Are you feeling good with Medications

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Are you feeling good with Medications?

For a moment at least we have all stopped and are focusing on our health and the health of our fellow human beings. Our lives and our health seem to really matter during this epidemic. How will that change us and what we accept from our society and our healthcare providers in the future?

If you or your loved one see a doctor in the future and she/he tells you that a medication they will prescribe to you may help alleviate some of your symptoms, but will also likely contribute to your weight gain (and a whole host of other side-effects) will you accept that as a reasonable exchange? Are these our values? Numb the symptoms while we quietly acquiesce to deterioration of our physical health?

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A large epidemic disease such as we are seeing now with coronavirus highlights cracks in our healthcare system as well as the psychiatric healthcare system. Over the past several decades’ psychiatric practice has been almost exclusively reduced to psychopharmaceutical practice, which either leads to or contributes to physical deterioration of the population it purports to be treating. Indeed, there is a 10-20 year life expectancy reduction in patients with severe mental disorders (WHO, 2015).

The World Health Organization (WHO) (2015) lists the following as key reasons for premature death among people with severe mental disorders (note that they are almost identical to established risk factors associated with COVID-19 disease complications and mortality):

· cardiovascular disease

· respiratory and infectious diseases

· diabetes

· hypertension

It is hard to ignore the fact that the above-listed reasons for premature death among people with severe mental illness are at least partly related to psychotropic medication use. This problem is not only affecting those with “severe” mental illness, but also the larger population that is being prescribed antidepressant (i.e., SSRIs and SNRIs) medications also known to be causing hypertension (e.g., venflaxine or Effexor), and weight gain (almost all SSRIs such as Paroxetine or Paxil, Sertraline or Zoloft, and Fluoxetine or Prozac), and which may contribute, if not lead, to development of obesity, one of the risk factors associated with COVID-19 disease complications and mortality. Sedation is another very common side-effect of psychotropic medication, and while it’s often overlooked as a “milder” or more subtle side-effect, it may be extremely disruptive, as it leads to less activity, which, in turn, may contribute to weight gain and eventual development of the metabolic syndrome.

To be fair the WHO (2018) recommends “initiating a psychotropic medication with lower propensity for weight gain,” but such recommendation is almost futile given that majority of psychotropic medication have either high propensity for weight gain and in instances when they do not, then they present with other problematic side effects (e.g., Atomoxetine or Strattera is known to lead to increasing in heart rate and blood pressure).

Ilyas, Chesney, and Patel (2017) argue that those with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. The authors argue that greater emphasis should be placed on “primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.” While Ilyas and colleagues (2017) acknowledge the need to consider “avoiding long-term prescription of antipsychotics associated with adverse metabolic effects in people with serious mental illness,” they then propose use of pharmaceutical treatments in smoking cessation, even though there are well-established non-pharmacological therapies.

The most obvious solution to the problems related to excessive use of medications in people with mental illness is to improve and increase the amount of psychological care (e.g., psychotherapy) as well as psychosocial, spiritual and community supports. Emphasis on physical health, regular exercise and diet seems to be just as important, and easily achieved if the society is willing to invest in programs that while at first may require more people and associate costs, will, in a long-run, reduce healthcare costs while improving health and quality of life for people with mental illness.

We just stopped everything in order to preserve lives and maintain our health. It was the best choice we made, and we need to keep the spirit of this “stay at home” moment by advocating for health of everyone moving forward. We need to advocate for better treatment of people with mental illness and assert that it is not acceptable for this population to die on average 10 to 20 years earlier than general public. It is not acceptable, it is not humane, and we must do better!

References

Ilyas, A., Chesney, E. and Patel, R. (2017). Improving life expectancy in people with serious mental illness: should we place more emphasis on primary prevention? The British Journal of Psychiatry, 211(4): 194-197.
Guidelines for the management of physical health conditions in adults with severe mental disorders. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
World Health Organization. Meeting Report on Excess Mortality in Persons with Severe MentalDisorders (2015). Available at: http://www.who.int/mental_health/evidence/excess_mortality_meeting_report.pdf (Accessed April 10, 2020).

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