Medical experts seek to dial back over-prescription for schizophrenia

by Tomoko Otake

Staff Writer

Doctors in Japan have long prescribed a cocktail of several types of drugs to people with mental illnesses, often leading to various side effects.

But the practice of over-prescribing is facing a rethink, as evidenced by the recent publication of guidelines on how to reduce the number of prescription drugs for schizophrenia patients.

The National Center of Neurology and Psychiatry (NCNP) last week released the “evidence-based” guidelines on reducing the number and doses of antipsychotic drugs prescribed to patients with schizophrenia.

The guidelines, designed for use by doctors only and downloadable from the center’s website, lists numerous anti-psychotic drugs currently in use, along with a table on how doses for each drug can be converted to equivalents of Chlorpromazine, a major tranquilizer from the 1950s that is often used as a yardstick for measuring the effectiveness of newer drugs.

Using the table, doctors are encouraged to reduce the volume of drugs gradually, at a pace of once a week or once every two weeks, over three to six months.

“Multiple prescriptions (of anti-psychotic drugs) are a result of the medical culture in Japan, where many doctors have sought to help the patients while finding one particular drug not effective enough,” said Yoshio Yamanouchi, head of the NCNP department of social psychiatry. “But there has been a movement to review the practice over the last 10 years or so, as Japan’s tendency to over-prescribe was found to be conspicuous by international standards.”

According to the latest data from the Health, Labor and Welfare Ministry, as of June 2012, the average number of anti-psychotic drugs prescribed to schizophrenics in Japan was 7.3. The number is higher than ones for other mental illnesses, such as 4.95 for mood disorders and 3.56 for neuroses and stress-related illnesses.

Evidence on the positive effects of mixing different drugs for schizophrenia treatment is thin, experts say, while side effects include symptoms similar to Parkinson’s disease, such as tremors, muscle stiffness and unsteadiness, as well as over-sedation, which could lead to extreme drowsiness and dullness.

Yamanouchi and others created the guidelines based on the results of a clinical study covering 163 schizophrenia patients at 55 institutions from 2010 to 2012 that found that patients were able to gradually decrease the doses and numbers of anti-psychotic drugs safely, without worsening their conditions.

Yamanouchi said the key to reducing drug doses successfully is perseverance.

“Doctors should be patient and not panic” while dealing with patients going through the program, he said. “Patients also often complain about having their drug doses reduced, but they should deal with changes calmly.”

Schizophrenia is the second-most prevalent mental illness in Japan, following depression. According to the health ministry, an estimated 800,000 people are seeking care for the illness at hospitals and clinics.