Reducing Antipsychotic Use May Improve Health for People with Mental Health Diagnoses

Peter Simons
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A new study offers radical solutions for improving the cardiovascular health of people with mental health diagnoses: reducing antipsychotic prescriptions.

The researchers, led by Athif Ilyas at King’s College, London, examined the evidence for current approaches to cardiovascular health, and whether they appear to be working. Unfortunately, they found that cardiovascular health (as well as metabolic health), for people with mental health diagnoses, continues to decline.

U.S. Air Force photo by Senior Airman Taylor Curry/Released

Ilyas cites a large analysis of people with diagnoses of psychotic disorders, in which nearly every participant was overweight, and 57% were diagnosed with metabolic syndrome—a side effect of antipsychotic drugs that leads to weight gain, diabetes, and other health problems. About 20% of the participants had diabetes.

Although people with mental health diagnoses are known to have more than three times the normal risk for cardiovascular problems, studies have shown they are screened for cardiovascular problems at a lower rate than people without diagnoses.

However, Ilyas and the other researchers analyzed the evidence on screening programs and interventions for cardiovascular disease risk. They found no evidence for the effectiveness of screening programs or interventions for cardiovascular disease. In fact, studies suggest that screening for cardiovascular risks had no impact on disease outcomes or mortality rates. Interventions fared slightly better: they have been shown to reduce some behaviors that were risky, such as smoking. However, they also appeared to have no actual impact on outcomes, including mortality rates.

Because of this, Ilyas and his co-authors argue that increasing screening and standard interventions for people with mental health diagnoses would not be effective. Instead, a different approach is needed if we are to reduce cardiovascular risk.

They offer the following alternatives:

“Smoking cessation, dietary interventions, exercise interventions and avoiding prescription of antipsychotics associated with adverse metabolic outcomes. Such interventions are relevant to all patients with serious mental illness and not just those who are found to have abnormal results from physical health monitoring.”

That approach, according to Ilyas, is not dependent on screening for risk—instead, these are guidelines that promote health for everyone.

However, the researchers also note that smoking cessation, dietary interventions, and exercise interventions have only slight evidence of effectiveness. Most often, the individual is not able to effect enough change to impact the severely increased metabolic and cardiovascular risks.

Reduction of prescribed psychopharmaceuticals, however, is a feasible intervention that results in massively reduced risk. Ilyas focuses on antipsychotic drugs, which are known to carry an immense side effect burden that significantly reduces life expectancy. However, evidence also indicates that antidepressants, including SSRIs, carry serious cardiovascular risks as well. In fact, a recent study suggested that SSRIs increase risk of death by about 50%. Antidepressants have also been linked to increased risk for diabetes.

Ilyas concludes:

“Healthcare services should consider a shift away from physical health monitoring strategies and instead focus their resources on primary prevention strategies that are provided to all people with serious mental illness from the moment they first present to mental healthcare services. These include assertive smoking cessation (with pharmacological support), diet and exercise interventions and where possible, to avoid long-term prescription of antipsychotics associated with adverse metabolic outcomes. This approach could help to substantially improve the long-term health and life expectancy of people with serious mental illness.”

 

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Ilyas, A., Chesney, E., & Patel, R. (2017). Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention? The British Journal of Psychiatry, 211(4), 194-197. doi: 10.1192/bjp.bp.117.203240 (Link)

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9 COMMENTS

  2. Need you be so tentative. I think we can safely say, Reducing Antipsychotic Use WILL Improve Health for People with Mental Health Diagnoses. I have known a few people in treatment who died of heart attacks. Were shrinks more health conscious, given a reduced dosage, some of them might still be around today.

  3. “Healthcare services should consider a shift away from physical health monitoring strategies and instead focus their resources on primary prevention strategies that are provided to all people with serious mental illness from the moment they first present to mental healthcare services. These include assertive smoking cessation (with pharmacological support), diet and exercise interventions and where possible, to avoid long-term prescription of antipsychotics associated with adverse metabolic outcomes. This approach could help to substantially improve the long-term health and life expectancy of people with serious mental illness.”

    The problem with this strategy is that the “safe smoking cessation” drugs are antidepressants, as opposed to being “safe smoking cessation” drugs. And the antidepressants can create mental health symptoms, including “mania” and “psychosis.” Symptoms which get misdiagnosed as “bipolar” or “schizophrenia.” Misdiagnoses which result in patients inappropriately being put on the antipsychotics.

    A better strategy would be to encourage smoking cessation, WITHOUT the use of pharmacological support. I do agree, the psychologists and psychiatrists who have been telling patients to “quit all your activities and concentrate on the meds” and to quit exercising, have been giving patients insanely stupid advice. Exercise and proper nutrition are, of course, both important for a healthy mind, body, and soul.

    And I absolutely agree ending the massive over drugging of people with “long-term prescription of antipsychotics associated with adverse metabolic outcomes” is very important. Especially since the antipsychotics can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and anticholinergic toxidrome.

    Which, of course, means that the most common cause of the “serious mental illnesses” is likely iatrogenesis, as opposed to the incorrectly assumed “genetic” etiology. It’s a shame today’s “genetic” obsessed psychiatrists didn’t learn from the eugenics deluded Nazi psychiatrists’ mistakes.

    One does wonder how many decades it will take for today’s DSM deluded to realize their “bible” is a classification system of the iatrogenic illnesses that can be created with the psychiatric drugs, as opposed to being a scientifically valid classification system of “real” “genetic” illnesses.

    • In the old days, people with “mental illnesses” lived as long as anyone else. What would we do without those “safe and effective treatments?”

      I have lost 35 pounds of the 180 I packed on over the years. While I continue to lose, my heart arrhythmia shows improvement. I prefer water to soda pop when thirsty and only crave junk food occasionally. Coincidence?

      Remember boys and girls: neglecting your mental health can add 25 years to your life! Lol.

      • Kudos, FeelinDiscouraged, keep going! 🙂 Motivate me, I need to lose a few too. I’ve had what feels like a strange heart arrhythmia, ever since my last encounter with our satanic “mental health” industry. It is horrendous how the antipsychotics make you crave sweets and junk food, isn’t it?

        What’s good, though, is being weaned off the neuroleptics can cause a drug withdrawal induced super sensitivity “manic psychosis.” Which can result in lots of dancing, bike riding, gardening, and other forms of exercise, which does result in weight loss. My friends were actually telling me I was “too skinny,” just after I was weaned off of the psychiatric drugs.

        Soon you may have to change your name?

  5. Thanks for the article Peter. You’re preaching to the choir here.

    Of course the doctor you quote only suggests occasional switching to “less damaging” drugs. Old school neuroleptics I presume?

    The obvious solution–finding another remedy for madness–is not worthy of consideration. Dr. Ilyes would need to give up his prestigious job with a 7-digit income. Better to shut his eyes and grope around the elephant in the living room. 🙂

  6. When I was a teenager, I went to a psychiatrist who practically made a religion of polypharmacy. When the initial drugs made me worse, she tried to medicate the adverse effects as if they were a new mental illness. I was never psychotic or manic. I did not fit the criteria for antipsychotics. She just used them as a shot in the dark because the SSRIs had failed to magically fix this so-called chemical imbalance, and it was easier for her to write prescriptions then to actually talk to me.

    I refused medications that would cause weight gain, as I wanted a healthy metabolism. This was seen as evidence of irrationality and noncompliance. So she lied about the risk.

    I gained 15 pounds in 2 weeks. This was with no change in diet or exercise, only change was the drugs. I very quickly developed symptoms of diabetes: constant thirst and frequent urination, puffiness, constant hunger that could never be satified, sleepiness after meals, lethargy, mood swings, weight gain, fatigue, high cholesterol, etc. This continued after cessation of the drugs. I spent my 20s 40 pounds overweight and ashamed.

    Because my fasting blood sugar was normal, doctors ignored the signs of diabetes. Given my symptoms and medication history, it should have been in the radar. It wasn’t. It was finally diagnosed through a glucose challenge.

    I am a normal weight now and have been off psych drugs for years but I have to take diabetes medication with every meal. I have to strictly limit carbs and the times of day I can eat. I cannot tolerate ANY carbs without medication. If I eat an evening meal, even with medication, I will get dawn syndrome, neuropathy, frequent urination, and eye problems. I gain weight if I eat extra carbohydrates, even in a calorie deficit.

    The kicker is, I’m technically not even in the diabetic range, I’m still prediabetic. Do these drugs not only cause metabolic syndrome, but also make us more sensitive to it?