Posted on 01/29/2009 6:14:20 PM PST by 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?
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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?
I know a lot of Muslims, personally, who denounce the attacks. One of them is a guy who set me up with my wife for our first blind date. He knew I was Christian at that time, and hey I’m still alive. Why would he want us Christians to propagate, according to your logic?
C’mon, you can have a spirited debate without resorting to the name-calling.
Your story breaks my heart. There is a time and place for Haldol in the short term management of dangerous psychotic behavior but I do not think it should be used on a long term basis and it should never be used to manage what might be called annoying behavior, especially in the very young and the very old whose cells are so fragile. My sincerest condolences.
I did not get the sense bdeaner was minimizing the seriousness of schizophrenia and other mental illness. I just think that our industrial approach to treating the disease is not working by any measure. bdeaner was providing some historical accounts of a more humane approach to treating the mentally ill. I worked in locked psych for a number of years and while the patients had very obvious psychotic symptoms these people were able to respond to behavioral therapies especially when the environment was peaceful. The character of the people working with the patients was also key but unfortunately there were some angry cruel people working on every ward. Sadly about a third of the patients in locked psych wards are so mentally ill that no therapy works and they must be chemically restrained for the safety of society, but this must be considered as an absolute last resort.
With regard to overuse - the problem as this lay person sees it is that these days, GPs are diagnosing and treating with these drugs with the encouragement of pharamceutical marketing, and psychiatrists are overprescribing all psychotropics (it seems to me that many don’t seem to do much therapy these days, opting instead for drugs as first choice treatment for just about everything).
I can understand use of these in the most severe cases (such as the one you cite), but should someone diagnosed (misdiagnosed, as it turned out) with a lesser mental illness such as bipolar 2 be given a cocktail of antidepressants and anti-psychotics?
I have personal experience with watching someone go from somewhat anxious (enough to warrant a dr visit) to severely anxious, agitated and paranoid (after the introduction of ADs), to downright psychotic and completely disfunctional (after the introduction of antipsychotics).
Here was the progression - zoloft = agitation and insomnia —> wellbutrin = agitation, insomnia, anxiety attacks, racing thoughts, akathisia, paranoia, desperate thoughts —> diagnosis of BP2 + effexor = psychotic reaction + alarmed GP —> lesser effexor dose + risperdal + referral to psychiatrist —> cymbalta + wellbutrin + seroquel = passed out zombie —> cymbalta + wellbutrin + lamictal = increasing neuro effects + job loss —> cymbalta + wellbutrin + depakote = daily neuro effects + mild nightly psychosis —> cymbalta + wellbutrin + the suggestion of lithium, but upon balking of the patient, return to seroquel —> rejection of psychiatric advice, slow weaning off all drugs, second opinion and rejection of initial diagnosis = drug free and happier for it one year later.
I’m sure that sounds crazy, but every word is true, and as a result of my desperate studies on all involved I have to ask, how many low level patients who should just be in therapy to deal with life issues (in this case, the unexpected sudden death of his mother due to a massive stroke combined with a family move and a high pressure sales job) are put on drugs that do nothing but harm them in the long run?
I’m thanking God every day that our experiences were short-lived, because articles such as this one - knowing that these kinds of drugs are the most prescribed class in America today, knowing that at least 10% of the entire US population is on psychotropics of some kind, knowing that these drugs are often prescribed for off-label use for things such as bipolar 2, chronic pain, and incontinence, for Pete’s sake - are downright frightening.
(This article deals with anti-psychotics, but studies on the effects of messing with seratonin levels are just as alarming.)
In severe cases are they a good idea? Sure, maybe. In such a large percentage of the general population? Not on your life. Or should I say, not on their lives.
Well you are half right; the mental hospital population is down but I don't think I agree that most of these people are functioning in society. Where I live they live under bushes and hang out on State Street accosting tourists.
Or perhaps behavior changes the brain chemistry. This is a kind of "which came first; chicken or the egg?" loop.
But you cannot possibly be suggesting that anti-psychotics should NEVER be used, are you?
I can only speak for my own experience. My mother is bipolar and has had 3 psychotic breaks in the last ten years, leading to our having her involuntarily committed. The last 2 resulted from her stopping her meds, the first time was prior to her having been diagnosed as bipolar.
Getting her back on her bipolar meds has been entirely insufficient for repairing the pyschotic break. It has only been with the introduction of the anti-psychotics that she is able to get better and get out of the hospital.
That you believe as you do is no issue to me, have read these sentiments for years now here at FR, wherein a sizable anti-psychiatric meds population lives.
Clearly there is much unknown about brain chemistry and function. It is why the first few months after mom was released from the hospital the first time that there was almost weekly adjustments to her medication cocktail. And then they got it right (which is to say, allowed her to function ‘normally’ again).
This issue just seems to be anything but binary, either-or. Lots of gray in the area.
And taking a discussion on the web a tad too seriously, I might add, dude.
Now that is just funny.
bdeaner (#28 this thread): "You sound like one of those drug rep whores" or this one (#37 this thread): "I suspect your psychology is not that different from the guys who rammed those planes into the towers on that day".
I don't take issue with your beliefs as stated on this thread. It's a great big world, and frankly, I suspect that (as is often the case) the truth lies somewhere in between the position you have staked out and the position taken by those you argue against.
But for you to pretend that you are being victimized by vicious ad hominems, while remaining lilly white pure yourself, is, as demonstrated, laughable.
I provided a personal anecdote, a story about my own family’s experience with my mother’s mental illness, and the medications used to allow her to resume normal functioning in society. No factual evidence to counter your factual statements. None will be forthcoming, at least not from me. My mom was hospitalized, took meds, and came home.
They were anti-psychotics. They worked.
I cannot pretend to know that they will work in all cases. I do know for a fact, though, that they do, in some cases, work. That’s all.
How long has your mother been taking the anti-psychotic medication? Just curious.
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