The Anti-Psychotic Myth Exposed?

Psychminded.com ^ | 4/2/08 | Adam James

[bdeaner]

Anti-psychotics are not effective long-term, shrink the brain and almost triple the risk of dying early, a London NHS psychiatrist and academic has written in a new book. Isn't it about time for a deep examination of the validity of such drugs asks Adam James?

.....

Christian was slouched in a chair in Bradford psychiatric unit. He was, seemingly, only half-conscious, half alive. He could hardly speak, let alone raise his head.

Christian had been diagnosed with schizophrenia. Two days before, in a haze of paranoia, he had punched a colleague of mine at a day centre. So Christian was sectioned and medicated, heavily, with neuroleptics. Most, on seeing Christian would have described him as being so whacked out he was a dribbling wreck. Treatment-advisory body, the National Institute of Health and Clinical Excellence (Nice) would say the neuroleptics had successfully “calmed” Christian, in preparation for treating the “underlying psychiatric condition”.

Neuroleptics – such as Clozapine, Olanzapine, Risperidone and Seroquel – are the “primary treatment” for psychosis, particularly schizophrenia. Indeed, 98-100 per cent of people diagnosed with schizophrenia inside our psychiatric units – and 90% living in the community – are on neuroleptics, also called anti-psychotics. “There is well established evidence for the efficacy of anti-psychotic drugs”, Nice told mental health professionals in its guidelines for the treatment of schizophrenia.

Nice claims a similar efficacy for the widely-prescribed SSRI anti-depressants in treating depression. Some researchers disagree. A recent widely-publicised meta-analysis asserted that SSRIs are no more clinically beneficial than placebo for mild and moderate depression. London NHS psychiatrist Joanna Moncrieff is one such dissenting researcher. But she has conducted a far wider examination of psychiatric drugs, and has endeavoured to expose the “myth” of anti-psychotics. She claims there is no sufficient evidence to support their long-term use and they cause brain damage, a fact which is being "fatally” overlooked. Plus, because of a cocktail of vicious side-effects, anti-psychotics almost triple a person’s risk of dying prematurely.

Moncrieff, also a senior lecturer at University College London, particularly strikes out at her own profession, psychiatry, claiming it is ignoring the negative evidence for anti-psychotics. In her book, The Myth of The Chemical Cure, Moncrieff argues the increasing prescribing of these drugs is unleashing an epidemic of drug-induced problems. She argues, effectively, that psychiatry is guilty of gross scientific misconduct.

Having scrutinised decades of clinical trials, Moncrieff's first point is that once variables such as placebo and drug withdrawal effects are accounted for, there is no concrete evidence for antipsychotic long-term effectiveness.Moncrieff’s interpretation of the relevant meta-analyses and trials is radically different to Nice which arrived at an opposite conclusion for antipsychotic effectiveness.

At the heart of dissent against psychiatry through the ages has been its use of drugs, particularly anti-psychotics, to treat distress. Do such drugs actually target any “psychiatric condition”. Or are they chemical control, a socially-useful reduction of the paranoid, deluded, distressed, bizarre and odd into semi-vegetative zombies? Historically, whatever dissenters thought has been largely ignored. So, it appears, have new studies which indicate anti-psychotics are not effective long-term. For example, a US study last year in the Journal of Nervous and Mental Disease reported that people diagnosed with schizophrenia and not taking anti-psychotics are more likely to recover than those on the drugs. The study was on 145 patients, and researchers reported that, after 15 years, 65 per cent of patients on anti-psychotics were psychotic, whereas only 28% of those not on medication were psychotic. An intriguing finding, surely? So what about the mainstream media headlines of “breakthrough in schizophrenia treatment”? Afterall, broadsheets react positively to the plethora of alleged genetic "breakthroughs" in schizophrenia, even when it comes to genetically-engineered schizophrenic mice. But there wasn't a squeak.

Interestingly, the researchers of the Journal of Nervous and Mental Disease paper hypothesised that it was patients with "inner strength”, “better self esteem” and “inner resources” who were more likely to recover long-term without neuroleptics. However, not one peer-reviewed study examining the necessary individual characteristics and support networks to live through psychosis without drugs has, in the last 48 years, appeared in The British Journal of Psychiatry, the publication that each month drops through the letter box of every psychiatrist in the land.

The “psychological factors” of, for example, inner strength, are, perhaps more the terrain for clinical psychologists. Such as Rufus May who was compulsory treated with anti-psychotics when diagnosed with schizophrenia as an 18-year-old.

May argues withdrawal effects of anti-psychotics often get wrongly interpreted as “relapse”. So, he has launched a website advising people how safely to come off psychiatric drugs. Many patients, like May (who perhaps had the required "inner strength”), have successfully come off anti-psychotics and gone on to recover. The irony is that they frequently have had to do it behind the backs of their psychiatrists, who fear relapse.

Moncrieff’s second point is that the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that anti-psychotics cause extensive damage, the most startling being permanent brain atrophy (brain shrinkage) and tardive dyskinesia. As in other neurological conditions patients suffer involuntary, repetitive movements, mental impairment, memory loss and behaviour changes. Brain scans show that anti-psychotics cause atrophy within a year, alerts Moncrieff. She accuses her colleagues of risking creating an “epidemic of iatrogenic brain damage”. Moncrieff is a hard-nosed scientist, so she is respectfully reserved. But her carefully-chosen words are still alarming. "It is as if the psychiatric community can not bear to acknowledge its own published findings,” she writes.

How worrying it is, also, that the Healthcare Commission should report last year that almost 40 per cent of people with psychosis are on levels of anti-psychotics exceeding recommended limits. Such levels cause heart attacks. Indeed the National Patient Safety Agency claims heart failure from anti-psychotics is a likely cause for some of the 40 average annual “unexplained” deaths of patients on British mental health wards. Other effects of anti-psychotics include massive weight gain (metabolic impairment) and increased risk of diabetes. Two years ago, The British Journal of Psychiatry - Britain’s most respected psychiatry journal - published a study reporting that people on anti-psychotics were 2.5 times likely to die prematurely. The researchers warned there was an “urgent need” to investigate whether this was due to anti-psychotics. But so engrained is the medication culture in mental health that many psychiatrists regard that not medicating early with anti-psychotics amounts to negligence, Moncrieff notes.

Moncrieff does acknowledge there is evidence for the short-term effectiveness of anti-psychotics. But again Moncrieff asks psychiatry to be honest. Moncrieff points out that when anti-psychotics, such as chlorpromazine, were first used in the fifties they were called “major tranquillisers.” Why? Because that’s an accurate description of their effect, particularly short term. They sedate, numb, or tranquillise, the emotions, so reducing the anxiety of paranoia and delusions. Any person on anti-psychotics would verify this (Go to askapatient.com). So, in this respect, they are effective. Nowadays, however, these drugs are referred to as “anti-psychotics”. For Moncrieff, this is a wheeze because there’s no evidence that anti-psychotics act directly on the “symptoms” – paranoia, delusions, hallucinations – of those diagnosed with psychosis. There’s nothing anti-psychotic about anti-psychotics.

Embedded in Moncrieff’s thesis is that, unlike other medical conditions, there is no evidence that psychiatric illnesses, including schizophrenia, are caused by physical abnormalities. As clinical psychologist Mary Boyle penned it, schizophrenia is a "scientific delusion” which drugs can never cure.

The alternatives? Moncrieff - like her fellow psychiatrists in a group called the Critical Psychiatry Network - asks services to look seriously at non-drug approaches, such as the Soteria Network in America. She believes psychiatrists such as herself should no longer have unparalleled powers to forcibly detain and treat patients with anti-psychotics. Instead, they should be “pharmaceutical advisers” engaging in “democratic drug treatment” with patients. Psychiatrists should be involved in “shared decision-making” with patients, and would have to go to civil courts to argue their case for compulsory treatment. "Psychiatry would be a more modest enterprise” writes Moncrieff, “no longer claiming to be able to alter the underlying course of psychological disturbance, but thereby avoiding some of the damage associated with the untrammeled use of imaginary chemical cures.”

Mental health policy is, it appears, swinging away from a reliance on antidepressants. Surely a deep re-examination of the true validity of anti-psychotics is also due?

[bdeaner]

FYI

[NonValueAdded]

Plus, because of a cocktail of vicious side-effects, anti-psychotics almost triple a person’s risk of dying prematurely.

Ah, but tripled from what baseline? that of a typical "healthy" person of the same age and gender or that of an unmedicated person with the same psychosis? (ses?).

If the question came down to "you are a clear danger to yourself and the community. We can sequester you in a hospital or, with the use of anti-psychotics, can let you rejoin society but you might die sooner," which do you choose? That's a whole different kettle of fish. I don't see the article being clear on that.

"What? time for another pill? just a second while I post this ..."

Later, FRiends :)

[pieceofthepuzzle]

Whereas anti-psychotics are probably over-used, and inappropriately used in many instances, they can and do help truly psychotic patients. I have personally seen a schizophrenic who thought aliens were after him totally revert to reality and what would pass with pretty much anyone as normal cognition and behavior in about a day after receiving an effective anti-psychotic. Patients who have abnormal brain chemistry can be markedly helped by the right medications. The problem is that psychosis is a wastebasket diagnosis that probably includes a large number of different syndromes and causes. The same drug may work for one person, but be ineffective, harmful, or totally inappropriate for others. Haldol has been way overused and has been given very frequently to elderly patients who became confused during hospitalization. That is inappropriate and very unfortunate.

[Zevonismymuse]

Tardive Dyskinesia is practically inevitable if a person remains on the drugs long enough. I worked in locked psych for many years and I agree with most of the points made in this article. In my experience most psychosis has a very young age of onset, usually in late teens or early twenties and people tend to cycle out and have diminished symptoms after a period of a few to several years depending on the severity of their symptoms. In many cases the side effects of these drugs is worse than the illness being treated. And to the best of my knowledge the damage done to the brain is not reversible. This is a serious and complex issue. People who are psychotic can be a danger to themselves and others but I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

[Starfleet Command]

People who are psychotic can be a danger to themselves and others but I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

In America, we typically elect them.

[Zevonismymuse]

Haldol has been way overused and has been given very frequently to elderly patients who became confused during hospitalization. That is inappropriate and very unfortunate.

While I was typing my first reply I was thinking about how Haldol has been used routinely to manage dementia in nursing homes. It is a terrible drug for the elderly. I agree with you that there is a time and a place for psychotropic medications but I became very frustrated with the treatment of patients in locked mental wards.

[Hank Kerchief]

“Patients who have abnormal brain chemistry can be markedly helped by the right medications.”

Can you name a single scientific study that has identified any abnormal brain chemistry with any identified psychosis or neurosis, and what the specific chemical imbalances are?

You cannot. There has never been one. This is entirely fiction.

Hank

[hinckley buzzard]

I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

Name one. Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

[Quix]

Note.

[blueplum]

well, it would seem one would have to add some version of, the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that anti-psychotics cause extensive damage, the most startling being permanent brain atrophy to that question for a truely informed consent to be obtained.

[Al B.]

Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

Well, if you're talking about psychiatric "treatments" such as ice picks driven through eye sockets to lobotomize victims, I would agree with you.

My aunt was on Thorazine for 15 years back in the 50's and 60's. She developed tardive dementia and died at the age of 54 as a complete vegetable. I wouldn't want anybody else's loved one treated that way either.

You and I have gone round and round on this in years past and I don't intend to start again, but I agree with you on the "precious little" comment because that's what the sum total of psychiatric solutions over the years amount to from my vantage point....precious little.

[Zevonismymuse]

I don't think you would like your loved one to be treated that way.

You make many assumptions based on a few sentences. I do recognize that it is a very complicated situation. My loved one would have me for an advocate where as many of the people I dealt with were being warehoused. I take responsibility for my family so I would have the luxury of trying less harsh drugs and approaches. I realize this would not be practical in most cases. I have some ideas that I do want to get into here. I was simply agreeing that the long term side effects of many of the anti-psychotic medications is a tragedy and worth discussion. This is a site where people discuss articles. No need to get aggressive.

[bdeaner]

The problem is that psychosis is a wastebasket diagnosis that probably includes a large number of different syndromes and causes.

This is a good point. A huge problem is the lack of reliability and validity in the DSM diagnostic system. It's difficult to predict how a particular class of drugs will work, of even if drug treatment is necessary, when there is so much heterogeneity -- and massive error/variability -- in the diagnostic data.

[bdeaner]

Name one. Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

Perhaps you haven't dug far enough into the history. Between the horrors of Bedlam and the disasters of modern psychiatry, there were the moral treatments of the 18th century, which actually were very successful (albeit potentially quite costly to implement and maintain).

For the sake of brevity, let's just stick to the moral treatments in the U.S. which were inspired by the progress made by Pinel and Tuke in Europe. The basic idea here was that the mad had an inner capacity for regaining self-control, for recovering their reason. The ultimate source of their recovery lay inside themselves, and not in the external powers of medicine.

The first moral treatment asylum was opened by the Philadelphia Quakers in 1817, and others followed. McLean Hospital opened in 1818, in New York City in the year 1821 Bloomingdale Asylum opened where you can now find Columbia University, and Hartfored Retreat opened in Connecticut. Etc.

These places kept relatively few patients -- no more than 250 at any single facility. They were located in the country, surrounded by flowerbeds and gardens, where the mentally ill could take their fill of fresh air and find solace in tending to plants. They took great pains to design the architecture with the highest aesthetic values, mindful that patients are especially sensitive to environmental stimuli and uplifted by beauty and order. And perhaps most importantly, the superintendent of the facility was chosen in particular for his temparement -- reasonable, humane, possessing dignity and stability of character, mild and gentle, compassionate...

The patients were kept busy with activities -- gardening, playing games, educational pursuits. Theater groups performed; speakers were invited to give talks at meals. Restraints were used only as a last resort. They rewarded good behavior. Those who were disruptive were placed on ground floors furtherest from the social center of the asylum. Those who behaved got the preferred rooms on the top floor, and they were also given extra liberties. They were allowed to stroll about the grounds and were given the privilege of going into town, as long as they pledged not to drink and to return to the asylum on time.

This treatment appears to have been remarkably successful, according to modern historians. In the first decades of moral treatment, before the asylums were taken over by neurologists who changed everything, 35-80% of all admitted patients were discharged within a year's time, and the majority of those discharged were viewed as having been cured. That mean that their disturbing bheavior and psychotic thoughts had largely disappeared.

At Pennsylvania Hospital, during the tenure of Thomas Kirkbride, results were very good. Of 8,546 "insane" patients admitted from 1841 to 1882, 45% were discharged as cured, and another 25% discharged as improved. A long-term follow-up study of 984 patients discharged from Worcester asylum from 1833 to 1846, which was conducted in the 1880s, found that 58% had remained well throughout their lived. Another 7% had relapsed but had subsequently recovered and returned to the community. Only 35% had become chronically ill or had died while still mentally ill.

These results are far better than the terrible 8% recovery rate among schizophrenics in the U.S. today -- a statistics that pales even in comparison to recovery rates in third world countries that do not have anti-psychotics available for use.

[pieceofthepuzzle]

“This is entirely fiction.”

Your dogma is disturbing, and inaccurate. As I tried to point out, the clinical diagnosis of ‘psychosis’ includes a wide array of symptoms and likely a broad array of mechanistic causes. There have most certainly been many studies that have linked alterations in brain chemistry with alterations in mentation. How do you think LSD does it's thing? Do you not believe that alterations in brain chemistry affect perception and mood? Have you ever had a drink of alcohol? Do you believe that women experience mood shifts with menstruation-associated changes in circulating hormone levels? The list goes on and on. That a single gene or single receptor or single neurotransmitter abnormality that explains all or most psychosis has not been identified is not surprising, and is indicative of the complexity of the brain and the difficulty in understanding this incredible organ. What do you believe? Do you think schizophrenics just need a good talking to?

[gusopol3]

praecox dementia— the name for schizophrenia in the pre -drug era. Again the illnesses are serious and your attempts to minimize them are tragic and misguided.

[pollywog]

Tardive Dyskinesia is practically inevitable if a person remains on the drugs long enough.

This just breaks my heart to even read....

Long story.

We took a foster baby almost 30 years ago.He was deaf and had autism...we were at the mercy of neurologists not having any knowledge at all about the medications that he was being given.

Bottom line is he was " experimented with"...and we have had to go through a living hell with him ...and yes, he developed Tardive Dyskinesia because of the meds, NOT because of his conditions.

Would to God we had known. It breaks our hearts. He can hardly walk now. I hate these meds...

oh and the meds he was on for 5 years before we began to see the effects was Haldol!!!!

Now he can't get off of them. We have him in a special needs placement now. Broken hearted in Los Angeles...

Polly

[Hank Kerchief]

Instead of guessing what I believe or don’t believe, why don’t you just provide a citation to a single study that has ever established a chemical basis for any so-called psychosis or neurosis. If there is any evidence at all, that should be easy to do.

The argument is not about whether chemicals can affect the brain, but whether there are brain chemicals (or chemical imbalances) that cause “mental illness.” Two very different issues.

Hank

[Lucius Cornelius Sulla]

I didn’t realize that FR had become a Scientology haven. It might be useful to point out that before these drugs became available. the US was filled with mental hospitals filled with people under restraints. Now most of these people are functioning in society, and the mental hospital population is a fraction of what it was.