Abstract
It is risky to make causal assertions from complex cross-sectional data. It may lead to erroneous clinical advice.
Although a negative association has been revealed between alcohol ingestion in self-poisoning and taking psychiatric medications (particularly a tricyclic or a typical antipsychotic)1, persons who are prescribed those medications may be different people than those who are not, even after adjusting in covariate analysis for a generic category ‘psychiatric diagnosis’. This association even led Chitty et al to speculate that D2 antagonists might reduce the use of alcohol. However, there is evidence to the contrary: flupenthixol led to more drinking when tested in randomised controlled trials (RCTS) 2, and olanzapine caused a similar trend3. In the remaining 10 of 13 RCTs found in a systematic review, antipsychotics did not reduce drinking4.
Clearly, there are various interpretations of the association they found. For example, perhaps people who have access to highly sedating and potentially lethal drugs such as tricyclics and antipsychotics can self-poison seriously without recourse to added alcohol.
While Chitty et al raise some interesting questions, we are concerned lest those reading the Abstract alone might misperceive a role for antipsychotics in drinkers. Suicide rates in people who drink heavily might be best prevented by improving treatment and access to treatment for alcohol use disorders.
Although a negative association has been revealed between alcohol ingestion in self-poisoning and taking psychiatric medications (particularly a tricyclic or a typical antipsychotic)1, persons who are prescribed those medications may be different people than those who are not, even after adjusting in covariate analysis for a generic category ‘psychiatric diagnosis’. This association even led Chitty et al to speculate that D2 antagonists might reduce the use of alcohol. However, there is evidence to the contrary: flupenthixol led to more drinking when tested in randomised controlled trials (RCTS) 2, and olanzapine caused a similar trend3. In the remaining 10 of 13 RCTs found in a systematic review, antipsychotics did not reduce drinking4.
Clearly, there are various interpretations of the association they found. For example, perhaps people who have access to highly sedating and potentially lethal drugs such as tricyclics and antipsychotics can self-poison seriously without recourse to added alcohol.
While Chitty et al raise some interesting questions, we are concerned lest those reading the Abstract alone might misperceive a role for antipsychotics in drinkers. Suicide rates in people who drink heavily might be best prevented by improving treatment and access to treatment for alcohol use disorders.
| Original language | English |
|---|---|
| Type | eletter |
| DOIs | |
| Publication status | Published - 1 Mar 2017 |
