Antipsychotic drugs were developed in the 1950s as a primary treatment for mental health conditions such as schizophrenia, as well as other psychoses including agitation, severe anxiety, mania and violent or dangerously impulsive behaviour. Lately, however, they have been the centre of media attention due to concerns over serious side effects, bringing into question their use. By Dr Nina Bailey.
Antipsychotic drugs work by moderating the effects of neurotransmitters in the brain, including dopamine, serotonin, noradrenaline and acetylcholine, regulating numerous aspects of behaviour including mood, emotions, sleep and appetite.
In 2009 the Department of Health ordered a review into the use of antipsychotic drugs, and later found that they are over-prescribed for treating aggression and agitation in people with dementia, contrary to NICE guidance. In fact, the review went as far as suggesting that up to two thirds of those individuals with dementia receiving anti-psychotic drugs were prescribed drugs unnecessarily. The concern surrounding the use of such drugs in dementia patients appears to be a significant increase in the risk of sudden death (Ballard et al, 2009), and increasing evidence suggests that some antipsychotics may be associated with adverse cardiovascular side effects and arrhythmia (abnormal heart rhythms) which, if severe enough, can lead to sudden cardiac death (Karlsson et al, 2009).
What is extremely concerning is that the use of antipsychotics is widespread across a range of conditions. Indeed, antipsychotic medications are a common course of treatment for autism, including children who express behavioural problems, such as aggression, self-harming behaviour, and severe tantrums. Autistic spectrum disorders (ASD) affect more than 500,000 people in the UK. These neurodevelopment disorders include both autism and Asperger syndrome and involve severely impaired social, communication, and behaviour skills. Simply put, individuals with ASD have problems with verbal and non-verbal communication, difficulties with social interaction and demonstrate lack of imagination and creative play.
Whilst people with Asperger syndrome can lead relatively normal lives, individuals with autism are usually more severely disabled and show quite severe symptoms. Autistic children can often become hyperactive and aggressive, with seizures common in around 15 to 30 per cent of individuals. In these cases, children are often treated with antipsychotics. In relation to this, a Brazilian group of researchers have recently suggested that omega-3 fatty acid supplementation in ASD patients treated with atypical antipsychotic drugs may reduce cardiac arrhythmias and hence the risk of sudden cardiac death (Cysneiros et al, 2009). It appears that using fish oil as an ‘add-on’ supplement could help to protect vulnerable individuals from the adverse side effects associated with pharmaceutical drugs that are so commonly prescribed.
Omega-3 fatty acids have long been known to offer a protective role against cardiovascular disease (CVD), via their inhibitory role of cardiac arrhythmias, their uptake into cell membranes, keeping them fluid and flexible, improved function of cardiomyocytes (the cells that make up heart tissue), as well as their role in the production of anti-inflammatory substances in the body.
The omega-3 EPA (eicosapentaenoic acid), in particular, is gaining much interest for its role in regulating neurotransmitters. Already praised for its role in safely regulating and alleviating the symptoms associated with many mental health disorders – including schizophrenia, bi-polar disorder and depression as well as a number of neurodevelopmental disorders – it is therefore natural to wonder why it is that doctors and psychiatrists are still so eager to prescribe drugs with well documented, potentially life threatening, side-effects. Given the safe record of fish oil supplementation, not to mention their well-established benefits, might it not be sensible to concentrate on researching these fatty acids as potential replacements/add-on treatments for such conditions?
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Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R; DART-AD investigators. (2009) The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 8:151-7.
Cysneiros RM, Terra VC, Machado HR, Arida RM, Schwartzman JS, Cavalheiro EA, Scorza FA. (2009) May the best friend be an enemy if not recognized early: possible role of omega-3 against cardiovascular abnormalities due antipsychotics in the treatment of autism. Arq Neuropsiquiatr. 67:922-6.
Karlsson J, Wallerstedt SM, Star K, Bate A, Hägg S. (2009) Sudden cardiac death in users of second-generation antipsychotics. J Clin Psychiatry. 70:1725-6.