An Important Look at Mortality in Mental Illness

Jeffrey A. Lieberman. MD


October 28, 2013

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A Decade of Data on Psychotropic Drugs

A Decade of Data on Psychotropic Drugs

Hello. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

I would like to comment on an article that recently appeared in JAMA Psychiatry,[1] formerly known as the Archives of General Psychiatry. This article appeared online at the end of August. The authors were a group of investigators led by Dr. Arifulla Khan of the Clinical Research Center in Bellevue, Washington, who, through a Freedom of Information Act request, obtained data from the US Food and Drug Administration (FDA) about psychotropic drugs that were evaluated from 1991 to 2011.

The psychotropic drugs of interest were those used to treat schizophrenia; bipolar disorder; depression; and other conditions, such as anxiety disorders and attention-deficit/hyperactivity disorder. The focus of my comments will be on the very interesting results pertaining to schizophrenia, bipolar disorder, and depression. After obtaining these data, the investigators asked the question of whether mortality was increased in patients with these disorders relative to the general population, and whether there were differences in mortality rates in patients who received psychotropic medications compared with those who received placebo.

They found, as has been previously reported many times, that individuals who have psychiatric disorders, and particularly schizophrenia, bipolar disorder, and depression, have lower overall survival (increased mortality). Of interest, being on a psychotropic medication (antipsychotic, mood stabilizer, bipolar medication or a combination of drugs) was associated with increased survival and lower mortality in patients with schizophrenia or bipolar disorder.

This is important, because it has previously been suggested (and this fact has been used by critics of psychotropic medications) that psychotropic drugs, particularly the second-generation antipsychotic medications or mood-stabilizing drugs, contribute to side effects and medical comorbid conditions that shorten survival and increase mortality. These findings suggest that the opposite is true. Being on the medication in no way increased mortality; in fact, it actually reduced mortality, despite the fact that the studies that were obtained and analyzed were largely acute treatment studies of short duration, not the long duration that patients take these medications.


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