Psychiatric drugs may not increase death risk: study

NEW YORK Fri Aug 30, 2013 4:29pm EDT

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NEW YORK (Reuters Health) - Drugs that treat psychiatric illnesses may not increase a person's risk of dying over three to four months of treatment, according to a new study.

Researchers found people with mental illnesses such as schizophrenia and bipolar disorder are more likely to die at any given time than people without those conditions, but taking drugs to treat the disorders doesn't appear to increase that risk.

"If anything they seem to reduce the risk - except for a couple of old drugs," Dr. Arif Khan, the study's lead author from the Northwest Clinical Research Center in Bellevue, Washington, told Reuters Health.

For many years, researchers and doctors have known the lives of people with serious mental illnesses are about 25 years shorter than the rest of the population, on average. Their earlier deaths are caused by a combination of suicides, substance abuse and natural causes, such as heart attacks.

There had been lingering concerns, however, that drugs used to treat psychiatric conditions may contribute to early deaths.

For the new study, the researchers analyzed data on more than 92,000 people who participated in trials for 28 drugs approved for the treatment of schizophrenia, depression, bipolar disorder, anxiety disorders and attention-deficit/hyperactivity disorder between 1990 and 2011.

Their goal was to see whether people with psychiatric illnesses have higher death rates than people in the general population and whether taking medication increases that risk.

Khan and his colleagues said the overall U.S. death rate for people between the ages of 20 and 65 years old was 331 per 100,000 people around the year 2000.

Compared to the general population, the researchers found people with schizophrenia were almost four times more likely to die every year and people with bipolar disorder and depression were about three times more likely to die every year.

The researchers could not evaluate whether death rates differed among people with anxiety disorders, because so few deaths were recorded during the trials.

They did find, however, that people's risk of dying decreased when they were randomly assigned to take medications to treat their psychiatric disorders - such as antipsychotics for schizophrenia and mood stabilizers for bipolar disorder - compared to those who were assigned to take a drug-free placebo.

Suicide accounted for just over 40 percent of deaths in all patients across drug trials.

Khan said the researchers aren't sure why the drugs appeared to decrease patients' risk of dying, but the finding should be reassuring for doctors.

"For practicing clinicians, they should feel comfortable that they can prescribe these medications," he said.

The exception to the lower death rates was a class of older antidepressants known as heterocyclics, which include tricyclic and tetracyclic antidepressants. Those were linked to about a doubling in risk, but the drugs have been largely replaced by newer medications.

The researchers write in JAMA Psychiatry that more research is needed to confirm their findings, because the data they used were limited and not initially collected to evaluate death risks. Also, more data are needed on the risks of taking the drugs for more than a few months.

Dr. Timothy Lineberry, a psychiatrist at the Mayo Clinic in Rochester, Minnesota, told Reuters Health it's also important to remember that the patients included in these trials were receiving regular care and being closely monitored.

"The issue is still that the overall mortality was high and specific to the different types of psychiatric illness," Lineberry, who wasn't involved with the new study, said.

"We need to understand and come up with strategies … to improve and reduce mortality associated with psychiatric illnesses," he said.

SOURCE: bit.ly/1duVa7e JAMA Psychiatry, online August 28, 2013.

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