Major Canadian Professional Psychiatric Groups Speak Out Against Overusing of Psychotropics

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As part of its Choosing Wisely Canada campaign, a joint working group of the Canadian Psychiatric Association, the Canadian Academy of Child and Adolescent Psychiatry (CACAP), and the Canadian Academy of Geriatric Psychiatry has issued a 13-point list of recommendations to physicians for reducing the inappropriate use of psychotropic medications.

“We know there has been a disproportionate use of second-generation antipsychotics during the last 10 years, but the incidence of child youth mental health has not increased,” University of Calgary psychiatrist and president of CACAP Chris Wilkes told Medscape Medical News. “But as a community, we are medicalizing more of our kids and do not always use age-appropriate supports, like ensuring adequate sleep, nutrition, and exercise. Also, we have an epidemic of obesity, and some of these meds carry a significant risk of obesity.”

“Using antipsychotics to treat insomnia is a little like using a sledgehammer to drive in a thumbtack, especially in light of a variety of effective treatment options, both nonmedication and medication, with far fewer side effects,” a physician not affiliated with the CWC program commented to Medscape.

Each recommendation from the working group comes with a one-paragraph summary of research evidence. The recommendations include:

  • Do not routinely use antipsychotics to treat primary insomnia in any age group.
  • Do not use SSRIs as the first-line intervention for mild to moderately depressed teens.
  • Do not use psychostimulants as a first-line intervention in preschool children with ADHD.
  • Do not routinely prescribe high-dose or combination antipsychotic treatment strategies in the treatment of schizophrenia.
  • Do not use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.

 

Psychiatry: Thirteen Things Physicians and Patients Should Question (Choosing Wisely Canada, June 2, 2015)

Antipsychotics as First-Line Insomnia Treatment a No-No (Medscape Medical News, June 8, 2015)

8 COMMENTS

  1. Recommendations to the mainstream medical community that should have all been blatently obvious to the psychiatric industry decades ago. I guess it’s better late than never, but I’m quite certain a lot of us were harmed and killed by these supposedly misinformed / deluded doctors, thus dealt with malpractice. And we do deserve proper apologies and reparations from a well insured, but now claiming to be deluded, medical industry.

    I’d personally change the SSRI recommendation to include the SNRIs, and make that recommendation apply to all age levels, not just teens. And these dangerous drugs should not be fraudulently marketed as “safe smoking cessation meds” either.

    And I’d add warnings about the overprescribing of the synthetic opioid drugs, that are being handed out under names other than opium, by doctors who are not properly informing patients of the addictive nature of these “safe pain meds.” What is it? 75% of all opioid addicts today are doctor created opium ‘addicts’?

    When my brilliant son was very little he made an interesting comment to me, he said, Mom, there’s a catch in the Golden Rule. He said, if we’re supposed to treat others as we’d like to be treated, then when Jesus comes back to judge the people, he can treat them as they treated others. I smiled, and said yes, Jesus was no dummy.

    It appears I’m living in a world with a medical community that’s now claiming to be deluded, who also believes all delusional people need to be defamed and tortured for the rest of their existence. And Dante, in his infamous ‘Inferno’ did say it would be the unrepentant hypocrites that land in the depths of hell.

    I am now understanding why, during my drug withdrawal induced super sensitivity manic psychosis, Jesus said all the doctors would be going to the lake of fire, and fear he may have been closer to right than I care to admit. Last night I had a dream that the entire unrepentant psycho / pharmacutical / medical industrial complex turned into a giant red dragon. “She dreams in real, she dreams in red.” Good inspiration for a new painting. But I wonder if it’s possible dreams, or a drug withdrawal induced ‘manic psychosis’ / musical ‘magical mystery’ spiritual journey, could be prophetic? I guess only God knows.

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    • Pardon, I guess they did include adults in regards to the SSRI’s. I will say I think #6 is very bad advise. I was able to determine I’d been put on a hypnotic drug before being medically assessed and medically unnecessarily shipped a long distance to V R Kuchipudi, which had not been recorded clearly in the first hospital’s medical records, based upon my toxicity screening at the second hospital. And this was very helpful information for me.

      And it’s my understanding from my neighbor, who worked in the “mental health” industry for the past twenty some years, that most people stigmatized with a “mental illness” today are actually people dealing with some sort of toxic effect to some kind of drug – often times pot or heroine. And, of course, adverse effects to drugs are supposed to be excluded, prior to “mental illness” stigmatization. I guess that’s a medical malpractice suit prevention strategy?

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  2. This establishment and its doctrinaire commitments to paternalism in every routine professional-client interaction has outlived it’s entertainment value. The results are in on that–so, what’s new? The effects of your insomnia on the Dragon of Psychiatry’s little insiders who are all there to help make things about your life seem less difficult is bad for you. So kill the uneasy mechanism’s effects on your brain chemistry as a whole when and how you want. If you know something about what is keeping you sorrowful, frustrated, and frazzled by overanxiety, and if you know how you might like to sleep it off under the influence of some intoxicant decide on the nicest pill. But by all means, first try your most trusted drug-free alternatives for all your worth before choosing medicine as safely as you believe is needed, and if you feel is might work better with some help, then two heads are better than one. But you determine the need for stopping your bout of insomnia and what it means to you. You choose the effects you like and see about getting the ones you like out of the pill you choose. But that means only if you have the leisure to try that at last decision freely at all! I haven’t met the doctor yet who antes up with due diligence about experimenting with single low doses yet. Most in my experience want something less principled and more business as usual that goes with the program. However, oftentimes that seems basically to happen since it serves to represent what they stand to get out of the clinical arrangement: more control. If you are at all assertive, or skeptical and unamazed about the value of official authority control over your decisions, as you should openly be with any doctor, you get the expected communication shutdown. That they feel insecure about their position of authority is their problem and not ours to struggle with.

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    • Sorry about random typos–it’s bad to miss those– No less bad is leaving out the important adjective to qualify the criticism of the majority of prescribing physicians met with in my experience (but just there for a listen are about the same, too). Probably you will–You likely will–I usually, most usually have seen communication shutdown if the doctor wasn’t the first person to think of what to use. We see that the right idea for safety is unlikely to get around in the needed revolutionary way, and the word for making that possible never has been possible. Doctors want hegemonic influence ahead of patient advocacy and rights to choose your drugs with good advice freely offered in your favor, no matter what your goal in dosing.

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  5. I knew you weren’t talking to me. That talking the issue down to black and white of yours for a look at it was what struck me as needed. Your comments all hang together well and tend to get the simplest things connected to the significant elements for the overall case for abolishing coercion to be made every time. In addition, my level of incapacitation is now much more restricted to the terms of mechanically significant (motor reflex) matters of consequence for any mental state compromised by disorder of agency, as mine were almost my whole life some way. When I mess up any grammar or start going off on tangents with emotional overtones that seem incongruent, I can definitely stand to blame better than ever as far as formulating clear to see intentions for staying responsible about thoughts and actions. You take care, anothervoice.

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