July 13, 2009
EXCESSIVE caution by drug regulators has contributed to the deaths of thousands of patients with severe mental illness, doctors say. Patients with schizophrenia have been condemned to second-rate treatments, often for years, which are less effective at controlling the illness and preventing suicide because of misplaced anxiety about the safety of the most effective drug, clozapine.
A new study shows that clozapine, always thought tobe a dangerous drug, actually cut the death rate among patients with schizophrenia by 26pc, compared with the standard treatment. But the finding has been challenged by experts who said clozapine's side-effectsmeant patients needed close monitoring. Worldwide, millions of patients with severe mental illness are treated with anti psychotic drugs to control their delusions and hallucinations. Evidence shows that, onaverage, they die 25 years earlier than those in the general population, partly because of increased smoking and obesity, but also by suicide.
Professor Jari Tiihonen,of the University of Kuopio, Finland, and colleagues say that data shows clozapine lowered the risk of dyingthe most, despite being thedrug most closely restricted by the authorities because of safety concerns. Clozapine can cause a granulocytoisis, which destroys the white bloodcells and causes falls inblood pressure, convulsions, diabetes and weight gain. Writing in TheLancet, Professor Tiihonen said: Doctors and the [drug regulatory] authorities are too cautious." He added: "Patients are more willing to use it, probably because it is effective." Professor Tim Kendall ofthe Royal College of Psychiatrists said a study in China showed it was no more effective than the older anti psychotic chlorpromazine. "Clozapine seems to work better in people who have tried other drugs which have failed," he said.