Psychiatric Drug Effects - Adverse Reactions and Side Effects

What are side effects?
Side effects are undesirable effects of medication. Specific side effects can be found on the pharmaceutical literature inside each packet of medication. Because of the way pharmaceutical drug trials are designed it is unlikely that all the potential side effects are listed (Witte et al 2002). Side effects may be due to people's inability to metabolise psychotropic medications (Schillevoort et al 2003); it is akin to an allergy. Further information can be found at the Pharmacogenetic Section or click onto:

Bray J., Clarke C., Brennan G., Muncey T. (2008) 'Should we pushing meds'? The implication of pharmacogenomics Journal of Psychiatric and Mental Health Nursing Vol.15 No.5 p.357-364

What are adverse reactions?
Adverse reactions include all side effects experienced by patients and can cause permanent and detrimental bodily changes which can be potentially irreversible.

Adverse reactions /side effects to anti-psychotics and antidepressants vary considerably and is partly determined by individuals, inability to metabolise the drugs efficienlty due to inherited genetic variations.

Since biological psychiatrists perceive 'schizophrenia' necessitates 'treatment' with anti-psychotic drugs, they are more inclined to avoid using the term 'adverse reactions' preferring the term 'side effects'. Generally, the major priority of most mental health clinicians is patients' compliance with 'medication'. By using the term 'side effects', the possibility of non compliance is reduced, since patients are less likely to be alarmed ( as compared to 'adverse reactions') .

Additionally it provides clinicians with a subjective emotional distance from the potential reality of causing bodily harm. Many carers/service users are not fully informed about side effects/adverse reactions and in my experience the vast majority of side effects/ adverse reactions are withhold. One DH professional particpant remarked patients would not take the drugs if they knew all the side effects. This approach is psychologicallly abusive with the direct intention of deceiving patients in complying with medication.

All adverse reactions whether permanent or temporary occur as the direct result of medication; adverse reactions are iatrogenic - drug induced'.

Leaflets containing brief information about iatrogenic which professionals think would be acceptable to patients and carers, is sometimes provided by Care Trusts; the standard medication leaflets found in medication packets are not available for patients within hospital.

In 2008 the Department of Health in the UK produced a short booklet entitled 'Medicines Management: Everybody's Business. A guide for service users, carers and health and social care practitioners.' This document which was devised by carers and users was heavily scrutinised by psychaitrists and the DH so that it was more acceptable. The genotyping test which was initally promised by the director of NIMHE was eventually rejected from the document. Scores of publications were destroyed some months later.

www.newwaysofworking.org.uk Pharmacy Section.
This leaflet is an improvement on the previous situation, however does still not convey the full picture of all the potential adverse reactions.

Much of the pharmaceutical literature contains information resulting from short term studies i.e. six to eight weeks. However the long term studies about the insidious and long lasting impact on the brain and the physical body together with the psychological impact is in my experience, never shared with patients and carers. Long term studies are not in general undertaken.

The current Mental Health practice of withholding all neuroleptic/anti-psychotic side effects/adverse reaction information, I think is wrong, since patients and carers are prevented from having a truly informed choice about neuroleptic 'medication'.

In my experience challenging prescribers about side effects has resulted with the robotic response that the 'benefits of neuroleptics far out weigh the risks'. This attitude I think is uncaring and does not happen in general medicine where physical effects affecting body organs are taken seriously. Such psychiatric prescribers are in denial to the physical and psychological suffering incurred by service users and indirectly by carers.

The Lancet, 352 (9130) 784. states longer service users take psychotropic drugs the more likely will be the severity of side effects.

Reporting of Side Effects to the Medicines and Healthcare products Regulatory Agency

Yellow Cards are available on line at www.mhra.gov.uk, or from pharmacies, GP surgeries or the Yellow Card hotline (0808 100 3352) during business hours.

Schizophrenia Association of Great Britain reports adverse events and deaths form the following neuroleptics:

Clozapine: period 19.12.89 -7.03.01:

2813 Adverse events with 622 cardiovascular disorder
Many other systems were reported

Sertindole: period from 01.07.96 - 24.07.00

106 Adverse events with 46 cardiovascular disorder
Many other systems were reported

Amisulpiride: period between 26.01.98 - 23.03.01

247 Adverse events with 15 cardiovascular disorder
Many other systems were reported

Olanzapine: period between 01.10.96 - 28.03.01 391699

Adverse events with 231 cardiovascular disorder. Many other systems were reported

Quetiapine: period between 04.10.97 - 19.03.01302

Adverse events with 80 cardiovascular disorder
Many other systems were reported

Risperidone:

822 Adverse events with 139 cardiovascular disorder
Many other systems were reported

Zotepine: period between 16.12.98 - 15.01.01

14 Adverse events with 6 cardiovascular disorder
Other systems reported.

Ziprasidone no reports