How long-term medication harms – but why nothing may be done about it

In looking at mental health, we have previously examined the idea that while medication offers short-term relief, long-term change is brought about through lasting measures such as cognitive therapy. We have also seen that medication is more effective in individuals with more severe forms of mental health, while milder forms can also be dealt with through non-medicative measures. We can summarise by saying that the role of medication is to offer immediate relief, but over a long term, to stabilise the individual to a state where pressures or stressors can be managed to a point where they do not cause stress, but give the individual opportunity to live with them, while examining the root cause of their problems.

The underlying causes are usually non-medically related; they can be extrinsic factors such as the working enviroment or lifestyle. Medication is hence insufficient to deal with these because they cannot impact on them. The focus on the root of the problem is one that patients on medication need to ultimately address. Unfortunately patients taking prescription medicines often make the assumption that if a certain pharmaceutical drug has been prescribed to address a particular problem, then more of it, even within limits, can eventually help resolve it. That is only a mistaken assumption. Overdosing on medication does not address the root of the problem. It only lulls the body into a relaxed state, blinding us to the immediate surroundings, so while we feel calm, relaxed or “high”, this feeling is only temporal.

Medications and the prescription of medication are reactive, not proactive. They treat symptoms that have manifested, but do not treat the cause of the symptoms.

These views of medicine are not just limited to mental health problems; they can extend into physical realms. Take eczema for example. A doctor may prescribe creams containing hydrocortisone and paraffin for you to manage the itchy, red flaring skin conditions that usually see in eczema sufferers. However, these creams may only offer you temporary relief. As soon as you stop taking them, your eczema may return. Advocates of TCM, or traditional Chinese Medicine, suggest that eczema results from an overactive liver, and the trapped “heat” in the body, when it is seeking release, manifests itself as flared red patches over the skin. Creams such as paraffin or other barrier creams may be viewed actually as being counterproductive, because they only prevent the internal heat from escaping and make the eczema worse. Have you ever encountered anyone who, upon applying the cream for ezcema, reported it only worsened the itch? If you visit a TCM practicioner, you will probably be prescribed a cream with some menthol formulation for external use, oral medicine for your eczema, and the advice that in order to deal with the root cause of your eczema, you have to make changes in your diet – specifically, not to over-consume food such as fried food or chocolate, and to avoid alcohol and coffee.

It would be great if the immediate and short-term relief brought about by medication could be extended for long periods. If you were suffering from serious illness such as severe depression, the difference you feel would be very noticeable at the onset of medication. However, medication is only a short-term stress suppressant, buying time in order for longer-term (usually non-medical) measures to take effect. It is not the intention of any prescriber – be it a GP or pharmacist – that any patient be on medication for a prolonged period of time. While it might be good financially to have such patients, it is unethical to keep patients unwell to have a constant income stream and a source of revenue. In this situation the health of the patient has become secondary to the financial benefit he or she can bring, and it is against the ethics of the medical profession.

It is unwise to be on medication for long periods. First and foremost, the body adapts to the doseage and in time the effects that the medicine initially brought are diminished, to the point that either a higher doseage of the medicine is required, or the patient is switched to another new type of medicine which is more potent. In both cases, if medication is seen to be the cure, rather than just to buy immediate relief, then the patient will merely keep taking the medicine in the hope that one day it will completely cure his or her problems, and the potential for addiction to a higher doseage results. This is how all addiction begins, and it is unfortunate if patients who take medication find that it has not only dealt with their initial symptoms, but layered it with a secondary problem of addiction to painkillers.

Addiction is only one of the problems brought about by use of long-term medication. There is the possibility, too, that the body also adapts to new chemicals and is slowly malformed. But the negative impact of medication remains unnoticed until it reaches the tipping point and consequences are made apparent with a catastrophic event. With smoking, for example, constant exposure to the chemicals damages the lungs and malforms them, but often people only sit up and try to take corrective action when irreparable damage has set in and lung cancer has developed. Medication is on the opposite end to the scale as smoking and is taken at the onset to cure rather than harm, but it has the potential to change the human body when taken over prolonged periods.

But the changes are not necessarily just experienced by patients on medication alone. Research scientists from the University of Exeter found that, for example, certain species of male fish were becoming transgender and displaying female characteristics and behaviours, such as having female organs, being less aggressive, and even laying eggs. The fish had come into contact with chemicals in water near waste-treatment plants. Chemicals contained in birth-control pills, mixed with urine flushed down the toilet, were cited as a particular source of contamination.

Long term medication is also not a good idea for children. If hyperactive children are embarking on activities that require focus such as school, or piano lessons, it may not be a good idea for them to be on prolonged medication. It may be better to treat the underlying causes first, to teach the child management strategies, rather than to merely treat the outwardly present effects.

When it comes to mental health problems, the best approaches are a mixture of medication and therapy. Give that medication is meant to be short-term, it is hence, important that therapy be as effective as possible in order for patients to entrust it to fully healing them, rather than depending on medication. This is of course more appropriate in instances of mental illness rather than physical illness that involve pain-relief. Nevertheless, in the latter case, where medication is for physical pain relief, some have suggested therapies such as hypnosis and acupuncture as long-term substitutes for pain medication.

It is worth the NHS examining such therapies in order to study the scientific evidence behind them, to glean any insight that could either be applied elsewhere to other treatments, or to find more cost-effective, longer-lasting treatments that will contribute to the NHS being a sustainable health service. Already, at the present time, the current model of the state being a mere provider and source of medicines and advice to its citizens cannot carry on. The cost of patient care will rise and drain its resources, and it would be more cost-effective to spend resouces to encourage citizens to actively take responsibility for their own health, and hence lessen the burden on the health service, rather than merely look towards it as a provider of medication.

There are also other reasons why the NHS has to prime itself for a move towards being a sustainable health service. It has to limit its carbon footprint in order to minimise the impact it has on the environment.

The prescription of long-term medication can ultimately have its impact traced back to the environment. Constituents of medication are either obtained from natural ingredients from foods grown on land, or manufactured in factories, which again, commandeer land use. The process of turning them into medication requires power and electricity, which either use up fossil fuels and produces fumes and greenhouses gases that result in global warming and instances of extreme weather, or renewable energy in the form of wind farms that still use up land, or solar energy from solar cells whose manufacture might have been through unsustainable means. Waste from manufacturing processes, or from the manufacture and the disposal of the medical product enters landfill or pollutes natural resources.

Land is a limited resource. More specifically, land that can grow useful crop is a limited resource. And so even if the current level of pharmaceutical manufacturing remains the same – perhaps, by some freak balance where the number of people being newly prescribed medication is equatable to the number of deaths – the land, along with the space available for landfill can never be refreshed on that basis. It might not make an immediate difference to you, but every individual has a civic responsibility, as a global citizen, to preserve the earth to make it habitable for future generations, to avoid killing off the human race.

Essentially, we need to lower our dependency on medication to avoid this impact on the environment. So that future generations have a habitable environment.

The problem is in convincing pharmaceutical companies to embrace this thinking. These companies depend on sales and if sales were to fall, so would profits and the price of shares. Pharmaceutical companies are accountable to their shareholders, and need to raise their share prices and create growth. The moment they start thinking about sustainability, they are looking to reduce their growth, and their share price would stagnate. Would you invest in a company with stagnant growth? Thought not. And if a company reports less profit, the government would have raised less revenue through tax and has to make up the shortfall somehow.

Being on long-term medication harms the body, among other things by creates changes in the body and fostering dependency. Ultimately it has significant bearing on the environment. The challenge is for us to wean ourselves off long-term medication, only using it in the short term while we address the root causes of our problems through therapy. On a wider scale, we need to create new business models because current ones actually depend on a sizeable number being unwell, in order for the economy to function. Surely that last statement is not ethical in itself and must raise incredulity – that in this day and age we are not trying to heal people, but maintain a threshold of well and unwell people that is economically beneficial!

Red wine – the media’s Wonderdrink

If there is anything to be said about the British media, it is that it seems intent to make a superhero or villain out of the common everyday foods we encounter. Every now and again we are presented with small-scale research on food or drink that promises either a miracle cure or a dangerous red flag. One assumption peddled to us is by continuing to consume the food, we will either gain added health benefit without too much effort. Miracle cure just by eating! The counter to this is the article written to warn against continued consumption. Danger food – consume carefully! You are either a superhero, or a villain in the world of miracle foods.

It is safe to assume that the purpose of these articles is ultimately to hook the reader into buying the newspaper to examine the article further. And if it appears on an online version instead, you can be sure that the intention is to keep the reader glued to the page while paid-for advertising revenue flashes on the side panels. To state it cynically, the purpose of these articles is for sales. It might be long before certain foods such as milk might purportedly be the cure to cancer.

We need not spend too much time judging how effective these media reports are. If you are looking to a newspaper as a reference for health advice, you might as well ask about ballet lessons from the petrol station.

One of the poster children for miracle foods is red wine. Depending on what you’ve read, red wine can:

  • Boost immunity
  • Prevent tooth decay
  • Save your eyesight
  • Be good for the heart

But it won’t help you in the fight against diabetes, or help you lose weight. Was worth considering, though.

One of the latest research into red wine studied if, yes, it could find the ageing process. A US study suggested resveratrol, a substance found in the skin of red grapes, may help keep our muscles and nerves healthy as we get older.

Researchers gave mice food containing resveratrol for a year, then compared the muscle and nerve cells of those mice to cells from mice the same age who’d had a normal diet. In the mice who’d had the resveratrol-enriched diet, they found less evidence of age-related changes.

The researchers also looked at another chemical, metformin, but found it had less effect.

Researchers divided laboratory-bred mice into four groups and fed them either:

  • a normal diet
  • a lower calorie diet from four months of age
  • a diet enriched with resveratrol from one year of age
  • a diet enriched with metformin from one year of age

When the mice were aged two years, they looked at their muscle and nerves, at the meeting point of the two (the neuromuscular junction, or NMJ) in a leg muscle. They also looked at the NMJs of three-month-old mice to see how they compared to the older mice.

Compared with mice fed a regular diet, those who’d been given resveratrol or who’d had a calorie-restricted diet showed:

less fragmentation of tissue at the neuromuscular junction
fewer areas where the nerve cells had degenerated, which would have meant that the muscle no longer had input from nerves

The two-year-old mice which had calorie-restricted diets had neuromuscular junctions that were most similar to the three-month-old mice. Metformin had little effect in this experiment.

The researchers say that this indicates less ageing as muscle fibres increase in size with ageing. But this does not suggest if the ageing was beneficial or not to the subject.

Resveratrol has been of interest to anti-ageing scientists for many years and researchers have previously shown it may be linked to a slowing of the decline in thinking and movement, at least in rodents. This study suggests a possible way this might happen.

But the results don’t tell us anything about what happens in humans. They suggest this substance may be useful for further research in humans at some point. They certainly don’t provide a reason to drink gallons of red wine, in the hope of seeing an anti-ageing effect. Drinking too much alcohol is a sure-fire way to speed up deterioration of thinking skills, and can cause brain damage. Too much alcohol in the long term is linked to several cancers, heart disease, stroke and liver disease.

Although red wine contains resveratrol, the amount varies widely, from around 0.2mg to 12.6mg per litre. That’s nothing like enough to get the amounts consumed in this study.

The mice were fed 400mg of resveratrol per kilogram of body weight each day. To achieve the same level of anti-ageing purported in the study, the average weight woman in the UK (around 70kg) would need 28g of resveratrol a day for the same effect. This would be obtained by consuming more than 2,000 litres of the most resveratrol-rich wine. An average weight man would need even more. This would be going beyond side effects and into the realm of health dangers! Or if you were disturbed by the daily consumption of this amount of alcohol, and still wanted to try, you could eat bin loads of berries – you might need fifty of these a day. What’s for breakfast? Blueberries. Snack? Blueberries powerbar. Lunch? Blueberry soup? Dessert? Blueberry cake. Resveratrol occurs naturally in the skins of some red fruits, including some grapes, blueberries and mulberries. But this rate, anti-ageing might be more of a curse.

The study was carried out by researchers from Virginia Tech, Roanoke College and the National Institute on Aging, all in the US, and was funded by the National Institutes of Health.

Is there any thing of value we can glean from this research? One certainly hopes that the whole research was conducted for more significance than mere paper filler.

The effects of rosveratol will probably hold the most interest for researchers. One can imagine that scientists will be looking to produce genetically-modified grapes that hold more of the chemical, or refine the chemical until it reaches higher levels of purity. Drugs, medication, and anti-ageing creams may contain higher levels of rosveratol. Why is there the interest in slowing down ageing? It extends beyond the obvious physical aging. Slowing down the process may also inhibit age-related diseases such as cancer, diabetes, Parkinson’s and dementia.

And while it was of little effect in this particular trial, metformin is currently undergoing trials as an anti-ageing drug. While it is one of the drugs used in the treatment of type 2 diabetes, and marketed under brand names such as Glucophage, it is relatively new as an anti-ageing drug.

Belgian researchers researching metformin found it increased the number of oxygen molecules released into a cell. When tested on roundworms, the worms aged slower, did not slow down, nor develop wrinkles. They grew stronger bones and increased their own lifespan by nearly 40%.

Metformin only costs only 10p a day which means it falls well under the threshold of QALY (quality-assisted life years) cost that the NHS uses to measure cost-effectiveness. It is conceivable that either metformin or rosveratol could form the active ingredient of anti-ageing pills or creams in the future.

And when that happens, you can read all about it in the papers again, about how red wine really lengthens your lifespan! You might even want to sign up for a clinical trial!

The British media is really drunk on red wine.

And did you know, that if it wasn’t for red wine, the world of Classical music might not have reached the dizzy heights that it did? While the link is slightly tenuous, it can be said that if it weren’t for red wine, Classical music might not have attained its popularity. Read about it here and decide for yourself.

Why clinical trials exist, and how to sign up

A clinical trial is a research method that compares the effects of one treatment with another. The subjects of a clinical trial can be patients, healthy people, or both.

If you are interested to take part in a clinical trial, you can ask your doctor or a patient organisation if they know of any clinical trials that you may be eligible to join. Other ways of finding out including registering your interest in taking part in research online.

The UK Clinical Trials Gateway (UKCTG) website searches through different registers and pulls through information about clinical trials and other research from several different UK registers. When you sign up to it, researchers will get in touch about research that might be suitable for you.

While this is the main method of contact, you can also search the UKCTG site to find trials relevant to you, and you can contact researchers yourself.

If you are looking for something on a global basis, the World Health Organization’s Clinical Trials Search Portal provides access to clinical trials in countries all around the world.

Charities can also be a good source of clinical trials.

Some charities which look for people to take part in clinical trials include:

  • Arthritis Research UK: current clinical trials and studies
  • Cancer Research UK: find a clinical trial
  • Multiple Sclerosis Society: MS clinical trials
  • Target Ovarian Cancer: clinical trials information centre
  • Parkinson’s UK: clinical research

Why would anyone consider being a human guinea pig? If we are brutally honest, that is what it amounts to. And if we were being very honest, we might fine-tune it down to two reasons: treatment and financial incentives.

Clinical trials help doctors to understand about how they can treat a particular disease or condition. It may benefit you, or others like you, in the future. And if you participate in a clinical trial, you may be one of the first people to benefit from a new treatment. However, you must be prepared that the new treatment may turn out to be no better, or worse, than the standard treatment, and that your participation is the method through which they find out. However, you may be placed in the control group, which means you not receive any treatment, but others who do have their results compared to you – and that can be very disappointing.

Some clinical trials offer payment, which can vary from hundreds to thousands of pounds depending on what is involved and expected from you. The majority of trials however are unlikely to offer payment beyond your travel expenses.

Before you sign up to a trial, it is important to find out about the inconvenience and risks involved and to carefully weigh up whether it is worth it. You have to remember that trials can be time consuming – you may be expected to attend a number of screening and follow-up sessions, and some trials require you to stay overnight. In addition to the constraints placed on your time, there may be restrictions on what you can and cannot do – for example, you may be asked to not eat or drink alcohol for a period of time. As trials are essentially the assessment of treatment in their experimental stages, you may experience unknown side effects from the treatment.

All clinical trials of new medicines go through three or four phases to test whether they are safe and whether they work. The medicines will usually be tested against another treatment called a control and the results compared to note any significant effect. The control will either be a dummy treatment (a placebo) or a standard treatment already in use.

The first phase of the trials involves a small number of people, who may be healthy volunteers, are they are given the medicine. In this phase, the drug is being trialled in human volunteers for the first time and the purpose is for the researchers to test for side effects and calculate what the right dose might be to use in treatment. Unfortunately if the doseage is too high side effects can be uncomfortable. Researchers start with small doses and only increase the dose if the volunteers don’t experience any side effects, or if they only experience minor side effects. Sometimes the threshold to which side effects occur is sought – not nice!

In the second phase, the new medicine is tested on a larger group of people who are ill. After having passed the side effects filter, this stage is to get a better idea of its effects in the short term.

The third phase involves medicines that have passed phases one and two. These medicines are tested in larger groups of people who are ill, and then they are compared against an existing treatment or a placebo to compare the benefits or side effects. Often after this stage the treatment is examined for its cost-effectiveness as well.

Some medicines undergo a fourth trial phase while they have been passed for use. The safety, side effects and effectiveness of the medicine continue to be studied while it is being used in practice. However, this is not required for every medicine. It is only carried out on medicines that have passed all the previous stages and have been given marketing licences – a licence means the medicine can be made available on prescription. You can find out about the whole process here in greater detail.

You cannot choose which group you are put in when you are accepted for a clinical trial. You will usually be randomly assigned to either the treatment group – where you’ll be given the treatment being assessed, or the control group – where you’ll be given an existing standard treatment, or a placebo if no proven standard treatment exists.

And while the treatments are different in the two groups, researchers try to keep as many of the other conditions the same as possible, so that the effect of the treatment can be fully quantified. The conditions may extend to the trial groups. For example, both groups should have people of a similar age, with a similar proportion of men and women, who are in similar overall health. In most trials, a computer will be used to randomly decide which group each patient will be allocated to, in order to avoid human bias in selection. In many trials, nobody knows who’s been allocated to receive which treatment. This is known as blinding, and it helps reduce the effects of bias when comparing the outcomes of the treatments.

If you do express interest in a trial, a doctor or nurse is likely to tell you something about it in person before you undergo it. You’ll also be given some printed literature to take away, and if you have concerns over the trial you may come back with some questions you feel haven’t been answered.

Some questions you may ask may include:

What is the aim of the trial and how will it help people?
Who is funding the trial?
What treatment will I get if I do not take part in the trial?
How long is the trial expected to last, and how long will I have to take part?
How long will it be before the results of the trial are known?
What will happen if I stop the trial treatment or leave the trial before it ends?
What would happen if something went wrong? It’s rare for patients to be harmed by trial treatments, but you may want to ask about compensation if this were to happen.
Practical questions
How much of my time will be needed?
Will I need to take time off work?
Will I be paid?
Will the costs of my travel to take part in the trial be covered?
If the trial is testing a new drug, will I have to collect it from the hospital, will it be sent to me by post, or will I get it through my doctor?
Will I have to complete questionnaires or keep a diary?
What are the possible side effects of my treatment?
How could the treatments affect me physically and emotionally?
Who can I contact if I have a problem?
Will someone be available 24 hours a day?
How do I find out the results of the trial?

There are many questions you may have and it is best to feel fully secure before you undergo a trial. As in the case with any treatment, you can’t be sure of the outcome. And if you are part of the treatment group, you may be given a new treatment that turns out not to be as effective as the standard treatment. As with all medicines, it’s possible you’ll experience unexpected side effects. And while it is rare, you must be prepared that you may leave the trial in a slightly poorer state of health than when you entered it! You may decide to stop taking part in a trial if your condition is getting worse or if you feel the treatment isn’t helping you. Your departure can be at any point without giving a reason and without it affecting the care you receive.

A good thing to also bear in mind about trials, too, is that you may have to visit your place of treatment more often, or have more tests, treatments or monitoring, than you would if you were receiving the standard treatment in usual care.

At the end of the trial, the results are published by the researchers and are then made available to anyone who took part and wanted to know the results. If the researchers neglect to offer you the results and you want to know, you are well within your right to ask for them. Bigger agencies such as the National Institute for Health Research (NIHR), have websites where they publish the results of the research they have supported.

Trials are regulated and judged ethical by the MHRA. Before a clinical trial of a new medicine can begin, a government agency called the Medicines and Healthcare products Regulatory Agency (MHRA) needs to review and authorise it. One of the functions the MHRA performs is in inspecting sites where trials take place to make sure they’re conducted in line with good clinical practice.

Another body, the Health Research Authority (HRA) works to protect and promote the interests of patients and the public in health research. It is responsible for research ethics committees up and down the country.

All medical research involving people in the UK, whether in the NHS or the private sector, first has to be approved by an independent research ethics committee. The committee protects the rights and interests of the people who will be in the trial.

What are the benefit of clinical trials? Well, they can benefit us in many ways. For example, clinical trials can:

  • prevent illnesses by testing a vaccine
  • detect or diagnose illnesses by testing a scan or blood test
  • treat illnesses by testing new or existing medicines
  • find out how best to provide psychological support
  • find out how people can control their symptoms or improve their quality of life – for example, by testing how a particular diet affects a condition

Many clinical trials are designed to show whether new medicines work as expected. These results are sent to the MHRA, which decides whether to allow the company making the medicine to market it for a particular use. The company usually applies for a twenty year patent to cover the research and marketing of the drug exclusively.

If research has identified a new medicine, the MHRA must license it before it can be marketed. Licensing shows a treatment has met certain standards of safety and effectiveness. The safety of the medicine must be monitored carefully over the first few years of a newly licensed treatment. This is because rare side effects that weren’t obvious in clinical trials may show up for the first time.

You may not have been selected for a trial but you may express interest in the results. You can find various results of clinical trials from sources such as:

  • The Lancet medical journal
  • British Medical Journal (BMJ)
  • The New England Journal of Medicine
  • Cochrane Library – a collection of high-quality evidence
  • NHS Evidence database

Many of these publications offer abstracts, which are shorter summaries of the research. If you wish to delve deeper,
you usually have to take up a subscription to the journal. But before you do so, consider that research papers are not written in plain English and often use many medical, scientific and statistical terms which then make them possibly very difficult to understand.

The mainstream media offer a more readable version of the research. But do bear in mind, too, that while news stories are easier to read than original research papers, sometimes the findings are exaggerated or sensationalised in order to sell papers!

Mental Health Medication – Concerns and Ethics

One of the most common questions about mental health problems is whether people need medication to deal with them, or whether they can be simply dealt with through therapy. Mental health problems can range from the not so severe – such as mild anxiety – to more severe problems like long-term depression. There are some that see medication as a short term, quick fix solution – it will give relief fast, but it doesn’t really teach one to deal with the heart of the problem – hence the suggestion of therapy and counselling. Yet there are those that remain convinced that while therapy re-educates the patient and deals with mental health difficulties on a long term basis, sometimes medication provides a greater level of immediacy in providing a solution, that its role cannot be denied. Should I take medication for _______” is one of the most frequent queries received. The ideal solution is probably a combination of medication and therapy, whilst gradually reducing the level of medication and therapy as the patient progresses.

Medication can be useful. For example, for those with paralysing anxiety, medication can minimise the stress and anxiety placed upon an individual by these stressors until the level of anxiety is at a comfortable and manageable level, enabling one to live their daily life while keeping their anxiety at a level they can control. However, for individuals with a severe mental health condition such as schizophrenia, the use of medication may be necessary in order to attain a level of mental stability and hence safety.

But medication is not just for a stabilising calm influence. For those, however, for whom facing the day is a burden, and who remain unable to get out of bed in the morning because depression has stolen all motivation, mental health medication can provide a jumpstart, an impetus to face the day. Certain people may benefit from taking psychotropic medication. For example, a study funded by the National Institute of Mental Health found that some individuals who were prescribed the selective serotonin reuptake inhibitor (SSRI) Paxil, because they experienced moderate to severe depression, experienced positive changes in mood, together with significant improvements in depressive symptoms. There was a marked decrease in the level of neuroticism and a similar increase in extroversion. These effects occured over a period of eight weeks and were nearly equivalent to the changes most adults experience in the course of a lifetime.

According to Maslow’s hierarchy of needs, human beings must satisfy more basic needs such as food and shelter before they attend to more self-actualising needs. It is difficult for most people to focus on avenues of self-growth when they are in crisis or struggling with anxiety, depression, or other mental health conditions. In some cases the polarisation can even lead them further into depression. In this instance, medication can support the psychotherapy process, and a stabilised person can progress further in psychotherapy having had the needs at the lower end of the hierarchy addressed. For example, a study published in the Journal of the American Medical Association shows that cognitive behavioural therapy combined with targeted medication tends to lead to significant improvement of attention deficit hyperactivity symptoms in adults. And in the long term, of course, a common outcome of successful psychotherapy is the reduction or elimination of the need for medications, so medication can be viewed as a temporary measure.

And while we have to recognise its benefits for the short term, we have to realise that medication can be harmful for some individuals if taken over a prolonged period. Most, if not all, drugs come with potential risks and side effects. Some can be minimal and tolerable while others carry disadvantages best considered as trade-offs. The side effects range from physical ones to emotional and psychological ones. Physical side effects range from dizziness, drowsiness, or changes in appetite, and/or weight gain. Emotional and psychological side effects may range from mood swings, disinterest in activities, or emotional numbness and a lack of empathy. Prescribed over a long term, antipsychotics may cause permanent damage by leading to conditions such as tardive dyskinesia or Parkinsonism, and may even cause death. The death may not be triggered by physical caused, but by mental irrational thinking. A 2005 article in the Harvard Mental Health Letter spelt out in detail the increasing awareness of risks associated with SSRI antidepressants, such as a potential increase in suicidal thinking and behaviours for adults and children under 24 years of age. One could, however, speculate if the suicidal thoughts were triggered by the medication directly, or whether it was the prospect of lifetime medication without an apparent cure that caused these feelings of hopelessness. Whichever you look at it, it is fair to say that there are people who will benefit from taking these medications, but also people who may experience lasting harm as a result of antidepressant use. The use of medication remains a double-edged sword.

But there are lines of thought that ascribe that medication is not always a necessary process. While medication may be effective for treating certain conditions, researchers at the University of Pennsylvania and Vanderbilt University suggested that, over a period of 16 months, cognitive therapy was a more effective means of preventing a relapse into depression than antidepressants alone. Research findings published in the Journal of the Amercan Medical Association found that while antidepressants were helpful for those experiencing severe depression, milder to moderate forms of depression derived more benefit from other treatment options, such as therapy. A 2010 article published in Newsweek arrived at the same conclusions, suggesting that, for some individuals, antidepressants are little more than a placebo.

To summarise what I’ve said so far: mental health is best addressed through a combination of therapy and medication. Severe forms of mental depression, which require more immediate intervention, would benefit from prescription drugs and therapy, while therapy alone may be sufficient enough for milder forms. Medication provides short-term benefit, especially in higher forms of depression, but we must be cautious over its long-term use because it can have side effects.

Medication can interfere with the emotions as well as the psychotherapy process. One of the most common side effects of psychotropic medication is difficulty feeling certain emotions, perhaps even a lack of empathy, once enough doseage of a drug accumulates in a person’s system. When we consume too much of a drug that is meant to limit our nerves, for example, many people complain of losing the feelings they used to have, report a reduction in their ability to laugh or cry, or experience a decrease in libido. These are the effects of medicines with a calming influence. Other side effects extend to one’s sexuality and love relationships, such as diminished sexual interest. Medication can also limit hyperactivity in the brain, acting as an emotional relaxant, but this slows emotional processing for some, and in doing so, covering up underlying issues and causing the psychotherapy process to be slowed down. A possible consequence of taking too much medication and becoming numb to feelings is the increased likelihood that a person will not become conscious of the emotional or somatic burdens which can cause of stress and suicidal feelings. It may be stretching things a little, but if you view medication as a substance, just like we view alcohol – too much consumption leads to physical health problems, as well as a capacity for clear thought processing – we can get a better idea of how the prescription of medication might not always be a clear-cut issue.

Proponents of a little- or no-medication approach to mental health point out that many emotional and mental health issues are not reducible to a biochemical imbalance. Life events — what happens to and around us – can impact on our mental health, and because medications do not change how people relate psychologically to their experiences, medication alone cannot “fix” all psychological issues. In fact, the temporal masking of life circumstances by medication is probably what induces people to overdose in the first place, taking more medication to completely obviate one to one’s surroundings. Treatment with medication alone can be like stitching up a bullet wound without taking the bullet out first – dealing with the effects without dealing with the cause. It is one of the main criticisms of the medical profession.

Furthermore, an over-simplification of what causes depression has led to the development of anti-depressant drugs that are actually designed to treat or minimise stress. These medications are often of little use because they have been tested on animals, and for the laboratory animals such as rats chronic stress does not cause depression. Psychotherapy, on the other hand, is often able to discover and treat some of the mental health issues that may contribute to depression, such as psychological trauma and anxiety. For example, a 1995 Consumer Reports study shows that some individuals experiencing mental health issues were significantly helped by psychotherapy. The study found that long-term therapy had, in general, the most beneficial effect, and that treatment with therapy alone was no less effective than treatment with medication and psychotherapy.

In an article “Mind over Meds,” which appeared in a 2010 issue of The New York Times Magazine, Dr. Daniel Carlat, a psychopharmacologist, found that the individuals he treated responded better to a combination of treatment with psychotherapy and medication together than they did purely with medication alone. The provision of counselling in addition to medication helped them to be better able to understand the true nature of their concerns. His findings are supported by research that therapy can stimulate the growth of neurons and synaptic connections between neurons. However, medication for depression, anxiety, and other emotional problems do not stimulate the brain; instead they dampen the brain’s mental activity. Therapy is capable of healing core problems and facilitating long-term changes, and why medication alone cannot. But medication is important in areas where the mental thoughts of the individual needs to be reduced to a lower level of activity.

Psychotropic drugs are prescribed to treat a variety of mental health issues when those issues cause significant impairment to healthy functioning. They work by changing or balancing the amount of important chemicals in the brain called neurotransmitters. The reduction or increase of neurotransmitters such as dopamine, serotonin, and norepinephrine have shown better mood improvements in some individuals. The ideal s to achieve a tolerable balance of these chemicals in order for the individual to attain a healthy life. Psychotropic drugs are usually prescribed by a psychiatrist, a psychiatric nurse practitioner (PMHNP), or a primary care physician

According to the WHO, one in four individuals will experience a mental health issue at some point in their lives. Depression and anxiety are among the most common issues, and these issues can affect people regardless of age, gender, ethnicity, or background. Researchers cannot point to the triggers of mental health impairment, but they can be attributable to environmental factors, genetics, traumatic events or serious injuries and result in psychological symptoms that persist for years.

As we have seen before, for some individuals psychotropic drugs are often not enough are best used as a supplement, and not a replacement, to therapy. Social support from family and friends, structured therapy, lifestyle changes – all leading to a change of environment – can all be important factors in the recovery process. But in some severe mental health issues may require inpatient rehabilitation before the person experiencing them can return to everyday life.

Certain individuals who are prescribed psychiatric medications may prefer not to take them, or they find that these medications do not improve their symptoms enough to outweigh any side effects or risks. Before you take any medication, it is always advisable to speak with your GP or seek specialist advice.

One major cause of concern regarding mental health and medication is the practice of prescribing medications that were originally developed for adults to children. The increase in diagnoses of psychiatric conditions in children – bipolar in particular – has led to an increase in the amount of children who take psychiatric medications. Many of which have only been fully tested in adults, and children take them in smaller doses, but the long-term impact of medication, as well as the effect on children who have yet to reach puberty needs to be examined.

Several different types of medications are used to treat mental health conditions. These include antipsychotics and anti-depressants.

Antipsychotics: These medications are most often prescribed for the treatment of psychotic issues such as schizophrenia. These drugs fall into two categories, typical and atypical antipsychotics.

The brand name is listed first, and the active ingredient is in parentheses.

Typical antipsychotics include:
Thorazine (chlorpromazine)
Trilafon (perphenazine)
Stelazine (trifluoperazine)
Serentil (mesoridazine)
Prolixin (fluphenazine)
Navane (thiothixene)
Moban (molindone)
Mellaril (thioridazine)
Loxitane (loxapine)
Haldol (haloperidol)

Atypical antipsychotics include:
Abilify (aripiprazole)
Clozaril (clozapine)
Geodon (ziprasidone)
Risperdal (risperidone)
Seroquel (quetiapine)
Zyprexa (olanzapine)

Antidepressants are a broad category of psychotropic drugs used for treating depression. There are several different classifications of antidepressants:

Selective serotonin reuptake inhibitors (SSRIs): These medications gradually increase the amount of serotonin, a neurotransmitter, in the brain. Common SSRIs include:

Celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)

Monoamine oxidase inhibitors (MAOIs): A less common variety of antidepressant drugs, MAOIs are often a last option with complex, treatment-resistant depression. Common MAOIs include:

Emsam (selegiline)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)

Tricyclics (TCAs): These older antidepressant medications have been pushed to the sidelines by newer, generally safer medications. Still, some people do not respond to the new antidepressants, so TCAs may be prescribed. Tricyclic medications include:

Anafranil (clomipramine)
Asendin (amoxapine)
Elavil (amitriptyline)
Norpramin (desipramine)
Pamelor (nortriptyline)
Sinequan (doxepin)
Surmontil (trimipramine)
Tofranil (imipramine)
Vivactil (protiptyline)

Selective norepinephrine reuptake inhibitors (SNRIs): These medications work by slowly increasing the amount of norepinephrine in the brain. Common SNRIs include:

Pristiq (desvenlafaxine)
Effexor (venlafaxine)
Cymbalta (duloxetine)

Antianxiety/antipanic medications: These medications are used to treat a variety of chronic and acute anxiety issues, from generalized anxiety to panic attacks. Antianxiety and antipanic medications on the market include:

Ativan (lorazepam)
BuSpar (buspirone)
Inderal (propranolol)
Klonopin (clonazepam)
Librium (chlordiazepoxide)
Serax (oxazepam)
Tenormin (atenolol)
Tranxene (clorazepate)
Valium (diazepam)
Xanax (alprazolam)

Stimulants: Typically, stimulants are prescribed to people with attention-deficit hyperactivity (ADHD). They help regulate disorganized thought processes. Psychomotor stimulants include:

Adderall (amphetamine and dextroamphetamine)
Dexedrine (dextroamphetamine)
Ritalin (methylphenidate)

Mood stabilisers: This category of psychotropic medication is typically used to treat intense, repeated shifts in a person’s mood, which may be common for those experiencing bipolar, schizophrenia, or borderline personality. Many mood stabiliser drugs are also commonly categorized as anticonvulsant medications.

Lamictal (lamotrigine)
Lithium

In 2013, the most prescribed psychotropic drugs in the United States (with the number of prescriptions written during the year) were:

Xanax (alprazolam), 48.5 million
Zoloft (sertraline), 41.4 million
Celexa (citalopram), 39.4 million
Prozac (fluoxetine), 28.3 million
Ativan (lorazepam), 27.9 million
Desyrel (trazodone HCL), 26.2 million
Lexapro (escitalopram), 24.9 million
Cymbalta (duloxetine), 18.6 million
Wellbutrin XL (bupropion HCL XL), 16.1 million
Effexor XR (venlafaxine HCL ER), 15.8 million

Should one be dismayed by the number of prescriptions in a YEAR alone, as well as the various types of medications available? However you feel about them, they all point to mental health as a significant issue, one that we cannot ignore. We have, however, to cautiously consider that medications that seem appropriate at this time may not be at a later stage. Ultimately, it is best that we learn to function without additive medication in the long term, not just because of their side effects – but if we are being cynical, under pressures of financial cost, medical research may in time suggest that certain forms of mental health medication were inadequate in the first place, and if funding is withdrawn patients may find themselves dependent on medication that they have to make their own provisions for – or worryingly, do without.

And it would be unfortunately ironic if the concerns over provision for mental health became another life stressor.

Beta blockers and their impact on heart attack sufferers

 

Recent research suggests that the prescription of beta blockers for heart attack patients may not have the benefit ascribed to them.

In the UK, the prescription of beta blockers is routine for patients who have had a heart attack. There are two categories of patients – those who have had a heart attack, and those who have had a heart attack with heart failure, the latter of which is the more severe case. A heart attack involving heart failure is a complication in which the heart muscle has experienced damage and where proper function is compromised.

Beta blockers work by reducing the activity of the heart and lower blood pressure. In essence, the pressure on the heart is lessened by a reduced demand on it.

Current guidelines recommend that the first group of patients are prescribed beta blockers, while for those in the second group, who have experienced heart failure, beta blockers are mandatory.

The research investigated the effect of beta blockers on the first group, for whom beta blockers are recommended but not compulsory. The findings suggested that 95% of patients in the first group did not experience a significantly longer life span and beta blockers did not have any significant impact. There was no statistical difference in death rates within a year large enough to attribute to any positive impact of the beta blockers.

As the data involved tracking a very large sample size of 179,810 people, the results could be deemed to be fairly accurate.

So what the ramifications of this research?

The first is that the vast majority of the first group of heart attack patients are being over-prescribed beta blockers. Beta blockers, while reducing the workload of the heart, can induce side effects such as drowsiness and fatigue as a result of lower blood pressure. Patients may be experiencing these burdens on their health unnecessarily.

The second issue is that over-prescription causes an unnecessary burden on the NHS if it is prescribing drugs unnecessarily. Imagine a patient who has just had a heart operation. While he or she is recuperating in hospital, beta blockers are prescribed as part of the medication. Multiply that by over 100,000, and the result is an unnecessary annual cost to the NHS if the drugs that are needless and have no impact.

Furthermore, the use of drugs with no apparent benefit can, in the long run, only weaken the body’s immunity.

The findings of the survey, however, do not reflect on the impact of beta blockers on the second group of patients – those who have had a heart attack involving heart failure. Another outcome of the findings was the suggestion that treatment be more personalised in order to locate and target patients in the first group who would benefit from the prescription of beta blockers for heart attacks which did not involve heart failure.

Beta-blockers are prescription-only medicines, commonly referred to as POMS, which means they cannot be obtained over the counter. They must be prescribed by a GP or pharmacist. They work by blocking the action of hormones like adrenaline in order to reduce the activity of the heart.

Examples of commonly used beta-blockers include:

  • atenolol (Tenormin)
  • bisoprolol (Cardicor, Emcor)
  • carvedilol metoprolol (Betaloc, Lopresor)
  • nebivolol (Nebilet)
  • propranolol (Inderal)

The generic name which contains the active ingredient is named first, the brand name is in parentheses.

There are many types of beta-blockers and they may be used to treat symptoms such as angina, heart failure, atrial fibrillation (irregular heartbeat), heart attack or high blood pressure. Those are the more common uses of beta-blockers, also they can also be used for migraine or to treat an overactive thyroid (hyperthyroidism), anxiety, tremor, anxiety conditions or even glaucoma.

Beta-blockers, including beta-blocker eye drops, can interact with other medicines, and in doing so alter the effects of one of the medicines. Some of the more common medicines that can cause interference through interaction with beta-blockers include medicines such as anti-arrhythmics (used to control irregular heartbeats), antihypertensives (medicines for lowering blood pressure), antipsychotics, and clonidine, which is commonly used to treat high blood pressure and migraine.

While the most common side-effects of beta-blockers are dizziness and tiredness, other arising side-effects can include blurred vision, cold hands and feet, and slow heartbeat.

Less common symptoms may include sleep disturbance (insomnia), depression, impotence or libido.

The majority of beta-blockers are to be taken once a day, with the exception of certain beta-blockers that are used during pregnancy and the beta-blocker Sotalol, which is administered two or three times a day. The NHS estimates the annual cost of Sotalol per patient to be 77.09 a year.

On the face of it, the results of the research are pretty straightforward. But are they as almost too straightfoward, to warrant the question of why such research needed to be conducted in the first place?
One cannot blame the cynics for questioning what outcomes the research is meant to arrive at.

Let’s consider the matter in a different light. It is estimated that heart attack survivors have a higher risk of recurrent heart attacks or cardiac death, and 10% of heart attack sufferers die within two years. Only 50% of initial survivors are alive at 10 years.

It is not unreasonable to surmise that those who suffer initial heart attacks either experience mortality between the first and second year or develop recurrent attacks which push them to a compulsory prescription of beta-blockers.

Critics to the research point out that a fairer assessment on the effects of beta-blockers should have examined an extended time period of two years rather than one year. They also point out that the research should have focussed on how many heart attack sufferers, who did not have heart failure, and who then did not use beta-blockers, went on to develop recurrent heart attacks, or heart attacks that included heart failure, as it would be more indicative of the effectiveness of beta blockers.

So why did the findings choose to use the timeframe of a year?

The NHS makes baseline assessments on the cost effectiveness of medicines and treatments according to a scale of quality-adjusted life years, or QALYs. It weighs the cost of treatment against the number of years of significant benefit to the patient gained from the treatment. According to the NHS, a figure of twenty thousand pounds per QALY represents treatment that is value for money. In other words, if a treatment can extend and improve a patient’s life for a year, and costs under 20,000, it is worth it.

The NHS’s Regional Drug and Therapeutic Centre, based in Newcastle, gives the cost of beta blockers as between 10 and 512 pounds annually, depending on the type of beta-blocker required. While this falls well within the QALY threshold of 20,000 pounds, using the research findings that beta blockers have no significant impact on health within the first year allows it to scrap the cost of funding this treatment because beta-blockers supposedly offer no significant benefit. The research has focussed on a time period that cannot significantly examine the effectiveness of beta blockers.

Cynics suggest that the research is merely an attempt to reframe the data regarding beta-blockers in order to minimise the cost of healthcare in an NHS which is lacking in resources.

Medical research, is unfortunately often subservient to economics and often the research appears to be carried out to arrive at a pre-planned conclusion. Wasn’t it long ago, when the economic crisis was looming and the government was looking to raise tax on alcohol, that we were told a glass of red wine a day had health benefits? Yet when the NHS struggled years later and was overburdened by drunken citizens dialling emergency services the evidence peddled about red wine was to the contrary.