Major Risks from Drug Interactions in Common Psychiatric Polypharmacy

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It is very common for psychiatric patients, especially those diagnosed with schizophrenia, to be prescribed two or more psychiatric medications at once, and this confers significant health risks from rarely studied drug interactions, according to Turkish University School of Medicine researchers publishing in the Bulletin of Clinical Psychopharmacology. The researchers stated that theirs was the first such study to look specifically at the dangers of psychiatric drug interactions “in real life conditions.”

The researchers study sample consisted of 240 patients with a schizophrenia spectrum disorder. They found that over 70% (172) of them were taking two or more psychiatric medications, and they analyzed the risks of interactions based on the specific drug combinations occurring in all of these individual cases. They found that 87.8% of the interaction risks were moderate, and approximately one quarter of the patients were using medications with a major risk of interactions.

The found that 38.6% of the patients were at moderate risk for increases in anticholinergic side effects, such as dry mouth, bowel obstruction, blurred vision, impaired concentration, attention deficit, and memory impairment. Nearly a quarter were at higher risk of central nervous system and respiratory depression. And nearly 60% were at higher risk of heart problems due to QT interval prolongation. Other cardiovascular, blood drug level and neurotoxicity risks were also identified.

“As far as we know, no study has been done to evaluate the drug–drug interactions that patients with schizophrenia spectrum diseases experience in daily clinical practice, in real life conditions,” wrote the researchers.

“The present study reports that an important percentage of patients are exposed to drug–drug interactions with ever-increasing use of multiple medications in the schizophrenia spectrum of diseases, and among these interactions, most major risks were cardiovascular risks, especially QT prolongation,” concluded the researchers. “Prospective studies with larger numbers of patients are needed in this area.”

(Abstract) (Full text) Risk of Psychotropic Drug Interactions in Real World Settings: a Pilot Study in Patients with Schizophrenia and Schizoaffective Disorder. Sengul, MCB et al. Bulletin of Clinical Psychopharmacology. 2014. Volume: 24, Issue: 3. doi: 10.5455/bcp.20140311041445)

27 COMMENTS

  1. Since the “bipolar” patients are being given the same drug cocktails as the “schizophrenia” patients, at this point in time, this should also be studied in the “bipolar” patient population.

    I had to research this myself, since doctors apparently don’t have any clue, or pretend they don’t, as to the potentially toxic drug interactions they prescribe. (But it’s all quickly researchable via the drugs.com drug interaction checker, if you’re well versed in medical research).

    And I found the neurologist I was told “knew everything about the meds” ended up putting me on two drug cocktails, of six drugs each. And every single drug I was on had a major drug interaction with at least one other drug he was prescribing.

    But then again, I was dealing with what I’ve now learned is a typical psychiatric industry cover up of easily recognized iatrogenesis and a cover up of child abuse by a religion. What I was told by a subsequent ethical pastor is the “dirty little secret of the two original educated professions.”

    Perhaps, someday, the psychiatric industry should actually get out of the business of covering up easily recognized iatrogenesis for the incompetent doctors, and the covering up of child sexual abuse for the religions? Maybe then, you may achieve respectability?

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    • Barrab: I currently take synthroid to counter act damage from lithium which I successfully tapered off three years ago against medical advice. Unbelievable, the psychiatrist continued prescribing me the Lithium even after she, the primary care physician, and the kidney doctor pinpointed lithium as the culprit for my stage three Kidney Disease. Thanks to MIA I had become aware of the process of Out Patient Commitment laws, but when I went into the psychiatrists office I did not know what to expect after I reported to the nurse that I no longer was taking Lithium. (West Virginia in fact does have this law-but the psychiatrist punted-she has since segued into a legitimate branch of medicine. I am thirty pounds over weight and take a small dose of blood pressure medication, a sleep agent antihistimine, 1.5 mg of Zypreza and .5 mg of klonapin. The truth of the matter is that the contributors to MIA have given me a more accurate and realistic assessment of how to tapper off of these drugs than any psychiatrist ever has. I feel that I am close to successfully detoxing from Zypreza, hopefully by the end of the year. Then I will take it from there.

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    • Because they mostly don’t give a crap. It does not surprise me that no one has done this kind of study before. They just plain don’t want to know, because the knowledge is inconvenient, and they’re all about what is convenient for them, and profitable, of course.

      —- Steve

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  3. Having experienced “dry mouth, bowel obstruction, blurred vision, impaired concentration, attention deficit, and memory impairment”, my guess is that the anticholinergic effects of neuroleptic drugs are under reported. If you are relying on patient admission, a lot of patients like to downplay such things. For one thing they don’t like to think they’re being poisoned, they want to be optimistic, and for another, there is a lot of suspicion on the wards. People are far from straight forward in their dealings with staff. I would suspect that the 38.6 % figure is very much of an under estimate.

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    • Your comment reminds me of the studies Fuller Torrey likes to parade around showing that large percentages of people forcibly drugged are thankful for it. Glossing over the fact that the people being surveyed are trapped in a coercive relationship with psychiatry where saying anything negative about the drugs or their experiences with them will lead them back to the hospital for more drugs. It’s like confronting the slaves during the times of slavery and asking them what they think of their masters… of course they think the whole world of them, what wonderful people they are for saving us and letting us live here in exchange for work. smh

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    • …..People are far from straight forward in their dealings with staff.

      You have that right. I let my pdoc think I was taking the 20mg of Abilify he was prescribing me for 2 years until I was told that I would need to take up the tab and pay for it myself. This was not an active deception on my part as he never asked me about how the Abilify was working or if we could try reducing the dose. His shock seemed genuine that I threw $28,000 worth of it in the rubbish. That was 7 years ago and I have been neuroleptic free ever since my discontinuation 9 years ago.

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    • Involuntarily committed patients do not get a choice in who their prescriber is. They are assigned to a prescriber arbitrarily at the convenience of the institution where they are placed. They must see that prescriber once a week or once a month. Many involuntarily patients like my young adult daughter do not identify as having a chemical brain imbalance or ‘disease’ yet are told that their lack of insight is further proof of their ‘disease’ therefore any remaining dialogue between the prescriber and the patient is a moot point. Most precribers cannot see this conundrum for what it is: trying to have an open and frank conversation with a patient about medication side effects with someone who has been talked down to and forcibly medicated in the first place is simply not possible. Patients in this no-win situation are anxious to get every visit with a prescriber over with as quickly as possible. Of course the side effects are under reported. Patients learn to schwelch any side effects they are experiencing no matter how disabling the side effects are and cry in their pillows at night.

      The goal of institutionalization and forced/coerced medication is to brainwash patients until the patient forgets what it is like to have well functioning bowels, eyesight, sweat glands, no tremors, normal metabolism, etc. Perhaps with time, as the memories of their past start to fade, they will simply start assuming like most professionals in the mental health system that the side effects are a part of their ‘disease’. Remember, until recently medical schools taught their medical students that tardive dyskenesia was a symptom of the disease of schizophrenia, not a side effect of a medication.

      From observing what my daughter has had to endure under the paradigm of forced treatment, I would venture to guess that for many patients, a session with a prescriber to talk about side effects under the conditions of forced treatment is a very dangerous activity for the patient that can lead to misinterpretation and more drugging. In fact, for patients labeled with a severe mental illness in this utterly broken and corrupt system to have any level of engagement with the mental health system is to risk exposure to dangerous levels of psychic radiation. I think many of the symptoms of ‘mental illness’ today in people who have been chronically exposed to the mental health system are simply reflective of the huge range of disassociative behaviors that people adopt to protect the core of their being just like the radiation protection suits that nuclear power plant workers use.

      You cannot have a frank talk with someone about their side effects until they feel safe enough to take off their protection gear and that will never happen until you have hundreds of thousands of psychiatrists openly admitting to their patients that they routinely experience fear, regret or remorse as a result of their standard of care.

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      • MadMom: after the first of my two rounds with psychiatry in 1989 and 1990, I forgot an appointment with a psychiatric nurse at a “community mental health”organization. This set of bells and whistles, as if someone escaped from Sing Sing. I changed nurses, and when I got married, I switched to a psychiatrist at the hospital where my wife works. Because of a bundle of problems I went to WVU physicians where my primary care physician worked. I have not seen the psychiatrist since May 2013. My wife calls in the prescriptions at the hospital pharmacy. So far I am being let alone. I think I have wormed a little bit of middle class and white privilege in order to side step the more overtly totalitarian over reach that you and your family are experiencing. I don’t know if there are any clues for you here, but hopefully so.

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      • Madmom,

        I’m so sorry for what you’re still going through. And absolutely, you’re correct, when a patient, or even another doctor, tells a psychiatrist about adverse effects of their drugs (like a medically confessed “Foul up” with Risperdal). The patient gets put on massive drug cocktails to cover up the ADRs. I ended up on six drugs, all that have major drug interactions with each other according to drugs.com, because I had an extremely adverse reaction to Risperdal – and each subsequent drug added.

        Before too long, however, I learned. I stopped complaining about how sick the drugs were making me, and just said I was fine. The pdoc was really confused, according to his medical records.

        And eventually, I politely tricked the pdoc into thinking it was his idea to wean me off the drugs. He did, and he even declared in my medical records that he personally cured me of the “life long, incurable, genetic” “bipolar” (“Recov’d disorder”).

        The psychiatrists are sick, sadistic, stupid psychopaths – they just want their staggering egos stroked, and to cover their asses. Try playing the stupid psychiatric game, maybe it’ll work for your daughter, too.

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        • Forgive me, I shouldn’t generalize so. That was my personal experience with the psychiatrists I personally dealt with; but I am grateful for those psychiatric practitioners who are honest, repentant, and are trying to sincerely help other human beings.

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  4. This is exactly the problem. Psychiatry is allowed to use these drugs even before they do the science to determine whether they should ever be used by humans in the first place. If the future does indeed bring an advanced civilization I can not imagine that tthey could anything but shake their heads at people from this time.

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    • Davidcorckery,

      You are absolutely right, and according to an ethical pastor of mine, the mainstream doctors advocate and protect the psychiatrists AND the mainstream religions advocate psychiatry because the psychiatrists’ role, historically, has always been to cover up easily recognized iatrogenesis for the incompetent doctors and child abuse for the religions. My pastor called these crimes against victims of unethical “professionals,” the “dirty little secret of the two original educated professions.”

      Perhaps now that we all live in the Information Age, and can research medicine and pick up medical records with evidence of child abuse in them, it’s time to put an end to the “dirty little secret of the two original educated professions”?

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  7. I had numerous poly pharmacy reactions including: nausea that the last 4 years on these drugs I had to sleep upright in a recliner, diarrhea, constipation and dehydration so severe was repeatedly hospitalized (has several gastrointestinal invasive procedures)), dizziness, menstrual bleeding for 2- 3 weeks every month insomnia (up 3 days), akathisia (paced the house all night), wavy vision, depressed breathing (had invasive testing and put on oxygen) and the list goes on. As these drugs made me physically ill they also altered my behavior, my perception and relationship with everything around me. When I told my prescribing psychiatrist about how I felt he said it was my worsening mental illness and gave me more drugs. At the very end I was hospitalized with Seroquel Induced Acute Pancreatitis in the ICU.

    Guess what?? Once I successfully tapered off these psych drugs the “symptoms” went away. Scary no one had a clue way I was so ill and when I got my psychiatric notes I saw one doctor had called my psych doctor saying I was incoherent (but again the drugs I was on was not mentioned). I did get to ask my clueless psychiatrist why he hadn’t known how the drugs made me so ill and my behavior so bizarre. He just looked at me like he’d never meet me.

    Psychiatry is akin to the Inquisition, just as barbaric, cruel and wrong..

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    • Aria: I have not experienced the physical disabilities that others have reported onMIA. I am trying to cover my bases. My uncle has offered to give me a kidney, but he is 73. One can legally buy a kidney in Iran, but a presume that you have to be an Iranian national.

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  8. it just seems like common sense that one drug with a likelihood for side effects, combined with another drug with the likelihood of side effects…will compound the potential for adverse effects. Then add more drugs and increased dosages…I don’t need a study to know what will happen.

    But it doesn’t surprise me in the least that this hasn’t been studied.

    As an herbalist, I am constantly confronted by the fear that an herb will interact poorly with a psych drug. There are indeed contraindications…but I have rarely heard of severe complications. On the other hand, adverse side effects of drug drug interactions are commonplace but are rarely highlighted in news stories, or seen as necessarily bad…just need to adjust the meds.

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