A study published in the January 2016 Behavioral Health Roundtable Discussion, by Kenneth Anderson, MA, found that psychiatric medications are killing more Americans than heroin. One of the major contributors to this alarming statistic is what is known as “polypharmacy.” This practice must be counteracted with measures to help protect the health and safety of those who are diagnosed as being mentally ill, and who are victims of overmedication with life-threatening drugs.
Very simply, polypharmacy is the prescription of two or more psychiatric medications at the same time. In cases involving psychiatric treatment, there is little research to back up advantages of utilizing polypharmacy, but alarmingly, inappropriate polypharmacy can be harmful, or even deadly.
Our son, Mark, is an example of the deadly effects of polypharmacy. He died at the young age of 46 and his death was caused by toxicity/cardiac failure from two of the five medications he was taking, at higher than recommended doses, as prescribed by his psychiatrist.
He was treated as an outpatient at a clinic for over four years, up until the time of his death, and was prescribed a mixture of five psychiatric medications, some at increasing dosage levels throughout his treatment. The treating psychiatrist completely ignored the warnings of the dangerous side effects of these medications, including sudden death.
These precautionary physician messages were clear and succinct, warning that the medications being prescribed separately, and in combination, could cause toxicity, dilated cardiomyopathy, heart arrhythmia, coma, and sudden death. The warnings appeared on the prescribing information of the medications, and some were included in special warnings issued by the Federal Drug Administration (FDA).
In addition to ignoring the warning signs, the psychiatrist never conducted monthly blood draws to measure the concentration levels of these powerful medications being prescribed; the psychiatrist never monitored his heart with an ECG or EKG; and never checked for signs and symptoms of known side effects, even though there were published recommendations to do so. And inexplicably, the psychiatrist never warned him, or us, about these dangerous warning signs, including FDA published warnings.
Mark lived at home with us, and was diagnosed as having a schizoaffective disorder. He was a wonderful person and a great son; he was the perfect patient. He never smoked, drank alcohol, or took street drugs. He made all his appointments and took his medications, following his psychiatrist’s instructions, almost to the letter, and yet he died. We were very much involved in his treatment, and he, as did we, believed that his clinic, hospital and mental health care staff would do no harm, and protect him. Unfortunately, and sadly, we were wrong.
A study by Moitabai and Olfson (2010) found major increases in psychiatric polypharmacy in office-based psychiatry practices in the United States. The median number of prescriptions doubled within a ten-year period.
Relatedly, studies have shown that the likelihood of death is directly proportionate to the number of medications a person with a psychiatric disability is taking, and helps explain the reason why patients diagnosed as mentally ill and taking multiple medications die 25 years sooner, on the average, than the average death age of the general population. This is a well-known fact within the mental health care community, but is seldom shared with patients, or their caregivers. And what is more disturbing is that nothing is ever done about it.
Kevin Pho, MD, an American physician of internal medicine, and founder/editor of KevinMD.com, a website visited by medical professionals, states this: “Polypharmacy has never been, and will never be, systematically studied in controlled clinical trials… It is impossibly impractical to do studies comparing multiple drug regimen, because these would require too many cells and too big a sample size to test all the possible permutations. The result: Polypharmacy is rarely ever evidence-based, almost always a shot in the dark.”
“Shot in the dark” treatment is equivalent to voodoo medicine, and it must be addressed immediately to ensure that those patients diagnosed as mentally ill are not harmed, or worse, die from this method of treatment. I am not a mental health professional, but my own research since my son’s death, plus my over 25 years of experience in dealing with a flawed mental health system, leads me to conclude that families, government agencies, policy makers, insurers, and health care providers must address this crisis to protect the health and safety of those diagnosed as mentally ill.
Family Involvement. The family should not solely rely on the psychiatrist to properly treat the patient. Instead, the family needs to be fully engaged with the mental health patient’s treatment plan. The family should insist on a multi-disciplinary approach to the patient’s treatment, to regularly include communications involving the patient, family members, psychiatrist, mental health counselor, pharmacist and primary care physician. The family should be aware of the medications, the indications for use and the risks, side effects and warnings associated with the medications. The family should ensure that the health care professionals are regularly questioning the patient’s physical as well as behavioral condition with these concerns in mind. This team approach should be in effect until the patient no longer requires psychiatric medications.
The FDA. The FDA issues reports of known and proven adverse effects of certain psychiatric medications, individually and in combination with other medications. The FDA should institute stricter regulations. Currently, FDA warnings are essentially useless because many psychiatrists/physicians often ignore them. The FDA should require appropriate and periodic health exams including heart monitoring, drug concentration measurements, liver enzyme testing and other appropriate tests when medications with known, dangerous side effects are being prescribed.
Less Is More. Clearly, overmedication is not the solution to treating those diagnosed as mentally ill. Newer, more effective treatment strategies, focusing less on psychiatric medications, are being used elsewhere. An example is the mental health program in Northern Finland that has had an extremely high rate of recovery for patients with severe mental disorders. Their program uses a technique that began over 25 years ago called Open Dialogue. The approach de-emphasizes the use of drugs and focuses instead on developing a social network of family and helpers and involving the patient in all treatment decisions. Ongoing research shows that over 80% of those treated with the approach return to work and over 75% show no residual signs of psychosis. Unfortunately, only a few small programs are offered here in the U.S.
Integration Is Needed. There is a large body of knowledge showing that those patients classified as mentally ill fare best when their physical and behavioral health needs are addressed in tandem. But the current health care delivery systems are disjointed and fragmented. They tend to operate independently, without coordination between them, and gaps in care and inappropriate care can result. What is needed is a cohesive framework that enables providers to deliver integrated care to patients with physical and behavioral health needs. There should be accountability for the whole person. A single provider, care team, or health care entity should be responsible for coordinating or delivering the full spectrum of physical and behavioral services, and to the extent applicable, long-term support services, such as housing and employment assistance.
The problem of overmedication of those diagnosed as mentally ill is similar to the opioid crisis in the US, but receives far less national attention because people labeled as mentally ill in our society have historically been stereotyped, ignored, and forgotten. Many stigmatized as “mentally ill” will continue to die at a young age unless and until our society recognizes that our most vulnerable and ignored merit the same attention and care as those suffering from other physical ailments and addiction disorders.
Editor’s note: An Allegheny County jury returned a $2 million verdict on Wed., May 16 in favor of Stanley and Marianne Truskie as a result of the death of their son Mark who died at the age of 46.