Psychotropic medications affect the mind and are some of the most commonly prescribed drugs in the U.S. today. Classes of psychotropic drugs include antidepressants, antipsychotics, mood stabilizers/antimanics, stimulants and anti-anxiety agents. According to the World Health Organization, 15 to 23 percent of Americans were taking antidepressants as of 2010. Up-to-date data on how many Americans taking any class of psychotropics are not available to the public, but it can safely be assumed to be even higher than that by now.
Some people who take psychotropic medications experience side effects. For example, stimulants for attention deficit disorder can cause insomnia while selective serotonin reuptake inhibitors (SSRIs) can cause sexual dysfunction. Short-term side effects are generally tolerable and resolve when the medication is discontinued.
Long-term side effects develop after taking certain medications for many years. For example, typical antipsychotic drugs (that antagonize dopamine receptors) often cause uncontrollable, irreversible muscle twitching (tardive dyskinesia) or extrapyramidal side effects. The long-term side effects of newer medications, like SSRI antidepressants and atypical antipsychotics, are only now beginning to emerge.
Some serious long-term effects have been reported. Antidepressants, antipsychotics and mood stabilizers/antimanics often cause weight gain and obesity, and loss of pleasure (anhedonia). Stimulants and barbiturate anti-anxiety agents can lead to brain changes and addiction. Electrocardiographic changes (QTc interval prolongation) associated with risk of sudden death have been reported with some psychotropics. Others contain ingredients that cause cancer in laboratory animals.
The SSRI and related antidepressants have come under scrutiny in recent years, fueled by reports that mass shooters had been taking them. Research on antidepressants causing violence in adults has been inconclusive so far, but the risk of suicide and aggression doubled in research on adolescents and children. Furthermore, the underlying premise for prescribing SSRIs is that depression is caused by an imbalance of neurotransmitters, like serotonin. This premise remains merely a theory with no scientific proof.
Peter Breggin, M.D., described chronic brain impairment (CBI) as a syndrome caused by long-term use of psychiatric drugs. The following four symptoms are paraphrased from his 2011 article in the International Journal of Risk & Safety in Medicine:
- Cognitive problems: Occur in the early stages and include short-term memory loss, impaired learning, and difficulty paying attention and concentrating.
- Apathy: Manifests as indifference and fatigue. Also includes loss of interest in usual activities, especially those which require higher mental processes, sensitivity to others and spontaneity.
- Affective dysregulation: Emotional worsening demonstrated by increased impatience, irritability and anger, as well as frequent mood changes with depression and anxiety. These symptoms, along with loss of empathy, have an insidious onset and may be attributed to other causes.
- Anosognosia: An inability to recognize brain dysfunction in oneself so that someone other than the person experiencing the symptoms notices them.
Overall, the quality of life in those with CBI is reduced slowly over time.
Professor Peter C. Gøtzsche, M.D., from the Nordic Cochrane Centre in Denmark started a fiery debate published in the May 12, and June 2, 2015, issues of the British Medical Journal over the risks versus benefits of the long-term use of psychiatric medications. Gøtzsche compiled mounting data and warned that the risks of brain damage, suicide and premature death do not justify the minimal benefit. He stated that over half a million people over age 65 die every year in the Western world due to overuse of antipsychotics in the elderly. He was criticized for making clinical recommendations based on his findings.
Regarding the discontinuation of psychotropic medications, most experts agree that short-term use can be beneficial for some patients, and that the drugs should not be stopped abruptly and should be tapered. However, no specific guidelines for tapering medications after long-term use exist. Gøtzsche stated: “Because psychotropic drugs are immensely harmful when used long term, they should almost exclusively be used in acute situations and always with a firm plan for tapering off, which can be difficult for many patients.”
Kelly Brogan, M.D., a holistic women’s health psychiatrist and lifestyle medicine proponent, suggests a method for tapering. She emphasizes the importance of eating a healthy diet and getting adequate sleep and exercise for 30 days before beginning the taper to reduce withdrawal symptoms and prevent rebound depression. While her rationale is based on scientific research and extensive clinical experience, such an approach also sounds like common sense. In any case, prescribed medications should only be tapered or discontinued in collaboration with a qualified health care provider.
While evidence supports the use of psychotropic medications for acute psychiatric conditions and to prevent acute exacerbations of severe chronic illnesses, the risk of long-term use may outweigh the benefits for some patients. Individual differences among patients, medications and circumstances prevent a single approach to management, but anyone taking psychotropic drugs should feel free to discuss a long-term care plan with a health care provider. Any side effects experienced by the patient or noticed by loved ones should also be discussed to minimize adverse effects and optimize beneficial results.
Sovereign Health of California treats individuals with mental illness, substance use disorders and dual diagnosis. We use medications when necessary for acute stabilization, while providing lifestyle management, holistic methods, and psychotherapy to treat and resolve underlying issues toward optimal long-term outcomes. Comprehensive treatment and ongoing aftercare provide the support patients need to recover from addiction and all of its consequences. To find out more about specialized programs at Sovereign Health, please call us at our 24/7 helpline.
About the author
Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.