Anti-psychotic drug ‘plague running unchecked'

[Chip (OP)]

http://www.theaustralian.com.au/national-affairs/health/anti-psychotic-drug-plague-running-unchecked/story-fn59nokw-1227465457211

Anti-psychotic drug ‘plague running unchecked'

Doctors are putting an average of 20,000 additional Australians per year on antipsychotics, many of which are prescribed “inapprop­riately” for com­mon conditions, as experts warn of widespread costs to physical health from misuse and under-monitoring of the powerful drugs.

Prompting claims of a “plague” of unjustified prescribing, government figures released this week show that antipsychotics were dispensed to more than 433,000 Australians in 2013-14, a one-third increase on 2008-09.

The total number of anti­psychotic prescriptions — most of which are written by GPs — rose by 44 per cent in that period, from 2.5 million to 3.6 million, far outstripping the rate of growth in anti­depressants, as well as population growth.

Sydney University drug-use researcher Emily Karanges said the figures were “disturbing”.

“Antipsychotics are an import­ant and lifesaving treatment for some conditions, such as psychotic illness, but they are also powerful drugs with a lot of potent­ially serious side-effects,” Dr Karanges said.

“This idea that they are completely harmless and we can frequently use them in more mild conditions like anxiety and sleep is very concerning.”

Concord Clinical School psych­iatry professor Tim Lambert said there was a “plague” of inappropriate prescribing, rates of medical monitoring of their use were “atrocious” and significant adverse effects were “absolutely” occurring on a wide scale.

Antipsychotics are the “corner­stone”, evidence-based treatment for schizophrenia and are also effective in the treatment of other serious conditions, such as bipolar I disorder.

Experts say their concern about use in a widening array of conditions is that often benefits have not been substant­iated or are outweighed by the drugs’ ­adverse effects.

Sydney University professor of geriatric pharmacology David Le Couteur said adverse consequences included obesity and diabete­s, “and, in our older popul­ation, mortality, strokes, falls and fractures, and impaired quality of life”. Some antipsychotic medications can cause weight gain and metabolic disturbances, which can increase risk of future diabetes and cardiovascular disease.

Metabolic monitoring and management is recommended to help counteract side-effects, and research is showing exercise and diet programs can significantly reduce these effects.

The Weekend Australian has identified research audits showing many health services have been failing at high rates to complete monitoring protocols, often performing them for fewer than one-third of patients.

While agreeing there was “overuse and crude use” of antipsychotics, Univer­sity of Melbourne professor of youth mental health Pat McGorry defended their use and importance, and cautioned that there was “underuse and seriously delayed use too”. “For patients who respond well to antipsychotics, the benefits definitely outweigh the problems,” he said.

“For most people with serious psychosis, the antipsychotics work and either abolish or reduce their hallucinations and delusions — you can see them melt away over a period of weeks.” The drugs’ advent had transformed the lives of those formerly left to endure “decades of suffering”.

Regulatory authorities have named the unjustified prescribing of antipsychotics to elderly people with dementia and to older children, adolescents and adults with sleep and anxiety problems as particularly concerning.

Stopping antipsychotics can cause negative and dangerous outcomes. Experts advise those with concerns to consult a doctor.

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[Roman Totale]

Hmm, GPs writing anti-psychotic prescription, is something I don't think I've ever encountered/heard of, even in script-happy United States, where GPs will quite casually put their patients on serious SSRI (and often benzo) regiments.  Seems a bit much, other than maybe low-dose Seroquel or something for insomnia that hasn't responded.

[Chip (OP)]

the meds. have no street value and doctors must feel safe about prescribing them.

they also don't tend to get abused and I have seen them work like magic to the mentally ill.

I have my own reasons for using them, also.

[Roman Totale]

Well certainly I've seen people with severe mental illness (mainly schizophrenia) enormously helped by anti-psychotic medication.  And there's nothing like an anti-psych to knock you out when you absolutely can't sleep, if you're not on it all the time

In the States, Seroquel is definitely the anti-psychotic that's in vogue, with doctors prescribing 25mg-100mg just for insomnia. And anecdotally, Seroquel is picking up a little bit of street value in the US for coming down off crack binges or meth runs.  Plus some value in prison, for sleeping off stretches I guess.

[Narkotikon]

It's all too common for psychiatrists to overprescribe antipsychotics to certain patient groups.  While they can be helpful for Schizophrenia and Bipolar Disorder, they're also used "off label" for things they shouldn't be.

I've been scripted Risperdal, Geodon, and Abilify in the past for anxiety issues.  I can see them being helpful simply b/c they're sedating, but overall I think they're misused for that purpose.  There are just too many serious side-effects connected to antipsychotics to warrant their use for anxiety.

Suboxone doctors for instance encounter a lot of patients with anxiety problems.  Rather than use a benzo, which they claim is totally harmful and inappropriate when used with Suboxone, they'll often script Risperdal, Geodon, Abilify, or Seroquel simply b/c they're sedating.

I find that funny b/c Sub doctors are primarily concerned with added sedation on top of the Subs.  They automatically assume an OD will happen.  Therefore benzos are a  no no.  But honestly, antipsychotics are just as sedating, if not moreso.  They'll knock you on your ass.

Even the PDR says Suboxone and benzos should only be used in combination when the patient is either tolerant to opiates or benzos.  In that case, they're much safer.  Obviously if you're on Subs, you're tolerant to opiates.   

No, they're not afraid of sedation.  They just don't want to trust Sub patients.  Even if you've been compliant and been a "good" patient, some doctors simply refuse to trust their Sub patients.  They're forever marked with the taint of addiction. 

I find that amusing b/c part of the recovery process is to gain back trust.  Doctor's who aren't willing to trust undermine the whole process.  What's the incentive to progress and change if there aren't any noticeable results?      

At a certain point some patients need to realize their doctors aren't ever going to trust them.  At that point, I say move on and find a new doctor.  There are too many Sub doctors to stay with an uncaring asshole.