“Contrary to expectations,” a new study published by the Journal of the American Medical Association reports that the early death associated with severe mental illness is not related to short- and medium-term use of psychotropic medications, such as antipsychotics and antidepressants.
In fact, overall mortality was found to be lower among patients with schizophrenia who were treated with antipsychotic medications than among those given placebo (“Comparative mortality risk in adult patients with schizophrenia, depression, bipolar disorder, anxiety disorders, and attention-deficit/hyperactivity disorder participating in psychopharmacology clinical trials,” Aug. 28; full content available only to subscribers or by purchase).
“The increased mortality risk observed among patients with severe psychiatric illness, including schizophrenia, does not seem to be attributable to use of psychopharmacologic therapy,” according to a summary of the study published by Medwire (“Increased mortality in schizophrenia ‘not attributable to drug therapy,’”Sept. 4).
A research team from the Duke University School of Medicine used the Freedom of Information Act “to obtain data from the US Food and Drug Administration on the safety and efficacy of 43 psychopharmacologic agents approved between 1990 and 2011.” Data for 92,542 patients who participated in placebo-controlled trials were surveyed.
Risk of death was strongly associated with diagnoses of schizophrenia, depression and bipolar disorder but not with anxiety disorders or ADHD. Mortality risk was 3.8 times higher among patients diagnosed with schizophrenia, 3.2 times higher in those with depression and 3.0 times higher for patients with bipolar disorder.
Suicides accounted for 41.1% of the deaths that occurred in the study group, according to the study.
Opponents of court-ordered treatment for acute or chronic psychiatric disease often argue that the medications typically included in assisted outpatient treatment (AOT) orders place participants in the programs at risk for early mortality and other poor outcomes. As JAMA says in its abstract of the study, “There is concern that increased mortality risk among patients with psychiatric illness may be worsened by psychopharmacological agents.”
This study of nearly 100,000 patients will not be the final word on mortality risk – as the authors write, “further research is needed to support firm conclusions” – but it provides credible affirmation drug therapy for individuals with the most severe mental illnesses does not lead to early death and, for some, reduces risk.