First, Do No Harm

The New York Times broke a story yesterday asserting that “nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments”. A few other highlights from the article, and my thoughts, after the jump.

The article continues: “Mr. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are ‘potentially lethal’ to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses ‘putting profits before safety.’… The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.”

The New York Times in a frequent reporter of the abuse of psychiatric medication: in the past few years, they reported AstroZeneca’s $520M settlement for off label marketing of Seroquel, an anti psychotic, and two heartbreaking articles about children and psychiatric drugs. It breaks my heart that doctors continue to wrongly prescribe these medications to the most vulnerable amongst us. It is difficult for the mentally ill to be their own advocates: concerns and rights are too often passed over because we are deemed unfit to speak for ourselves. If this much off label marketing and irresponsible practice of medicine is reported, imagine the treatment endured privately, under lockdown, with no witnesses but the future these patients will live with.

In high school, I had an intense physical reaction to psychiatric medication that was poorly documented and understood at the time. I was treated as a psychotic person and worse, as a fraud (I’ll never forget the offhand comment a middle aged nurse with short curly hair made, expressing her ignorance and cruelty in curt, simple words: she’s just making it up). I was not making it up, and this drug comes with stern warnings for underage patients and their caretakers. I was not making it up.

Psychiatric medications have helped me stabilize and enjoy my life more than I believed possible just a few years ago. But they are only as effective as the doctors that prescribe them, and the decisions they make to trust the patient over the drug company, or vice versa. This time around, I had a conscientious, intelligent doctor who carefully studied my history and prescribed medications and dosages that made sense for me. He takes my symptoms and side effects, even when implausible, seriously. These are the types of doctors we need.

We may never know how or why some psychiatric medications work. We may never know for sure how some psychiatric illnesses work. This make neither less real or less dangerous. Is there higher leniency in the medical community for prescribing off label doses for psychiatric medications because we don't understand precisely what they do? Or prescribing more freely to mentally ill patients because we don't know what's going in their brains? I don’t know: but I do hope that doctors like mine continue to set a positive example and protect our most vulnerable patients.