Will UBC Tylenol study lead to more treatment of mental-illness symptoms instead of causes?

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A recent study by University of British Columbia researchers suggests that Tylenol can be used for more than just quelling a migraine. Acetaminophen may be used to reduce feelings of “existential dread”, the anxiety that comes with being threatened.

The findings of the study, The Common Pain of Surrealism and Death: Acetaminophen Reduces Compensatory Affirmation Following Meaning Threats, were published recently in the journal Psychological Science. Joint April 16 news releases by the university and the Association for Psychological Science (APS) announced the findings. (According to the APS release, the research was supported by a grant and doctoral fellowship from the Social Sciences and Humanities Research Council, a Canadian federal research funding agency.)

In the UBC release, the researchers cautioned against relying on Tylenol to prevent emotional distress, as “further research—and clinical trials—must occur before acetaminophen should be considered a safe or effective treatment for anxiety.” Similarly, in an article on National Public Radio’s online Shots “channel”, lead researcher Daniel Randles said: “We would in no way recommend Tylenol as a therapy.”

However, Randles did say in the APS release: “For people who suffer from chronic anxiety, or are overly sensitive to uncertainty, this work may shed some light on what is happening and how their symptoms could be reduced.” (The study can be viewed here.)

According to the third edition of Quick Facts: Mental Illness and Addiction in Canada, published in 2009 by the Mood Disorders Society of Canada, eight percent of Canadians will experience a major depression in their lifetimes, and anxiety disorders will affect 12 percent of Canadians.

And Canadian pharmacists fill more psychiatric-medicine prescriptions, per capita, for their customers than those of any other country.

Psychiatric medications do help those suffering from mental illness when prescribed and used correctly. However, overuse or abuse can become a problem. Benzodiazepines (such as Valium and Xanax) are psychoactive drugs commonly used to treat anxiety disorders. According to a 1986 report titled Adverse Effects of Prolonged Benzodiazepine Use, written by then–psychopharmacology professor Heather Ashton of Newcastle University, long-term use of the drugs could lead to dependence and withdrawal symptoms. Thus, although benzodiazepines are effective, they should only be taken for relatively short periods of time.

A related study a quarter-century later—Primum Non Nocere: An Evolutionary Analysis of Whether Antidepressants Do More Harm Than Good, a 2012 paper by researchers at Ontario’s McMaster University—says that antidepressants should be used with caution. “It’s important because millions of people are prescribed anti-depressants each year, and the conventional wisdom of these drugs is that they’re safe and effective,” lead author Paul Andrews said in a university statement. Andrews, an evolutionary biologist, and his colleagues found that the risks of antidepressants outweighed the benefits. The risks include digestive problems (such as diarrhea and constipation), sexual problems, abnormal bleeding, stroke, and even premature death in the elderly.

Given the wide use of (and the possibility of abusing) these medications, what are some of the possible ramifications of relying on Tylenol to treat anxiety or depression?

When taken, even as directed, for four days, acetaminophen was found to affect liver-enzyme levels, putting users at risk for liver damage. (This is according to a 2006 study, Aminotransferase Elevations in Healthy Adults Receiving 4 Grams of Acetaminophen Daily, conducted by researchers of the University of North Carolina.) Furthermore, a 2011 study (of patients admitted to hospital with liver damage due to acetaminophen) led by Dr. Kenneth Simpson of the University of Edinburgh found that gradual overdoses of acetaminophen were more likely to be fatal than a sudden, massive overdose.

Patients who suffered such “staggered” overdoses used acetaminophen to treat minor afflictions, like headaches, toothaches, and muscle pain, but used just slightly more than the recommended dosage. About 37 percent of those staggered overdoses in the study proved fatal. In a November 2011 release by the British Journal of Clinical Pharmacology, which published his paper, Simpson said that although gradual intoxication may not be noticed at first, “over time the damage builds up, and the effect can be fatal”.

Psychological dependence may also pose a risk to those who rely on Tylenol for treatment. The American Psychological Association’s Dictionary of Psychology defines psychological dependence as “dependence on a psychoactive substance for the reinforcement it provides”.

According to the APA’s website, cognitive-behavioural therapy (CBT), a type of psychotherapy, is “highly effective in treating anxiety disorders. Psychologists use CBT to help people identify and learn to manage the factors that contribute to their anxiety”. The APA does not recommend halting the use of psychoactive medications and acknowledges their possible role in treatment, provided that they are monitored closely for side effects.

And rightfully so. Psychiatric medication can help those who: need it to respond and benefit from psychotherapy, are a danger to themselves or others, or need it to be able to function normally in their lives. But alone, medication will only fix the symptoms of anxiety or depression; it will not address the underlying problems for those issues.

At the APA 2011 annual convention, a symposium titled “Psychotherapy Effectiveness: What Makes it Work?” noted that effective therapy involves customized treatments, a reliable and persuasive therapist, and forming relationships. The convention discussed the benefits of psychotherapy as opposed to medication alone, which included better effectiveness in the long term, cost-effectiveness, and fewer relapses of anxiety and mild-to-moderate depression.

Nonetheless, psychology professor Steven Hollon said at that convention that, increasingly, pharmaceutical companies are gaining market share at the expense of therapy because they directly target health professionals and the public.

For these companies, business is booming. According to Quick Facts again, this country has the highest number, per capita, of psychiatric-medications users in the world. In 2006, Canadian doctors wrote 51 million prescriptions for psychiatric medications.

Avoiding the use of acetaminophen to treat mood disorders would prevent its known drawbacks and perhaps also some of the risks and side effects associated with other psychiatric medications. The whole issue of whether or not to market Tylenol, for instance, as an anxiety antidote might persuade people with mood disorders to examine (or reexamine) their own treatments. They may find that using medications alone is not enough and that some other approach is needed to understand and treat the root cause(s) of their issues.

Some medications can be used effectively alongside psychotherapy for treatment of anxiety- and depression-related conditions. But medications alone do not offer the same lasting benefits that psychotherapy does.

Unless psychotherapy is installed as the remedy of choice for mental-health treatments, though, the number of people being prescribed these drugs will only increase.

As will their associated problems.

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