental illness ‘harmful’
Dr King said that untreated psychiatric conditions, such as schizophrenia, bipolar disorder and depression, could have tremendously harmful effects on the individual, their family, and society.
He said depression itself was recognised as the leading cause of disability worldwide, according to the World Health Organisation.
“People who are depressed can stop going to work or school, stop interacting with their friends and family, and even commit suicide,” Dr King said.
“These risks need to be weighed against the potential risks of any form of treatment, and this is sometimes complex without straightforward answers. Ultimately, it is one that should involve the patient, family, and other supports as much as possible.”
Dr Looi said the report could also create negative messages to mental illness sufferers about seeking treatment.
“They should know they have the same rights as anyone else with a medical condition, to seek advice and treatment from their health professional,” he said.