While drugs such as gabapentin, Lyrica and topiramate can treat chronic pain, cut anxiety and have ancillary benefits in terms of mental health, several medications designed to block the constriction of blood vessels in the brain have sparked controversy for years.
Often used to treat conditions such as Alzheimer’s and schizophrenia, the medications, called anti-clotting drugs, or coumadin, have proven only marginally beneficial in reducing the risk of strokes and heart attacks. And their long-term effects, including alterations in speech and motor coordination, have been the subject of recent scientific scrutiny.
In its research published in the journal Neurology on Monday, a team of doctors at New York-Presbyterian Hospital/Weill Cornell Medical Center asked doctors whether they had seen any evidence of a possible benefit to their patients after taking the drugs for months. The findings are a slightly different take on the issue than other recent studies, which had found a small benefit in preventing blood clots and producing less inflammation in patients with atherosclerosis.
“This is the largest meta-analysis we’ve had to date,” said Dr. Jennifer Shu-He, a neurologist who led the study. “In terms of the physical and mental health benefits of these drugs, it doesn’t appear that they’re doing that well.”
The effect is not negligible. More than a quarter of the doctors who participated in the analysis reported that they had seen a decrease in the risk of a serious cardiovascular event, for instance, after taking a coumadin tablet for two months. (The authors cautioned, however, that when used on a cumulative basis, the effect could diminish.)
In some cases, the risk of stroke or a heart attack fell after the patients who took the drugs lived for seven months, compared with the patients who did not. In other instances, blood pressure decreased by the same amount after seven months, and cases of depression declined by 10 percent.
The researchers cautions that their work was limited to patients with heart disease or diabetes. And although previous findings suggested that the drugs, called among other things, coumadin and triptans, helped patients, their most recent analysis took a different approach.
“We thought the results were sufficiently reassuring to say that clinicians should be thinking about these things,” Dr. Shu-He said. “But we should be cautious about trying to compare it to current medication guidelines, such as statins, aspirin and beta blockers.”
Although the results of this study suggest that the drugs aren’t doing well in certain patients, research funded by manufacturers suggests that they do well in others. A study published this year in the journal Vascular Biology and Biomarkers, also published by the Wake Forest University Research Institute, concluded that levodopa, a commonly prescribed medication to treat Parkinson’s disease, seemed to improve mental functioning in patients who had suffered a stroke.
After taking levodopa, 70 percent of patients reported having an improvement in their mental abilities, and only 4 percent had a worsening. “The findings are consistent with the theory that levodopa acts as a kind of shock absorber for the brain,” said Dr. Joel S. Motze, a neurologist at the Ann Arbor Veterans Affairs Health Center and study co-author.
Opioids, a category of drugs also known as opiates, such as methadone and buprenorphine, are the most frequently prescribed of all opiates, and widely used to treat chronic pain. Side effects of buprenorphine are less common, but the addiction, which triggers relapses, can lead to abuse and criminal activity. But those addictive effects can be tempered by treatment, Dr. Motze said.
“Opioids continue to be under-dispatched for pain management — a big public health issue — despite ample evidence of their positive benefit,” he said. “Our results underscore the need for more resources to better diagnose and treat opioid addiction so that the full implications of this medication is known.”