Does long term use of psychiatric drugs cause more harm than good?

This article is unhelpful, typical of the BMJ.

There are so many different classes and types of psychiatric drugs that even attempting to make sweeping comments like this (one way or the other) are ludicrous.

Maybe. There were several I tried that were horrible and only one I liked.

Most drug trials are 30-90 days. I haven't seen a study that tracked drug vs. placebo over years/decades.

In only 30-90 days, drug withdrawal can cause placebos to seem worse, if a patient switches from drug to placebo during the experiment.

The first few comments posted here didn't even describe the article, so I thought I should at least do that. You can, of course, read the whole article yourself to form your own opinion. The article is organized as a pro-con debate (with the "con" side first) on whether the broad classes of medicines prescribed for psychiatric conditions (mostly mood disorders and schizophrenia) are helpful or not.

The writer who says that the drugs' "benefits would need to be colossal to justify [patient deaths associated with their use], but they are minimal" is Peter C Gøtzsche, a professor at the Nordic Cochrane Centre in Copenhagen. I would ordinarily expect someone with an affiliation with the Cochrane centers to have an evidence-based perspective on evaluating treatments for human disease, and I think he makes some good criticisms of study designs about drug effectiveness for treating psychiatric disorders.

The writers who say that "Psychiatric drugs are as beneficial as other treatments used for common, complex medical conditions. Leucht and colleagues reviewed the efficacy of psychiatric and general medicine drugs by analysing meta-analyses: they found that psychiatric drugs were generally as efficacious as other drugs" are Allan H Young, professor of mood disorders at King’s College London and John Crace, psychiatric patient and a writer for The Guardian. They in turn make several thoughtful criticisms of the studies Gøtzsche relies on to infer harm. My personal impression is that they have the better of the argument, because the conditions treated with the drugs mentioned in this article are themselves fatal, and if left untreated greatly increase patient mortality.

I think everyone who follows this research closely (as I do, as part of my journal club participation with researchers on human behavior genetics) has settled on the conclusion that patients are genetically diverse even if they have the same diagnosis, and therefore a drug that works for one patient may not work for another. But a drug that works for an immediate family member of the patient probably will work for the patient, and "talk therapy" of a kind proven to be safe and effective is an important both-and to add to treatment of major psychiatric disorders. Patients with major psychiatric disorders ARE living longer and enjoying better day-by-day functioning than ever before in my lifetime, so the statistics trump the anecdotes in showing that something about current treatment is working to help patients.

I haven't read the article. But I've done something just as important---sought to understand the interests of those who wrote it. Here goes:

The authors: "Peter C Gøtzsche, professor, Nordic Cochrane Centre, Rigshospitalet, DK-2100 Copenhagen, Denmark, Allan H Young, professor of mood disorders, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, UK, John Crace, psychiatric patient and parliamentary sketch writer, Guardian, London, UK"

Declaration of competing interests: "Competing interests: All authors have read and understood BMJ policy on declaration of interests and declare the following interest: AHY has done paid lectures or been on advisory boards for all major companies producing drugs used in affective and related disorders. He was the lead investigator for Embolden Study (AstraZeneca), BCI neuroplasticity study, and Aripiprazole Mania Study, and received funds for investigator initiated studies from AstraZeneca, Eli Lilly, Lundbeck, Wyeth. He has received research grants from NIMH (USA); CIHR (Canada); NARSAD (USA); Stanley Medical Research Institute (USA); MRC (UK); Wellcome Trust (UK); Royal College of Physicians (Edinburgh); BMA; UBC-VGH Foundation (Canada); WEDC (Canada); CCS Depression Research Fund (Canada); MSFHR (Canada); and NIHR (UK)."

So Allan H Young has been bought and paid for by the pharmaceutical industry. Just keep that in mind.

John Crace would also seem to have an interest in justifying the status quo because he participates in it as a "psychiatric patient".

Gøtzsche would of course benefit from acceptance of his argument, because it would likely mean more book sales.

hmm Well considering heroine use has doubled in the passed 5 years, and doubled from 2012-2013, and that three-quarters of all heroine users now started out by getting addicted to their prescribed pharmaceutical equivalent, due to the delay in the administration cracking down on the pharmaceutical pill farms who incentivized the healthcare system to hand these out like candy with anyone who used the word "pain, back pain or anxiety", I would say, yes, psychiatric drugs and painkillers, are causing more harm than good. We are in the middle of the biggest heroine epidemic in U.S. History.

The Huffington Post has three articles in 2015 detailing this epidemic and providing the statistics on this for anyone interested. This one is the most in depth and compelling I have seen so far: http://projects.huffingtonpost.com/dying-to-be-free-heroin-t...

The best part is there is a compelling treatment, but it is stigmatized in favor of abstinence/cold turkey teaching. Of course there is no data to support this is more effective (in fact a disturbing amount of data to show otherwise) but alot of politics of holier than thou to support the failing system. Read more about this tragedy here: http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...

The truth is that we need lots of well designed clinical trials to decide if psychedelics are helpful or not. It's really difficult to decide on efficacy of drugs. For example, we still aren't certain how much salt is bad for you, who knows if LSD and other drugs that react in mindblowingly complex ways in the brain can be good or bad.

We can only get somewhere with this by being as scientific as we can and refining our view of these drugs, be they prove to be good or bad. Prohibition of them definitely hasn't helped us decide. I'm willing to believe that they do help some people, some of the time.