The lead author is Dr. David Healy, an internationally recognized authority both as a psychopharmacologist and a historian documenting the profession’s mood swings that have largely determined the course of clinical practice in psychiatry.
The historical review, "Lifetime Suicide Rates in Treated Schizophrenia: 1875-1924 and 1994-1998 Cohorts Compared," is the largest study ever to address suicide in schizophrenia patients. The following findings are reported:
In 1875-1924, the suicide rate in treated patients with schizophrenia in an asylum in North Wales, was 20/100,000 hospital years–less than 0.5% lifetime rate. The suicide rate for all psychoses during those years was 16/100,000 hospital years.
But among the 1994-1998 patient group, the rate of suicide was135/100,000 patient years—a 4% lifetime rate. This 4% risk estimate represents "a 20-fold increase in suicide rates for patients with schizophrenia in the modern period."
In an invited accompanying commentary, Dr. Trevor Turner, Consultant Psychiatrist and Clinical Director, Department of Psychiatry, of a university hospital in London, writes: “If their figures are carefully boiled down, they show that in the course of 5 years the historical cohort had 1 suicide in 594 individuals, whereas the present-day cohort had 7 suicides in 133 individuals.” Thus, patients treated with the latest antipsychotic drugs had a 20-fold increased risk of suicide compared to those treated without drugs in Victorian times.
These startling findings are certain to stir much controversy because they challenge a key mental health treatment goal—suicide prevention—which is also offered as the prime justification for mental screening in U.S. schools. These findings also challenge the widely cited 10% lifetime risk of suicide among schizophrenia patients.
Dr. Healy and colleagues analyzed schizophrenia patients’ records–which for the historic patient cohort are much more detailed with mandatory assessment of patients for suicidality. The authors note, "The records from the North West Wales service offer an opportunity to shed some light on comparative rates of suicide and suicide attempts in schizophrenia, from the pre and post-community care eras as the population of North West Wales has remained essentially unchanged in numbers and ethnic mix for 120 years. Thus in 1891 the population was 232,109, with 116,924 people between 15 and 55, while in 1996 it was 240,683 people with 119,323 in the 15-55 age band).”
Dr. Turner notes in his commentary, “most suicides today are not known to mental health services.” If so, then the findings may significantly understate the contemporary suicide incidence rate.
At the very least, Dr. Healy and colleagues’ historical findings raise serious questions about current practices—and the possibility that the drugs upon which psychiatry relies on so heavily may be doing harm. Indeed, recent suicide case reports to the British Medicines Healthcare Regulatory Agency (MHRA)—which are said to represent 1 in 100 adverse events—seem to confirm that antipsychotics as well as antidepressants are implicated in the greatest number of suicides and suicide attempts in the UK. See, MHRA statistics posted on the AHRP website at: http://www.ahrp.org/cms/content/view/90/28/
Prescribers of antipsychotic drugs must weigh the total risk profile of these drugs: they cannot afford to disregard the possibility of a 20-fold increased suicide risk, as well as the proven severe adverse effects of these drugs—some of which are disclosed in black box warnings in these drugs’ labels.
The findings may also be read as lending support to the findings of prize winning author of Mad in America, Robert Whitaker. Whitaker analyzed US government disability data, discovering that the outcome for schizophrenia patients in the US has worsened since the psychotropic drug paradigm was adopted. Every year, the Social Security Disability Insurance (SSDI and SSI) increases with 150,000 new mentally disabled persons.
See: Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, published in Ethical Human Psychology and Psychiatry, Volume 7, Number I , Spring 2005. http://www.ahrp.org/infomail/05/08/29a.php and http://psychrights.org/Articles/EHPPPsychDrugEpidemic(Whitaker).pdf
In light of the disturbing possibility that the drugs are doing serious, irreparable harm: increasing suicides, heart attacks, diabetes and much more, how can we let stand state statutes that allow mental health professionals to force antipsychotic drugs on patients? How can Dr. Fuller Torrey reconcile his endorsement (indeed, promotion) of state mandated, forced treatment with drugs shown to put patients at increased risk of death?
As the unfiltered evidence of harm is brought to light, prescription guidelines, such as the Texas medication algorithm (TMAP) that mandate the use of harm producing antipsychotics, should be discarded. The drugs recommended in the TMAP guidelines are undermining the life safety of patients.
Dr. Healy, it should be remembered, had delivered the most potent challenge to his peers in the psychiatric establishment and to drug regulators (FDA, MHRA)—when he confronted them with evidence from unpublished industry produced controlled, clinical trial data, showing that SSRIs increased the risk of suicide in children and adolescents. Thus, he overturned more than a decade of widely made, unsubstantiated claims about the safety of antidepressants of the SSRI class.
Although the data in this review are not from controlled clinical trials, the finding of a 20-fold increase in suicide and suicidal acts compared to the rate prior to the introduction of psychotropic drugs need to be validated or refuted. Until then, a reassessment of the current paradigm in the treatment of schizophrenia is essential inasmuch as there are indicators suggesting that psychotropic drugs may be increasing the risk of suicide rather than reducing the risk.
See full text of BJP article at: http://bjp.rcpsych.org/cgi/content/abstract/188/3/223
Contact: Vera Hassner Sharav