Twenty year survival shortfall: ‘It’s very easy to kill a patient’

THE magic pills used to treat some people suffering severe mental illness are also killing them, according to experts.

Psychiatrists, clinical psychologists, medical researchers and other professionals from around the country have this week gathered at the annual Society for Mental Health Research Conference in Sydney.

Among the issues broached Wednesday was a life expectancy gap between people with and without mental illness.

St Vincents Hospital endocrinologist and clinical researcher, Professor Katherine Samaras, said there was a “20-year survival shortfall” and the gap was not “getting any closer to being zero”.

She attributed the discrepancy in part to antipsychotics and antidepressants that have previously been linked to weight gain and subsequent physical conditions including diabetes, cancer and hypertension.

In a session called ‘Can we stop killing our patients?’ Prof Samaras said there were many silent diseases “that occur in severe mental illness”.

“It’s the diabetes, the heart disease, the hypertension and cancer that occur on average two decades earlier than they would occur in people who didn’t have severe mental illness,” Prof. Samaras said.

“For women it starts very, very early with disturbances in menstrual cycle.”

Prof. Samaras said some antidepressants were known to cause patients to gain “seven per cent of their body weight within 12 months … and double the risk of diabetes … which is guaranteed to bring on metabolic disturbances”.

She said a “slow way (to) … kill a patient” was to “just add sweetener”.

“It’s probably very easy to kill a patient,” she said.

“Many of us in physical health know how quickly and easily that can happen.

“Weight gain occurs because we’re not intervening with interventions that we now know work.”

Clozapine is the one drug that works for many patients with schizophrenia who have proven resistant to other drugs. But it comes with many side effects.Source:Alamy

She said Clozapine therapy — effectively used to treat people with schizophrenia and Parkinson’s disease — was associated “not only with rapid increases in weight but the greatest risk for incident premature diabetes”.

Clozapine has been effective in the treatment of patients with schizophrenia who have proven resistant to other drugs, experts said.

But according to the medical researchers, 68 per cent of users are at extreme risk of developing type two diabetes over the next five years.

Psychiatrist Dan Siskind said he prescribed Clozapine to a patient suffering schizophrenia because it was the only drug available that would work on him but while “he’s not tormented anymore, he’s morbidly obese and has diabetes”.

“I am failing him,” Dr Siskind said.

“The people who are on Clozapine … my patients tell me they are not full. One patient eats a casserole in one sitting. They crave fatty foods and sugar foods.”

Psychiatrist Dr Julia Lappin, of the University of New South Wales School of Psychiatry, said premature death among people with severe mental illness was the “scandal of our generation”.

“There’s a mortality gap that continues to grow,” Dr Lappin said.

“We really need to think about what we’re going to do about reducing the mortality gap for our population and assisting them with domestic health care.”

Dr Lappin said people with severe mental illness were dying younger “largely due to very high rates of cardiometabolic risk factors: they smoke much more than the general population; they’re more obese; their blood pressure’s higher; they have diabetes and extraordinarily high rates of metabolic syndrome”.

“In addition they have very sedentary lifestyles and poor nutrition,” she said.

She said it was possible for appropriate dietary and exercise interventions to combat the problem.

NSW Minister for mental health and medical research Pru Goward said mental illness was “an enormous burden on society and the economy”.

“You don’t get your fair whack of funding,” she told the conference.

“No longer is a mental illness diagnosis the end of the road. It’s the beginning of another journey: The journey to recovery with the right support and care.

“We need to incorporate mental health research into everything we do.

“Good mental health is everything.”

Ms Goward said the NSW government had invested $1.8 billion in mental health, including “new models of care … like recovery”, this year.

If you or someone you know needs help, call Lifeline on 13 11 14.

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