Perils of prescribing antipsychotics to nonpsychotic patients

Perils of prescribing antipsychotics to nonpsychotic patients

The past several years have seen a significant spurt in the number of people diagnosed with mental disorders. While there are many reasons for this sudden increase, lack of social interaction, breakdown of family as an institution, and extreme popularity of the social media are considered some of the major causes of the high prevalence of mental disorders among all age groups.

Mental disorders can be primarily divided into two categories, the psychotic and the nonpsychotic. Psychotic disorders like schizophrenia and bipolar are characterized by delusions, hallucinations and phases of mania, while nonpsychotic conditions, such as depression, anxiety disorders like phobias, OCD, etc., are characterized by irritability, restlessness, compulsive behavior, excessive worrying and so on. At the root of most nonpsychotic disorders is an unresolved grief or trauma. Unlike psychotic disorders that require medication for controlling the symptoms, most nonpsychotic disorders can be effectively treated using a combination of therapies and counseling. Even a supportive family environment can be helpful during the recovery process.

Off-label use of medications can produce devastating effects

Antipsychotics, also called as major tranquilizers, are generally used for the treatment of psychosis, however, their efficacy in the management and control of nonpsychotic disorders is still debated. In 2005, the Food and Drug Administration (FDA) had warned that second-generation antipsychotics (SGAs) may increase the mortality risk in older patients.

Antipsychotic medications can be divided into either first-generation antipsychotics (FGAs) and SGAs. However, all types of antipsychotics are associated with side effects, with FGAs known to cause serious side effects such as “tardive dyskinesia” or uncontrolled movement of the tongue, mouth and other parts of the body, while SGAs being associated with minor side effects like weight gain, diabetes mellitus, sexual side effects, cataract etc.

Lately, SGAs are increasingly being used off label, i.e., for conditions other than those that it has been approved for. In recent times, SGAs are being widely used for eliminating the distressing symptoms of schizophrenia and bipolar disorder. Although, the medications are effective to a certain extent in eliminating or reducing distressing behavior, distorted thinking, hallucinations and paranoia, in most instances, however, the rate of recovery depends on the psychosocial rehabilitation, counseling, therapy (behavioral or cognitive or both) that is offered to the patient alongside the medication.

In schizophrenia patients, SGAs not only help in improving appetite and sleep patterns, but also considerably reduce the psychotic symptoms associated with the disorder. The drugs also play a vital role in improving cognition and reducing the risk of drug abuse.

While there is some evidence to support that SGAs can be used off label, the ill effects of such usage are more than the benefits. Studies have shown that under no circumstances can SGAs be used as the first line monotherapy, (treating a disease with a single drug) or first and second line add-on therapy in the treatment of anxiety disorders. Doctors also caution the off label use of many SGAs. Unless there is rigorous and independent research that approves the use of medications such as these for the cure of anxiety disorders, their use should be limited.

Road to recovery

Chronic mental illnesses are extremely disabling, however, counseling can help manage the symptoms and enable a person to lead a normal life. An experienced therapist can help a person in getting rid of unwanted behaviors and incorporating positive behaviors. For most nonpsychotic disorders, counseling and therapies are sufficient, however, one must keep away from off label use of medications, which has more side effects than benefits.

If you or a loved one is suffering from any kind of mental illness, contact the California Mental Health Help to know about the best mental health facilities in California. Call our 24/7 helpline number 855-559-3923 or chat online with our representatives to know about one of the best mental health centers in California. One should not delay the treatment or things can get out of hand.