An expert has argued that long-term use of psychiatric drugs for many conditions, including antipsychotics and drugs prescribed for people with dementia, may do more harm than good. His views are countered by a professor of mood disorders and a psychiatric patient as part of a debate published in The BMJ.
In the article, Prof Peter Gøtzsche of the Nordic Cochrane Centre in Copenhagen argues that many drug trials have failed to properly evaluate the effects of many drugs. Prof Gøtzsche points out that a study of antipsychotics in people with dementia showed people taking the drugs were more likely to die than those not taking antipsychotics. He also suggests that evidence for the effectiveness of dementia drugs such as cholinesterase inhibitors – which are usually prescribed to help with the symptoms of Alzheimer’s disease – is lacking.
Countering this argument, Prof Allan Young from King’s College London and John Crace, a psychiatric patient, point out that all drugs are assessed by regulators both before and after they are licensed for use. They argue that, although any treatment may do both good and harm, it is important assess the risks for individual patients on a case by case basis.
Dr Simon Ridley at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:
“This important debate focuses on a wide range of drugs used for numerous conditions, but it is very difficult to generalise about the relative benefits and drawbacks of such a large number of varied treatments.
“The dangers of long-term use of antipsychotic drugs for symptoms of aggression and agitation in dementia were highlighted in an Alzheimer’s Research UK-funded study in 2009, and since then moves have been made to reduce their use. Antipsychotics may be prescribed in the short term to help with agitation, an extremely challenging symptom of dementia, but these drugs should only be given when there is no other option for dealing with these symptoms, and their use should always be carefully monitored.
“The most commonly-used drugs for dementia, cholinesterase inhibitors, have been found in several studies to help some people cope with symptoms such as memory loss. Although these do not work for everyone and the effects for some people may be small, many people report significant benefits with these drugs offering relief from distressing symptoms. Alzheimer’s Research UK would not support the removal of these treatments from people who may benefit.
“All medicines carry side effects and it is important for the potential harms of any drug to be weighed against its possible benefits, and for treatments to be monitored closely. Ultimately, we still need treatments that can stop the diseases that cause dementia in their tracks, and these can only come through research. With 850,000 people living with dementia in the UK, the need for continued investment in research has never been more urgent.”