I haven’t written about my opposition to the widespread use of psychiatric medications in quite some time, mostly because I feel I’ve already said most of what I have to say on this issue. (See the collection of posts under the heading “The Medicalization of Mental Health,†to be found at the lower right of this page.) But a new study was recently released which demonstrates a link between the use of benzodiazepines and the risk of developing Alzheimer’s disease. While this study says nothing about the long-term effects of SSRIs, the history of benzodiazepine usage offers a cautionary tale as to how little we truly understand about a drug’s side effects during the years immediately after psychiatrists and physicians begin prescribing it.
In the study, a team of researchers from France and Canada linked benzodiazepine use to an increased risk of being diagnosed with Alzheimer’s disease. Relying on a database maintained by the Quebec health insurance program, they identified nearly 2,000 men and women over age 66 who had been diagnosed with Alzheimer’s disease and then looked at their drug prescriptions during the five to six years preceding the Alzheimer’s diagnosis. These people were compared to a larger group of subjects who were matched for age and sex.
People who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken one. But taking the drug for three to six months raised the risk of developing Alzheimer’s by 32%, and taking it for more than six months boosted the risk by an astonishing 84%. Those who had taken longer-acting drugs like Valium and Dalmane were at greater risk than those who had taken a shorter acting one.
One major caveat: men and women in the early stages of Alzheimer’s might turn to benzodiazepines in order to cope with anxiety and sleep disruption – two common symptoms of early Alzheimer’s disease. In that case, their use of a benzodiazepine may not be a factor in causing dementia but rather an indication that it is already in progress. In other words, based on the results of this study, we can’t identify an actual causal relationship with certainty.
Still, it’s enough to make one worry. For me personally, this study helped me to understand what likely happened to my own mother, who began demonstrating early symptoms of Alzheimer’s in her late-50s and died in her early 70s, by which time she hadn’t known who I was for many years. Our family physician and a dentist friend kept Mom well-stocked first with Miltown and later with Valium. She took them on a daily basis throughout my childhood. The study made me wonder whether her benzodiazepine usage actually brought on her dementia.
Librium, the first benzodiazepine, was made available to the public in 1960; Valium has been available since 1963. Not until 2014 — fifty years later — did results from a controlled study indicate a probable connection between benzodiazepines and the risk of developing dementia. Prozac hit the U.S. market in 1987, followed by Zoloft in 1991 and Paxil in 1992. Twenty years from now, who knows what future studies may demonstrate about their long-term side effects. Recent meta-analyses have debunked the “miracle pill†hype that surrounded Prozac in the early 90s, proving anti-depressants to be no more effective than a placebo for most forms of depression, but not enough is known about what damage they may be doing to those who have already taken them for years.
Even now, doubts about their safety are beginning to surface. In a 2012 article published in Frontiers in Psychology, the authors discuss growing evidence that anti-depressants cause neurological damage: they may kill neurons in a way that causes structural damage to the brain, the kind that produces symptoms of Parkinson’s disease and tardive dyskinesia, a condition characterized by involuntary and repetitive body movements. Other evidence links anti-depressants to cognitive decline and an increased risk of developing breast cancer.
On an entirely different subject: another study recently published in Nature has demonstrated a link between the use of artificial sweeteners like saccharine or Splenda and the development of glucose intolerance – a condition that leads to obesity. For decades, these products have been marketed to the public as entirely safe and guilt-free sugar substitutes, trusty weapons in the battle against weight gain; ironically, it now turns out they are likely implicated in the obesity “epidemic†sweeping our country.
I bring up this further study to point out the unknown risks we run by loading our bodies with chemical substances produced in the laboratory, be they psychiatric medications or artificial sweeteners. In truth, there are no “miracle pills†for depression and there’s no “free lunch†when it comes to sugar substitutes. Exercise has been shown to be an effective treatment for depression, along with psychotherapy and exposure to sunlight. Reducing the intake of carbohydrates and eating more protein (combined with moderate exercise) leads to weight loss. I speak from personal experience, but much has been written on this subject, in particular by Gary Taubes, a man I deeply admire.
Both of these approaches to change involve more personal activity on our parts, rather than the passive approach promoted in particular by the pharmaceutical industry. “Here, take this pill and it will correct the imbalance in your serotonin levels.†I understand the simplistic appeal of this approach but it’s important to understand the grave risks we run when we buy into the lie, despite the growing evidence as to the ineffectiveness and potential dangers involved in taking anti-depressants.
Hi Dr. Burgo,
Please keep writing about this! I’ve written here before about my experience as a pediatric health care provider watching children and adolescents get prescribed these same meds without ANY STUDIES. As you point out we don’t know what these drugs do to adult brains let alone the developing brain of a child or adolescent. It is insane and bizarre that our society has condoned this. I also believe it is partly the “quick fix/no work on my part I am incapable of tolerating any pain” sort of mentality that is so prevalent today. God forbid someone should be anxious or sad or fearful or have any uncomfortable emotion. It is like we are denying ourselves the very emotions that make us most human and compel us to grow. What is happening!! Hopefully these studies will start helping and thank you for pointing them out and writing about it.
Hi Kim, I will keep posting my comments. Don’t you feel as if you are swimming upstream a lot of the time? — that the “quick fix/no work” attitude you describe is pervasive in our culture, and that painful emotions have become pathologized, rather than viewed (as you point out) as a normal part of the human experience.
Yes, swimming upstream. The whole thing has become so very odd. Primary care is tasked with taking care of mental health because insurance companies don’t reimburse therapy. Primary care takes it on because people are desperate. Primary care has no training and has basically taken on the prescribing of meds because we have no idea how to do therapy. Primary care also has very little training and/or time for true diagnosis so every child who comes into our practice has one of 3 things. ADHD, Depression, or Anxiety. The meds have some, but very little research backing up the use of them. (ADHD) has a little more research to back up the use of stimulants but if you carefully read the MTA study (which everyone sites as the study that proves stimulants work) it has a lot of flaws. AND the 3 and 8 year follow up studies the MTA researchers did show NO DIFFERENCE anymore between the groups studied. And believe me, after we put these kids on meds, it is hard to get them off! I don’t feel like I’m swimming upstream, I kind of feel like I am swimming in a different river! Like doesn’t anyone see what I see? Anyway, I will stop. I am so sad about this and you have opened up a place to rant. But I will continue to fight the good fight with parents and I hope more mental health resources will start coming.
The whole thing breaks my heart.
Dear Dr Burgo
Thank you for another thought provoking post. It’s a topic that has been in my mind a lot. My training is in medicine and so obviously also the medical model of looking at things. However in my exploration of these issues both personal and professional I have come to agree more with your point of view, maybe landing somewhere in the middle.
I am a GP in Cape Town. I recently started my own private practice and I have found that more than half of my patients have mental health issues, even though they often present with physical symptoms. I spent a lot of time connecting with many psychologists and some psychiatrists in my area and tried hard to match people and do good referrals, but people just don’t go. I found it so frustrating seeing the same people come back worse and worse and I was powerless to really give them the help they needed. It felt like working in an under resourced government setting again!
So I have enrolled to do both a diploma in mental health ( a more psychiatry oriented course) for which studies are well on their way. I have also applied for a diploma in psychotherapy which I am hoping to get accepted to. In the meantime I am getting supervision from an experienced clinical psychologist with a psychoanalytic background, supervision from a psychiatrist and I am in analysis myself.
I must clarify, at this point, I don’t offer psychotherapy – I realise that I am not nearly skilled enough. I wish all the people who need it could afford it and were able to overcome their fear and have the experience of good psychotherapy, but that is not the reality of the world I live and work in.
I have been really trying to grapple with what I can realistically do and where the right balance lies. I still don’t really have an answer and I have a feeling it’s going to differ drastically from patient to patient.
To be honest, if someone really is depressed or having significant anxiety (not even to mention manic or psychotic) I seldom don’t offer them medication, but I don’t do it lightly. All my appointments are half an hour. In the first appointment, I exclude medical causes like thyroid etc. Then we make a special hour long mental health appointment and I take at least one of these to come to a working diagnosis and a treatment plan. I then present the same patient to both the warring disciplines and try and make sure I am reasonably balanced in between. I offer weekly hour long sessions for a bit while the person is in crisis and I take the time to get to know them, try to make a good match with a therapist and “midwife” the process of getting them into therapy.
I would love your thoughts and input in general, but in particular relation to your post – given that in depth psychotherapy with a skilled therapist is first prize, do you believe there’s a role for medication where this isn’t realistically available?
Kind regards
Dee
I do think medication has its uses; it’s the long-term use I object to, and I worry that once on these drugs, patients rarely come off them. While you may not yet feel qualified to offer psychotherapy per se, I think what you are doing is outstanding … so why not keep doing it? Often, the depressed patient improves when someone takes an ongoing interest in his or her condition. You don’t necessarily have to intervene in other ways but simply keep them talking, week after week.
Dear Dee,
I am the first commenter and I work in pediatrics and I just wanted to say how impressed I am with your true commitment to really helping people. It is really so beautiful! Most primary care providers don’t have the time/money/desire etc to even think about these things. One of the issues is obviously reimbursement. Do you get adequately reimbursed for you 1 hour visits with these lucky patients?
Thanks for being so thoughtful, you are a true healer.
Kim
Dear Dr Burgo
Thank you for your encouragement. More often than not I feel like I am swimming upstream as you mentioned to Kim and your perspective helps 🙂
Dear Kim
Thank you so much for your kind words. Reimbursement is something I am still struggling with. For the majority of my career I worked in state run hospitals/ clinics. I was paid a salary by the government and my interaction with the patient cost them nothing. In fact, I was their advocate, trying to get the system to cough up the care they needed. I fully intended on doing that for the rest of my life, but after becoming a mom I realised it wasn’t sustainable. I remember being 8 months pregnant and seeing 50 patients a day in a clinic with no working toilets!
The worst was the stress of knowing I really wasn’t helping anyone properly, because with that many people to help it’s really just about avoiding disasters, not really getting anyone to be properly well. I realised I needed more control over how and when I work and so I went into private.
The billing is still awkward. It is still a new business and I am only just covering the costs of staying open, but that is more about lack of feet through the door. I have realised that however much I want to help people for free, I won’t be able to offer a service at all if I don’t bill for it.
Luckily, in private most people have medical aid and I am guided by what the medical aids are prepared to pay. The only thing I charge significantly less for is the hour appointments, especially if they are ongoing, because then the medical aid will get used up and the patient will be left with bills. Also I don’t think I should be charging the same rates for my brand of counseling as experienced psychotherapists. I am highly skilled and trained, but not in psychotherapy.
Sorry that was so rambling, hope I addressed your question.
Kind regards
Dee
Yes, I posted. My ex mother-inlaw, used to take half a Valium a night, for many yrs. she developed detia and her deterioration was frightening. Could hardly recognize the person she became. I did often wonder if those Valium contributed to this happening to her.
Re disappearing comments: darn it! I found this blog a month or two ago and posted comments on several pieces. I can’t remember exactly which ones (I read a ton of the posts), but I can’t find any of my comments. 🙁
Take care.
Greetings Dr. Burgo,
I agree with concepts of integrated therapeutic approaches. But, after several years of therapy with a “good fit” therapist, it was necessary to include mood altering medication. The therapy was not enough, and I do not think I would be alive without the medication. Here is the thing: I was eating in a very healthy manner, my physical health is good (I have “good numbers”), I do not use alcohol or recreational drugs and was on no medication. When I exercised moderately (mowing the lawn), I would become so depleted that it was hard to do anything for a couple of days and my mood would plummet further. I could not work and became increasingly withdrawn, with a negative perspective. The addition of a balanced approach to use of medications, carefully titrated to get positive effect relative to side effects has been helpful for mood, pain, endurance and the ability to think and relate in a more insightful and flexible manner. There are cognitive, emotional, social, spiritual and physical sides in our reactivity to trauma, and my traumas and reactivity have both been cumulative. I am content to be alive now, and more hopeful about making progressive steps in my future. I could not have gotten to this (better) state without the addition of medication; I was losing too much ground. It is my hope to decrease/eliminate the use of these meds over time, but I also must admit that this experience has been very scary. These meds may put increased risks on my future health, that is the state of the art, but at least I will have a future.
Thank you, Joe, for sharing your experience and thoughtful reflections.
I think your decision, despite the risks, is valid. I have a friend on various psychiatric medications who has found enormous relief from her OCD. She once told me that, even if she were to die from having taken these drugs for the last ten or so years, she felt grateful to have had those years. I guess it’s a quality vs. quantity issue, huh? Shorter and better vs. longer and miserable.
The results from the study you mention are shocking – the risk of getting dementia/alzheimer’s is so dramatically higher if indeed benzodiazepines are the true cause. This may be totally wide of the mark but I’ve often had the thought that people with personality disorders might develop diseases such as Alzheimer’s as a creative way to deal with the difficulties of growing old – nobody likes facing old age but people with personality disorders have more trouble than most so forgetting and retreating back to childhood might ‘work’ for them in a way!
Also I read some new research that is linking Caesarian sections with autism – they don’t know why but there does seem to be an link. Apparently more women are being given c-sections than ever before by doctors. Maybe personality disordered women don’t want the hassle of child birth! Is that going too far?
Your theory about people with PDs developing Alzheimer’s is fascinating and ought to be looked into. What you describe makes perfect sense to me. I also think that minds that rely persistently and heavily on extreme defense mechanisms become debilitated over time.