COMMENTARY

An Important Look at Mortality in Mental Illness

Jeffrey A. Lieberman. MD

Disclosures

October 28, 2013

Treatment Enhances (not Diminishes) Survival

These findings are consistent with earlier published reports that suggested that survival is enhanced by treatment as opposed to being diminished by treatment. The importance of this finding is that it suggests that although medications may have side effects, overall survival is affected more adversely by the illness or associated lifestyle factors, such as engaging in high-risk behaviors that could result in violent death or suicide. The illness itself is more injurious to survival than the medications that are used to treat it.

With respect to depression, mortality was higher, but in the comparison between people on serotonin reuptake or serotonin norepinephrine reuptake antidepressants and those on placebo, there was no difference in survival rates. No benefit or disadvantage was associated with taking the medication. However, when death by suicide was examined, it was found that being on medication as opposed to being on placebo was associated with greater longevity and lower mortality, suggesting that antidepressants were helpful in reducing suicide rates and mortality from suicide.

The bottom line from this very good and important study, which was carried out with a large amount of data obtained from the administrative database of the FDA, is that psychotropic drugs are in the aggregate very beneficial -- not just in suppressing patients' symptoms, but in extending their overall survival and reducing mortality. In the ongoing debate in the literature as well as in the media about whether psychotropic drugs are overprescribed or are potentially detrimental to health, as physicians we must always be aware that medications should be used only when indicated and very judiciously in all people, particularly in children and the elderly -- but we should never withhold them when they are needed, because they are very beneficial in terms of therapeutic effects. They should not be avoided, and their benefits are not substantially mitigated by concerns about adverse effects and shortened life spans.

Take a closer look at this study. It clearly illustrates the benefit of using medications when medications are warranted for treating mental illnesses, such as schizophrenia, bipolar disorder, and depression. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

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