Long-Term Psychiatric Meds: The Debate Gets Serious

Patient Expert

“This house believes that the long term use of psychiatric medications is causing more harm than good,” read the topic of the 52nd Maudsley Debate, which was streamed live last week and is available to view online.

The venue was the Institute of Psychiatry, affiliated with Kings College of London. The two debaters arguing in favor of the proposition came loaded for bear.

Peter Gøtzsche, director of the Nordic Cochrane Centre in Denmark, based his argument around the fact that an evidence base for psychiatric meds does not exist. Basically, there are far too many flaws in the design of clinical trials for the results to be credible, and that long-term studies are virtually non-existent.

Sami Timimi of the University of Lincoln acknowledged that psychiatric meds help in the short term, but argued that “we have very little evidence of lasting benefits that justifies exposing people to [long term] harms.”

In addition, he cited studies that also appear in Robert Whitaker’s 2010 Anatomy of an Epidemic. These studies indicate that in societies where antipsychotic meds are not common, patients with schizophrenia experience better long term functional outcomes.

The counter to these schizophrenia studies is that they are as methodologically flawed as drug company clinical trials and need to be taken with a grain of salt. Allan Douglas of the Institute of Psychiatry could have made this point with more authority. His most telling argument - and the one that matters most to us - is that neither speaker referred to lithium and bipolar.

A prominent psychiatrist made this very point to me in private several years ago when we discussed Whitaker’s book.

To freely interpret: In attacking antidepressants and antipsychotics, Whitaker - not to mention the Drs Gøtzsche and Timimi - were essentially shooting fish in a barrel. By contrast, lithium has a fairly substantial long-term track record. Not only that, the evidence indicates that long-term use may be good for the brain.

In other words, what the critics leave out is telling.

Needless to say, debates framed in terms of black-or-white hardly encourage nuanced thinking. Yes, it’s true that we lack a substantial evidence base to justify long term use of psychiatric medications, and the profession needs to get its act together on this.

It is also true that even good meds in the hands of a bad psychiatrist is a recipe for disaster.

What about good meds in the hands of a good psychiatrist, then? That only works with a good patient. Moral to the story: Be the best patient you can, informed and critical and willing to give your doctor the third degree. That much, we owe it to ourselves.

Further reading

Antipsychotics in the Long Term

Antidepressants Over the Medium and Long Term