(June 21, 2016) Often overlooked in debates over the merits and drawbacks of antipsychotic medication is its role in reducing suicide by individuals with schizophrenia, who die approximately 20 years younger than their unaffected peers in the United States.
"One way anti-psychiatry groups trivialize psychosis and marginalize psychiatry is by emphasizing the adverse effects of antipsychotic medications while denying or minimizing their benefits," writes Ronald Pies, MD, in the June issue of Psychiatric Times. "To be sure, the well-recognized metabolic, neurological and cardiovascular risks associated with many antipsychotic medications must be taken very seriously. Moreover, antipsychotics (APs) are often used when they are not needed....
"On the other hand, there is convincing evidence that in patients with chronic schizophrenia, APs play a crucial role in maintaining remission, averting relapse, improving quality of life and - importantly - reducing overall mortality" (author's emphasis).
In other words, despite their medical side effects, antipsychotic drugs appear to save lives.
Antipsychotics and Suicide Prevention
Pies writes that "even many psychiatrists" may be unaware of the role antipsychotic medications play in reducing suicide among individuals with schizophrenia, whose lifetime risk of killing themselves is at least 10 times that of the general public. He cites research that "the only consistent protective factor for suicide" is delivery of and adherence to effective medication, particularly clozapine, the only medication approved by the FDA for the prevention of suicide.
While clozapine is well-documented for its effectiveness in reducing suicidal behavior (e.g., suicide attempts, hospitalizations and rescue interventions), Pies reports "there is accumulating evidence that antipsychotic medication in general is associated with decreased risk of suicide" in schizophrenia. He cites studies with findings of:
- Excess mortality mostly in schizophrenia patients not taking antipsychotic medications (26 suicides in patients not taking APs vs 1 in patients taking them out of a population of 2,230 patients)
- 400% increase in risk of attempted suicide among patients who stopped taking prescribed olanazapine or risperidone for at least 30 days
- Maximum anti-suicide benefits at higher dosages of antipsychotics
"It would be incorrect to infer from this brief review that the optimal treatment of schizophrenia is simply a matter of giving patients antipsychotic medication," writes Pies, a professor of psychiatry at SUNY Upstate Medical University and Tufts University School of Medicine. Psychosocial services such as assertive community treatment, supported employment and family-based services also confer important benefits, he said
"But there is little question that, for patients suffering the chronic, debilitating symptoms of schizophrenia, antipsychotic medication is a critical component of treatment - and may literally be lifesaving."
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Pies, R. (June 2016). "How antipsychotic medication may save lives." Psychiatric Times.
- Torrey, E.F. et al. (November 2015). Clozapine for treating schizophrenia: A comparison of the states. Treatment Advocacy Center.
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