I regard myself as integrative which means working collaboratively with other health professionals to get the best outcomes for our shared patients, sometimes that means my patients are taking psychiatric medications & there have been instances where I have seen the necessity and benefit of the right drug at the right time. This might be in the form of short term use of atypical antipsychotics, so a recent article linking higher rates (approx. 50%) of diabetes with the use of atypical antipsychotics specifically in teenagers, caught my eye. The link between diabetes and schizophrenia has been known about for over half a century: there is an association between the two conditions directly (unclear mechanism), however, this association is actually strengthened in medicated patients – especially those on atypical antipsychotics (e.g. olanzapine, resperidone, quetiapine). Proposed theories include the dramatic weight gain typically caused by daily use of these drugs, for example 10kg in the first year is not uncommon however there are also studies which demonstrate insulin resistance in healthy weight patients taking the same meds.
When these findings initially came to light, they were largely disregarded because the ‘pros’ that these drugs offered psychotic patients compared with previous drug options was considered to outweigh the ‘con’ of this potential side effect but I am starting to wonder…just a bit.
The other part to this story is that atypical anti-psychotics are increasingly being prescribed off-label (for conditions which they are not specifically approved for by the TGA or equivalent international authority & for which there is often inadequate evidence of efficacy). So while, few of us would argue about the appropriateness of effective medication for someone diagnosed with schizophrenia, should we be considering the risks more closely in those individuals being given the same drug for anxiety, sedation, PTSD and dementia (the four most common off-label uses of atypical antipsychotics by NZ psychiatrists in 2011 https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2011/vol-124-no-1336/article-monasterio )?
Australian data in 2013 revealed that 66% of GP prescriptions for atypical anti-psychotics were for the treatment of conditions other than schizophrenia or bipolar disorder (https://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/psd/2013-08/antipsychotics) and in some instances this is in children and teenagers. This prescribing pattern reflects international trends but many authorities are calling for an urgent rethink.
Need more food for thought?…this extraordinary interview with Peter Gøtzsche (one of the founders of the Cochrane Review) on the risks of over-diagnosis & over-treatment of psychiatric conditions, specifically is an ABSOLUTE MUST WATCH! www.youtube.com/watch?v=VIIQVll7DYY. I’m keen to hear your thoughts…