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Lloyd I. Sederer, MD

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

Posted: 03/28/2012 8:17 am

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.

www.askdrlloyd.com

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

Visit Dr. Sederer's website (www.askdrlloyd.com) for questions you want answered, reviews, commentary and stories.

For more by Lloyd I. Sederer, M.D., click here.

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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 medica...
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 medica...
 
 
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This user has chosen to opt out of the Badges program
08:57 PM on 03/31/2012
There is now lab analysis diagnosis and very effective nutritionally based treatment for a broad spectrum of neurotransmitter related illnesses, without the use of dangerous psychiatric drugs, through this lab: http://www.sanesco.net/

my child's depression symptoms were completely cured after only 3 weeks of targeted nutritional therapy
04:40 PM on 03/31/2012
Drugs for Parkinson's actually hasten you to the grave . I know people with Parkinson's whose doctors admit that while they may get temporary symptom relief , the drugs make the condition progress faster.
Steroids actually make allergies ans asthma worse and they have a ridulous number of side effects such as ruining the immune system , adrenal exaustion, osteoporosis, depression that are usually much worse then the symptoms they are used to treat.
Aspirin is used for arthritis but it actually hastens destruction of joints.
You have about the same chance of being alive seven years after a breast cancer diagnosis whether or not you get chemotherapy. As far as psychiatric meds , you might want to look at www.antidepressantsfacts.com and books by Glenmullen and Breggin before you try them
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rosiesgal29
08:44 PM on 03/30/2012
PERSCRIBED BUT NOT AVILABLE FOR DIABETICS APEIDRA PEN IVE DECIDED TO JUST FORGET IT OVER A HUNDRED BUCKS A PEN AND WITH OUT THE PEN IM AFRAID ILL GET TO MUCH
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Kelly Carroll
04:34 PM on 03/30/2012
Fight the drug companies. Go organic and natural if you can. Taking synthetic drugs not only isn't very effective, there are tons of side-effects, and many times create another problem, so you have to take more drugs. Cure with food if at all possible.

A great book to read is 'Why Does My Body Feel this Way'? It explains how to work on making your symptoms less worse. Yes, it endorses Shaklee (mostly), a company they prefer. However, Shaklee has been around for 50+ years, and is a safe company, vs. what is on the shelves these days.

Did you know the FDA only requires 10% of what the bottle says to be in the bottle for stuff you buy off the rack? It is full of pesticides and poison, and just by doing research, you'd be horrified by what is out there, being encouraged as 'healthy' or 'nutritious'.
04:31 AM on 03/31/2012
i agree that the FDA is not doing enough. they are so understaffed and limited as far as resources and power go that their hands are tied. we ll suffer for that.

i'm sorry, though, but asthma, bipolar disorder, cancer, and schizophrenia need medication, point blank. i do think that there is room for alternative therapies or herbal or dietary changes that would help in conjunction with traditional medicine.
This user has chosen to opt out of the Badges program
08:58 PM on 03/31/2012
Natruropathic is the way to go.
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01:43 PM on 03/30/2012
More Big Pharma BS propaganda. Most Americans don't know that the federal entity tasked with (FDA) policing the drug companies is actually just a marketing tool for the drug companies. The very people paid to watch our back our being lobbied by BIg Pharma so the people controlling what drugs are deemed safe and effective are the people making money on those drugs. Big Pharma also pays scientists to conduct "studies" on effecicy of drugs and when the finding aren't good, they simply trash that report and do another until the drug is more effective than a sugar pill. Thats all it has to be, better than a sugar pill. I didn't write this very well so Google it lol sorry
04:19 PM on 03/31/2012
You are right . The FDA does not conduct studies on drugs. It just takes the results from the drug companies that run and spin the data and then approves drugs.
01:23 PM on 03/30/2012
In the USA there are alot of Drugs that are abused but the Pharmacuticul companies and Politicians like it that way because it means more money in thier Pockets. They wont make Marijuna Legal for medical use because the Pharmacuticul companies then wouldnt be able to make as much money and the Politicians wouldnt get as much in bribes,they Continue to Use the piece of 1940's Government Made Propaganda "Reefer Madness" As A Documentory and factual when there is nothing in the Movie that is even close to the truth except that sometimes people want to eat after using it
12:16 PM on 03/30/2012
My wife is on quite a few medications for several medical conditions. As long as she takes her medications regulariy and on schedule she is fine. She is also allergic to many medications and has to use name brand drugs for some of her medications because generics don't work. Recently she was hospitalized for pneumonia. I supplied the hospital with a detailed list of all her medications and which ones had to be name brand only. The hospital disregarded my instructions and gave her generic for all her medications. They also gave her a dosage of a medication that she has for anxiety that was 8 times the amount she had ever taken before in her life. She normally takes this when she is under a lot of stress and only 1/2 of the dosage that is prescribed. She was so messed up after she recovered from this pneumonia that it took a month to get her back to normal. Ifshe ever goes to the hospital again I will administer her own medications and keep her on schedule.
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rosiesgal29
08:45 PM on 03/30/2012
IF YOUR ON MEDICARE THEY WONT OKAY A NAME BRAND SCRIP AND LIKE THE WIFE IM ALLERGIC TO MOST EVERYTHING
12:16 AM on 03/31/2012
We are on Medicare, but our secondary insurance covers our drugs.
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LSULinebacker64
TRUTH, FAITH, & TRUST in your HEART, SOUL, & MIND
10:34 AM on 04/01/2012
I'm on Medicare an my seizures were getting very bad... I got my doctor to call mt local police station to chech the call they've been having on me... Then he got in touch with the Medicare company to get me my Zonegram instead of the other one...
04:21 PM on 03/31/2012
If she got pneumonia she may have gotten it from taking immunosuppressive drugs like steroids.
05:56 PM on 03/31/2012
Yeah, she has severe asthma and had a bad exposure to perfume that gave her a bad attack, which lowered her immune system. This is the danger we face everytime she gets exposed to one of her asthma triggers like perfume, smoke, pollutin or anything else that is a problem for her.
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Stagger Lee1
Never Back Down
11:12 AM on 03/30/2012
My last post about my medication for M,S. sometimes are used for other purposes, like ADHD. The medications that are a controlled substance are a pain to get. Sometimes my pharmacy has it and sometimes my wife will have to call other pharmacies in other cities and have to drive at least 50 to 100 miles to get the exact dosage. Prescription has to be handed by hand to the pharmacy. In other words my Dr. cannot call in another dosage, for the med. I have to be taken to the Dr. (120miles) for another. Geting my meds. are almost a full time job, mostly for my wife, because she can keep up with everything better than I can, and she is the only person I have to take care of all the problems that I have.
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susanherna121377
11:11 AM on 03/30/2012
Headline malfunction!
It said Drugs prescribed but unavailable!
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mspat44417
Rock it if ya got it...Music
11:10 AM on 03/30/2012
Why when I clicked on the link it says drugs no available ? Says nothing in the article that they aren't It only makes since that these drugs would work if it alerts the brain chemistry or mood...Only the people taking the meds can tell you if they work or not...
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Stagger Lee1
Never Back Down
10:53 AM on 03/30/2012
I have almost as much trouble getting my medication for Multiple Sclerosis, as the symyoms. I take 14 pills in 1 day. When I have a flair-up I can no longer have steroids to stop the nerve damage. I had so many flair ups in a 2 yr. period, they have destroyd my hip joints. I now have to take an IVCG introveniosly, the last one in December, I believe the flair up had already done its damage. It took almost a month for my Dr. to get my insurance to cover the 16,000 dollar cost. The treatment crosses the blood/brain barrier, causing me to have menigitis. More of my daily meds. are controlled substances, insurance has decided a different med. will work. Dr. says no, as does my pharmacist. now I am out several hundred dollars monthly too pay myself. After 1 hip replacement, and needing another, with the stress of worrying about getting meds. without withdrowels is a headache I could do without. 3 month statement says $44,000 has been paid on me. what do you do?,,give up?
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offcenterlevi
01:33 PM on 03/30/2012
I'm so sorry you have to go through this. The people who say we have the best medical system in the world, and that private insurance companies are a better alternative than socialized medicine, really don't know what they're talking about.
09:31 AM on 03/30/2012
I fought against my counselors for two years about seeing the psychiatrist to get proper medication on board for my mood disorder. I kept telling myself that talk therapy was enough. Finally, I agreed (I greatly distrust the pill doctor, and I told him that on my first visit with him). We spent a couple months figuring out what meds I needed and what dosages (he's very conservative in his approach to medication, and his goal is to give as as little as necessary, and only what is necessary, not to throw a bunch of pills at you).

Once the right medication was on board, it was amazing. It was as though I could finally USE the talk therapy I had been working through the past couple years. One did not work without the other.
04:34 AM on 03/31/2012
my experience was nearly identical to yours! happy to hear you are doing well!
04:26 PM on 03/31/2012
When properly anayzed, studies show that antidepressants are no better than placebos short term and that they are worse than placebos long term , not to mention common side effects such as tardive dyskinesia, dystonia, akathesia. The Nov 10 Newsweek had an article stating that millions of people are afflicted with mysterious tics and other neurological symptoms . These life altering symptoms are probably drug adverse reactions.
08:39 AM on 03/30/2012
i have a bipolar problem with severs depression,and ocd disorder im very impolsive i take at least 5 different meds for these issues nite and mornning i use to self medicate with drugs and alcohol my mother and our intire family on both sides have depression and bipolar problems its genitic if anyone says different they dont know what theryr talking about ive been taking these meds since 1990 i cant funtion with out them they work side affects are memory loss weight,and a few other side affects it took a long time to get the right meds to work for me everyone is different in thier therapathy if i mis a couple of doses of just one kind i get mean and become bad in with draws my children also have these problems lucky i knew what thier symtoms where and told them where to go for help as long as they stay on thier meds thier good it has changed theyer whole lives from being miserible to being productive members of society
07:45 PM on 03/30/2012
I'm glad you were able to get help and pass it on to your kids. Good job!
04:28 PM on 03/31/2012
Millions of people have had their lives ruined by these drugs. There are many support groups online for people suffering from these drugs long after withdrawal
viciousvirago
Veritatum Dilexi
10:22 AM on 03/29/2012
It is a fact that instead of using talk-therapy for their children, most parents will just medicate. Two reasons: so-called faster results; or 2) it is not covered by their medical plan.

I and my son have an excellent medical plan. I took my son to therapy years ago and it helped. When he broke his tibia, the total cost of everything was $27,000, nearly all covered.

Drugs are overprescribed in this country because the pharmaceutical industry has a vested interest in doing so. It DOES take, sometimes, billions of dollars to develop a drug and they have to get that money back. But are doctors complicit in this? Yes. Why? Because they have waaaay too many patients to see. Why is that? Because the reimbursement rates have gone down dramatically.

I am on 8 to l0 medications for my disease at any given time. One costs $490/month. The others are generic and I think have ceased to function adequately, yet still my internist says 'take them'. As a former surgeon, I know better and decided not to take them.

You, as a patient, HAVE TO ASK QUESTIONS of every drug you are prescribed. It is your body and doctors are not gods.
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GOODDOC1
"civil war" is an oxymoron
10:49 AM on 03/30/2012
It should be a health care TEAM, and you are the captain, although your various crew members have expertise to add. You have to make the decisions. The only exception MIGHT be in a true, life-threatenting emergency, where hopefully you've built up enough trust in your team so they can help you.
viciousvirago
Veritatum Dilexi
11:45 AM on 03/30/2012
Civil war IS an oxymoron, well put.

I agree with your assessment. And forgive the typo. I mean to say "...and I think THEY have ceased..."

I've had three good, very good o.r. nurses, one of whom went with me to Iraq for two years. Nurses are the BACKBONE or any surgical team, especially trauma surgery. Which is why I gave $l0K every Christmas to my team members, the nurses, that is. The docs made enough.

Thank you for your post. Most cogent.
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Vajara
vajara
10:06 AM on 03/29/2012
Why don't the researchers just compare apples with oranges, they are both fruit and come from a tree. Compare the drugs with placebo's and report their benefits & side effects. The mental health drugs produce side effects beyond the understanding and appreciation of their dangers. The protocol for mh drugs when side effects are encountered, take the patient off of the last drug prescribed. Is this science or Russian Roulette?