Antipsychotics

DEATH

FDA WARNING: NEWER ANTIPSYCHOTICS KILL THE ELDERLY 60-70 PERCENT FASTER THAN PLACEBO

“Older patients with dementia who are given antipsychotic medicines are far more likely to die prematurely than those given dummy pills, federal drug regulators said Monday.”

“Zyprexa and Symbyax from Eli Lilly, Risperdal from Johnson & Johnson, Seroquel from AstraZeneca, Abilify from Bristol-Myers Squibb, Clozaril from Novartis and Geodon from Pfizer are all affected by this warning.”

“The Food and Drug Administration said that it had analyzed the results of 17 placebo-controlled trials involving the drugs, which are known as atypical antipsychotics. The agency found that elderly patients with demetia who were given the pills were 1.6 to 1.7 times as likely to die as those given placebos.”

(Quotes taken from article by Gardiner Harris, “Popular Drugs for Dementia Tied to Deaths,” New York Times, April 12, 2005.)
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Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048500/
World Psychiatry. 2011 Feb; 10(1): 52–77.
Abstract: The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment
… This mortality gap, which translates to a 13-30 year shortened life expectancy in SMI [severely and persistently mentally ill] patients has widened in recent decades…

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HOSPITAL WARNS THAT OLDER ANTIPSYCHOTICS KILL THE ELDERLY EVEN FASTER

“Complicating this widespread use, in April 2005, the FDA issued a Public Health Advisory warning that newer or ‘atypical’ antipsychotic medications nearly doubled the risk of death among elderly patients.”

“The researchers identified those given conventional antipsychotics (such as Haldol or Thorazine) and atypical drugs (such as Risperdal and Zyprexa).”

“In this important study, BWH [Brigham and Women’s Hospital] researchers found that patients prescribed conventional antipsychotic drugs had a 37 percent higher risk of death in the short term than among those to whom atypical medications were prescribed.”

“In the first 180 days of use, 17.9 percent of patients on conventional antipsychotic medications died as compared with 14.6 percent of those taking atypical agents. The greatest increase in risk of death among conventional versus atypical drug users occurred with higher doses and during the first 40 days after starting threrapy.”

(Quotes taken from Brigham and Women’s Hospital press release in 2005, “First Generation and Newer Classes of Antipsychotic Medications May Increase Risk of Death Among Elderly FDA black box warnings should also include first -generation medications” )

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STUDY IN EIGHT STATES SHOWS MENTAL PATIENTS DIE, ON AVERAGE, 25 YEARS YOUNGER THAN THE GENERAL POPULATION; ANTIPSYCHOTICS INDICATED AS A MAJOR REASON WHY
(Quotes taken from study by Matti Joukamaa et al., “Schizophrenia, neuroleptic medication and mortality,” British Journal of Psychiatry, 188 (2006): 122-127.)

“People with serious mental illness served by our public mental health system die, on average, 25 years earlier than the general population.”

“However, with time and experience the second generation antipsychotic medications have become more highly associated with weight gain, diabetes, dyslipidemia, insulin resistence and metabolic syndrome.”

“Psychotropic medications may mask symptoms of medical illness and contribute to symptoms of medical illness and cause metabolic syndrome.”

“Polypharmacy

– Identified as risk factor for sudden death”

(Quotes taken from study by Joe Parks, MD; Dale Svendsen, MD; Paticia Singer, MD; Mary Ellen Foti, MD for the National Association of Mental Health Program Directors/Medical Directors Council, “Morbidity and Mortality in People with Serious Mental Illness,” 2006)

THE MORE ANTIPSYCHOTICS PATIENTS TAKE, THE FASTER THEY DIE

“The number of neuroleptic drugs prescribed at the time of the baseline survey was related to the subsequent mortality. Of people with schizophrenia taking one, two and three or more neuroleptic drugs, 11 (35%), 15 (44%), and 8 (57%) respectively died during follow-up, whereas the corresponding rate was 5 (20%) among those without neuroleptic medication.”

“The present study demonstrated a graded relationship between the number of neuroleptic drugs prescribed and mortality of those with schizophrenia. This relationship and the excess mortality among people with schizophrenia could not be explained by coexistent somatic diseases or other known risk factors for premature death.”

(Quotes taken from study by Matti Joukamaa et al., “Schizophrenia, neuroleptic medication and mortality,” British Journal of Psychiatry, 188 (2006): 122-127.)
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Psychotropic medications and the risk of sudden cardiac death during an acute coronary event
http://eurheartj.oxfordjournals.org/content/early/2011/09/14/eurheartj.ehr368
European Heart Journal
14 September 2011
Methods and results: The use of medication was compared between victims of sudden cardiac death (SCD) and survivors of an acute coronary event in a case–control study including a consecutive series of victims of SCD (n= 1814, mean age 65 ± 11 years) verified to be due to an acute coronary event at medico-legal autopsy and consecutive series of patients surviving an acute myocardial infarction (AMI; n= 1171, mean age 66 ± 12 years). The medication history was obtained from autopsy/hospital records and interviews with relatives of SCD victims and AMI patients… Combined use of phenothiazines and any antidepressant was associated with a very high risk of SCD…
Conclusion The use of psychotropic drugs, especially combined use of antipsychotic and antidepressant drugs, is strongly associated with an increased risk of SCD at the time of an acute coronary event.

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Do Not Work

ANTIPSCHOTICS NO BETTER THAN PLACEBO AT CURBING AGGRESSION

“The drugs most widely used to manage aggressive outbursts in intellectually disabled people are no more effective than placebos for most patients and may be less so, researchers report.”

“The finding, being published Friday, sharply challenges standard medical practice in mental health clinics and nursing homes in the United States and around the world.”

“The new study tracked 86 adults with low IQ’s in community housing in England, Wales and Australia over more than a month of treatment. It found a 79 percent reduction in aggressive behavior among those taking dummy pills, compared with a reduction of 65 percent or less in those taking antipschotic drugs.”

“The researchers focused on two drugs, Risperdal by Janssen, and an older drug, Haldol, but said the findings almost certainly applied to all similar medications. Such drugs account for more than $10 billion in annual sales, and research suggests that at least half of all prescriptions are for unapproved “off label” uses – often to treat aggression or irritation.”

(Quotes taken from article by Benedict Carey, “Drugs Offer No Benefit in Curbing Aggression, Study Finds,” New York Times, January 4, 2008.)

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MENTAL PATIENTS NOT TAKING ANTIPSYCHOTICS RECOVER BETTER

“..Devi is a living reminder of a remarkable three-decade-long study by the World Health Organization — one that many Western doctors initially refused to believe: People with schizophrenia, a deadly illness characterized by hallucinations, disorganized thinking and social withdrawal, typically do far better in poorer nations such as India, Nigeria and Colombia than in Denmark, England and the United States.”

“The astounding result calls into question one of the central tenets of modern psychiatry: that a ‘brain disease’ such as schizophrenia is best treated by hospitals, drugs and biomedical interventions”

(Quotes taken from article by Shankar Vedantam, “Social Network’s Healing Power is Borne Out in Poorer Nations,” Washington Post, June 27, 2005)

 

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ANOTHER STUDY SHOWING MENTAL PATIENTS NOT TAKING ANTIPYCHOTICS RECOVER BETTER
“People diagnosed with schizophrenia who are not on antipsychotics are more likely to experience recovery than those taking medication, according to an American study.”

“Over 15 years, schizophrenia patients not on antipsychotics showed more periods of recovery than those taking antipsychotics, states a research paper in last month’s Journal of Nervous and Mental Disease.

“Researchers reported that, after 10 years, 79% of patients on antipsychotics were psychotic, whereas 23% of those not on medication were psychotic. After 15 years, 65 per cent of patients on antipsychotics were psychotic, whereas only 28% of those not on medication were psychotic.”

(Quotes taken from article by Angela Hussain, “People with schizophrenia not taking antipsychotics more likely to recover, states research,” psychminded.co.uk, June 13, 2007)

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Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study.
http://www.ncbi.nlm.nih.gov/pubmed/22340278
Harrow M1, Jobe TH, Faull RN.
Abstract
METHOD:
A total of 139 early young psychotic patients from the Chicago Follow-up Study, including 70 patients with schizophrenia (SZ) syndromes and 69 with mood disorders, were assessed, prospectively, at the acute phase and then followed up six times over the next 20 years. Patients were assessed with standardized instruments for major symptoms, psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.
RESULTS:
At each follow-up, 30-40% of SZ patients were no longer on antipsychotics. Starting at the 4.5-year follow-ups and continuing thereafter, SZ patients not on antipsychotics for prolonged periods were significantly less likely to be psychotic and experienced more periods of recovery; they also had more favorable risk and protective factors. SZ patients off antipsychotics for prolonged periods did not relapse more frequently.
CONCLUSIONS:
The data indicate that not all SZ patients need treatment with antipsychotics continuously throughout their lives. SZ patients not on antipsychotics for prolonged periods are a self-selected group with better internal resources associated with greater resiliency. They have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery.
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Involuntary Muscular Movements

Tardive Dyskinesia Rates Remain High With Atypical Antipsychotics

Author: Ford Vox, MD
Feb 19, 2010
Source: Reuters Health Information

Tardive Dyskinesia Rates Remain High With Atypical Antipsychotics
NEW YORK (Reuters Health) Feb 19 – Although atypical antipsychotics have a better safety reputation than conventional antipsychotics, they actually pose similar risks for tardive dyskinesia, according to the first prospective study to evaluate the issue…

Lead author Dr. Scott Woods of Yale University’s Department of Psychiatry told Reuters Health that studies documenting low tardive dyskinesia risk in atypical antipsychotics were poorly designed. One by one, the perceived advantages of the atypical drugs, such as fewer cognitive side effects, better efficacy and lower risk for movement disorders have “dwindled away,” Dr. Wood said, and there’s little remaining justification for the high prices…

Compared to a Yale study in the 1980s, there was no significant difference in tardive dyskinesia rates between schizophrenic patients taking atypicals today versus those on conventional antipsychotics in the earlier cohort.
J Clin Psychiatry 2010.

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Harms Body & Brain Structure

FDA Drug Safety Communication: FDA warns about rare but serious skin reactions with mental health drug olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv, and Symbyax)

http://www.fda.gov/Drugs/DrugSafety/ucm499441.htm
[ 05-10-2016 ]

Safety Announcement

The U.S. Food and Drug Administration (FDA) is warning that the antipsychotic medicine olanzapine can cause a rare but serious skin reaction that can progress to affect other parts of the body. We are adding a new warning to the drug labels for all olanzapine-containing products that describes this severe condition known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).

Patients taking olanzapine-containing products who develop a fever with a rash and swollen lymph glands, or swelling in the face, should seek medical care right away. The combined symptoms together are commonly seen in DRESS. Talk with your health care professional about any questions or concerns. Do not stop taking olanzapine or change your dose without first talking with your health care professional. Sudden stopping of the medicine can be harmful without your health care professional’s direct supervision.

Health care professionals should immediately stop treatment with olanzapine if DRESS is suspected. When prescribing the medicine, explain the signs and symptoms of severe skin reactions to your patients and tell them when to seek immediate medical care.

Olanzapine is an antipsychotic medicine used to treat mental health disorders schizophrenia and bipolar disorder. It can decrease hallucinations, in which people hear or see things that do not exist, and other psychotic symptoms such as disorganized thinking. Olanzapine is available under the brand names Zyprexa, Zyprexa Zydis, Zyprexa Relprevv, and Symbyax, and also as generics.

DRESS may start as a rash that can spread to all parts of the body. It can include fever and swollen lymph nodes and a swollen face. It causes a higher-than-normal number of infection-fighting white blood cells called eosinophils that can cause inflammation, or swelling. DRESS can result in injury to organs including the liver, kidneys, lungs, heart, or pancreas, and can lead to death.

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Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia
Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; etal Arch Gen Psychiatry. 2011;68(2):128-137

Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit
review of dosage and duration of treatment as well as their off-label use.

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Changes in Cortical Thickness During the Course of Illness in Schizophrenia
van Haren, N etal, Arch Gen Psychiatry. 2011;68(9):871-880

In schizophrenia, the cortex shows excessive thinning over time in widespread areas of the brain, most pronounced in the frontal and temporal areas, and progresses across the entire course of the illness. The excessive thinning of the cortex appears related to outcome and medication intake.

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“Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings” Navari S., and Dazzan P., Psychological Medicine (2009) 39, 1763-1777

Conclusions: Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.
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Risperidone-induced symptomatic hyperprolactinaemia in adolescents. [creates lactating breasts in males]
http://www.ncbi.nlm.nih.gov/pubmed/16633146
J Clin Psychopharmacol. 2006 Apr;26(2):167-71.

Holzer L1, Eap CB.
Abstract: Studies performed in adult patients unambiguously demonstrate a marked effect of risperidone on prolactin blood levels, with possible clinical effects related to hyperprolactinemia, such as gynecomastia and galactorrhea. … Thus, risperidone administered to adolescents at doses commonly used for the treatment of psychotic symptoms can strongly increase prolactin levels, with clinical consequences such as gynecomastia and/or galactorrhea…
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Antipsychotic Drugs and Hyperglycemia

in Older Patients With Diabetes
http://archinte.jamanetwork.com/article.aspx?articleid=224705
JAMA Internal Medicine
July 27, 2009
Results: Of 13 817 patients studied, 1515 (11.0%) were hospitalized for hyperglycemia…
Conclusions: Among older patients with diabetes, the initiation of treatment with antipsychotic drugs was associated with a significantly increased risk of hospitalization for hyperglycemia (P_.001). The risk was particularly high during the initial course of treatment and was increased with the use of all antipsychotic agents.
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Speeds Up Dementia in Elderly

 

ANTIPSYCHOTICS SPEED DECLINE IN MENTAL ABILITIES OF ELDERLY
http://usatoday30.usatoday.com/news/health/2008-04-07-alzheimers-antipsychotics_N.htm
(Quotes taken from article by Kathleen Fackelmann, “Anti-psychotics may speed Alzheimer’s decline,” USA TODAY, April 7, 2008)

“Antipsychotic drugs frequently used in nursing homes to treat aggression in Alzheimer’s patients don’t provide benefit and seem to lead to marked decline in ability, a report says.”

“The study, published in the April issue of the journal Public Library of Science Medicine, adds to a long line of evidence suggesting such drugs aren’t safe in elderly patients and don’t work very well when used off-label.”

“Often an underlying medical problem, such as an untreated urinary tract infection, causes an Alzheimer’s patient to behave aggressively, Jacoby says.”

“Jacoby and his colleagues studied 165 people with severe Alzheimer’s living in nursing homes in four cities in Great Britain, where the drugs also are heavily used. The patients had been taking an anti-psychotic drug such as thioridazine, chlorpromazine, haloperidol, trifluoperazin or risperidone for at least three months. The researchers took half the patients off the medication and gave them placebo pills. The other half kept taking the medication.”

“After six months, the researchers found that patients who kept taking the anti-psychotic drugs showed a significant deterioration in their ability to speak fluently. Alzheimer’s ultimately destroys the brain’s language centers, but the study suggests the drugs might speed up that process and leave patients increasingly isolated, Nixon says.”

Causes Akathisia [Greek – can’t sit still], violence & suicide

Article: https://www.madinamerica.com/2016/11/neuroleptic-drugs-akathisia-suicide-violence/

Study: Suicide Associated with Akathisia and Depot FluphenazineTreatment

M. KATHERINE SHEAR, MD, ALLEN FRANCES, MD, elqn PETER WEIDEN, MD
Departntent of Psychiatry, New York Hospital/Cornell University Medical College, and the Payne Whitney Clinic, New York, New York
AKTHISIA is a common and distressing side effect of neuroleptic medication that can be difficult to recognize and treat. Several previous reports mention maladaptive behavioral consequences such as poor compliance with prescribed medication aud aggressive or
self-destructiveo utbursts. We are reporting suicides in two young Hispanic men who had developed severe akathisia after treatmeut with depot fluphenazine. Depression
with suicidal behavior has been observed following fluphenazine injection, but suicide associated with akathisia has not been previously noted.
Case Reports…

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Doubles Hip Fracture Rate

Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway
J Am Geriatr Soc. 2016 Jun;64(6):1203-9. doi: 10.1111/jgs.14162.Abstract

OBJECTIVES:To examine associations between exposure to various subgroups of antipsychotic drugs and risk of hip fracture in older adults.
Norway, 2005-2010. PARTICIPANTS: Everyone living in Norway born before 1945 (N = 906,422).
MEASUREMENTS:
Information was obtained on all prescriptions of antipsychotic drugs dispensed from 2004 to 2010 (Norwegian Prescription Database) and data on all primary hip fractures from 2005 to 2010 (Norwegian Hip Fracture Registry). Incidence rates of hip fracture during person-time exposed and unexposed to antipsychotic drugs were compared by calculating the standardized incidence ratio (SIR).
RESULTS:
Thirty-nine thousand nine hundred thirty-eight (4.4%) participants experienced a primary hip fracture. Greater risk of hip fracture was associated with exposure to any antipsychotic (SIR = 2.1, 95% confidence interval (CI) = 1.9-2.1), first-generation antipsychotics (SIR = 2.0, 95% CI = 1.8-2.2), second-generation antipsychotics (SIR = 2.2, 95% CI = 1.9-2.4), prolactin-sparing antipsychotics (SIR = 2.4, 95% CI = 1.8-3.1) and prolactin-elevating antipsychotics (SIR = 2.0, 95% CI = 1.9-2.2).
CONCLUSION:
In people aged 60 and older in Norway, those who took an antipsychotic drug had twice the risk of sustaining a hip fracture during exposure than during nonexposure. Although confounding by indication, comorbidity, or other drugs used cannot be excluded, this association is relevant for clinical practice because hip fracture and antipsychotic drug use are prevalent in vulnerable older individuals. Clinical studies examining mechanisms or causality of the observed association between antipsychotic drug use and excess risk of hip fracture are needed.

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Increases   Pneumonia Risk

Antipsychotic use and risk of hospitalisation or death due to pneumonia in persons with and without Alzheimer’s disease
Results
Antipsychotic use was associated with higher pneumonia risk (adjusted hazard ratio, 95% confidence interval (CI) 2.01, 1.90-2.13) in the AD cohort and somewhat higher risk in the non-AD cohort (3.43, 2.99-3.93). Similar results were observed with case-crossover analyses (odds ratio 2.02, 95% CI 1.75-2.34 in the AD cohort, 2.59, 1.77-3.79 in the non-AD cohort). The three most commonly used antipsychotics (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.
Conclusions
Regardless of applied study design, treatment duration, or the choice of drug, antipsychotic use was associated with higher risk of pneumonia…

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Withdrawal Effects

Attached are 51 studies as posted in Mad in America by Peter Simon December 19, 2016
https://www.madinamerica.com/2016/12/withdrawal-from-antipsychotics/

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