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Comparing Psychiatric and General Medical Medications: What Does the Evidence Say?

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The debate continues to rage about whether psychiatric medications work. This controversy especially has brewed about antidepressants and antipsychotic medications, some of the most widely used medications in the world. An important study just published in the British Journal of Psychiatry sheds light (not just makes for heat and wind) on this vital subject.

In a carefully constructed research study called a meta-analysis (where the results of many studies are examined to answer specific questions), the authors provide (in their words) "The first ... panoramic overview of major drugs." They looked at 48 different drugs used to treat 20 general medical diseases and 16 different drugs used to treat eight psychiatric diseases. The researchers concluded that the psychiatric drugs, overall, were as effective as those used in general medicine.

Their research approach was to select a specific disease and then look at rigorous studies on the response of that disease to medications commonly used to treat it. Examples for general medical diseases included:

  • In chronic heart failure, how well were angiotensin converting enzyme inhibitors and receptor blockers, beta-blockers and diuretics in reducing death and how did digitalis do in reducing hospital admissions?
  • How effective were proton pump inhibitors (PPIs) in controlling symptoms for acute reflux esophagitis and in maintaining control of those symptoms?
  • How effective was aspirin therapy in preventing cardiovascular events and death?
  • In the treatment of Parkinson's disease, how effective were drugs that increase brain dopamine?
  • How well did steroids and beta-2 agonists control chronic asthma?
  • What about the efficacy of chemotherapy for breast and lung cancer?

Some other common diseases (and their treatments) they reviewed included hypertension, hypercholesterolemia and rheumatoid arthritis.

The researchers also asked, and answered:

  • In people with schizophrenia, how well did antipsychotic medications reduce overall symptoms and prevent relapse?
  • In bipolar disorder, how effective were mood stabilizers in acute mania and for relapse prevention?
  • In major depression, how well did antidepressants (ADs) work for acute depression and for relapse prevention? (By the way, they found better for the latter, though the data is confusing for the former because ADs were used in mild and moderate cases where their performance is not as robust as it is with severe depression.)
  • For people with Obsessive Compulsive Disorder (OCD) how did the serotonin reuptake inhibitors (SRIs) do in controlling symptoms?
  • How effective were psychostimulants on the symptoms of attention deficit hyperactivity disorder (ADHD)?

They also reported on treatments for panic disorder and Alzheimer's disease.

While some individual drugs for (a few) medical conditions outperformed the psychiatric drugs they studied (and a few did not perform as well!), as a whole the two groups were about the same in terms of their efficacy.

The authors also noted that the benefits of medications can accrue over time -- a reminder that continuous (ongoing) treatment makes more of a difference. This is a message for patients, families and policymakers alike.

All medications have side-effects and risks, not only benefits. Informed patients and their families need to carefully weigh, and discuss with their doctor, risks and benefits when making decisions about their health, including the use of medications.

It is important for those affected by psychiatric illnesses to see this research. When it comes to benefits, psychiatric medications hold their own when compared with general medical medications in the treatment of a great number of diseases that affect so many people.

References:

[1] Stefan Leucht, Sandra Hierl, Werner Kissling, Markus Dold and John M. Davis. "Putting the efficacy of psychiatric and general medicine medications into perspective: review of meta-analyses." The British Journal of Psychiatry 2012, 200:97-106.

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