15 ms·

A psychiatrist thinks some patients are better off without antipsychotic drugs

79 points by gruseom 13y ago

tokenadult 13y ago
What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace? For historical perspective, the author of the opinion piece kindly submitted here has been practicing medicine for about as long as I have been an adult. At the beginning of his practice, the Freudian paradigm of "treatment" was just beginning its long decline into the ash heap of history, after decades of not working for patients. The current use of antipsychotic drugs to treat schizophrenia is imperfect, to be sure, but it is much better than what came before.
- jcampbell1 13y ago
  Are you commenting purely from the headline? It doesn't seem like you read the article. > Half remained on drugs continuously; the others stopped taking drugs when they became well but restarted them if symptoms emerged. After seven years, the researchers found that those who were not continuously on drugs had a much greater likelihood of getting a job and resuming their regular life activities than those who remained on medications. Remember that people who stop drugs have a higher rate of relapse? It turns out that over the seven years, those who remained on the drugs relapsed as often as the others.
- wissler 13y ago
  "What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace?" His point is that they are evidently not safe. There's good old fashioned self-discipline available for most people. I mean, just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control.
  - DanBC 13y ago
    This is a bizarre post. How exactly does someone who is having auditory or visual hallucinations exert self-discipline? I'd certainly agree that some people know the voices they hear are hallucinations, and that some of those people live happily with those voices and don't need meds. Is that what you're trying to say? Because it sounds like you're saying "pull yourself together", or "try harder" or similar. Someone who has a severely broken leg needs to have a cast and needs to do the physiotherapy, and both of those need some self discipline. But after that discipline isn't going to make the bone knit faster. Many people with "mental issues" can't just think themselves better.
    - wissler 13y ago
      Judging from the downvotes, looks like I've run into an institutional dogma here. To a large degree and for many people, mental health issues are something the individual can deal with on his own. To the extent that one can he should be urged to do so, not be put on drugs which we simply do not know all the unintended consequences of. I know that is an unpopular sentiment in our culture but it's the truth. To be more specific: often it's bad ideas and habits that lead to most mental health problems. E.g. if you sit around all day watching TV that's not good for your mental health. Everyone can choose to not do that, on their own, without drugs.
    - wissler 13y ago
      It's really bizarre, and telling, that in this culture you're not permitted to suggest that mental health problems can be caused -- and therefore, remedied -- by personal choices. It's not only bizarre, it's perverse and sick. No wonder mental issues are running rampant.
  - deleted 13y ago
    [deleted]
  - MarkPNeyer 13y ago
    > just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control. is this sarcasm?
- gruseom 13y ago
  How reflexive a dismissal this is can be seen in how you pooh-pooh the author's 30 years of experience, yet don't pay enough attention to read her name. Edit: I'm afraid the "historical perspective" you supply is not very historical. The decline of Freudianism began long before the 1980s, and pharmaceutical psychiatry has a much longer history than you imply. The antipsychotics that Steingard writes about were discovered about 60 years ago—something you might have learned from the fifth paragraph of her article. It is highly unlikely that she was trained as a Freudian; she says she spent 20 years routinely prescribing antipsychotics.
- deleted 13y ago
  [deleted]
- tokenadult 13y ago
  I am past my edit window, so I can neither delete the post above or edit it, but the replies that suggested I read the article kindly submitted here too hurriedly are correct. Sorry about that. On second reading, I think the doctor who wrote this article is trying to assimilate the latest research on long-term effects of antipsychotic drugs. The headline writer indeed didn't do her argument justice. I should have looked past the framing of the argument from the headline and dug more into the details before replying. I agree with her that it is a good idea to have a direct conversation with patients and ask, "Now that you've been on your medications for a while, and you are aware of the difference between your thought processes when you weren't treated, and your thought processes now, do you dare to reduce your medication dose, or stop it entirely, in view of the side effects from the medication you are experiencing?" That is a reasonable question for a physician to ask, and doesn't presuppose an answer from the patient. Thanks to the participants here who openly disagreed with me and prompted me to read the article a second time when I didn't have an appointment rushing me out the door.
losethos 13y ago
God is perfectly just, nigger. That's all you need to know. bastard Knock_you_upside_the_head bickering rich Yo horrendous lifes_like_chocolates joyful voodoo humongous why_is_it
andrewcooke 13y ago
it's really hard being a doctor. i have recently been trying to work out what is the best treatment with two doctors. both are decent, smart people who understand the current literature and who care about me. yet they came to quite different conclusions, and the arguments for either side are clear. there's just too little known about many illnesses (in my case, it's not mental, but ms) and you are left balancing risks and unknowns. i am not sure what the answer is. i wonder if casting a much broader net, and collecting much more data, would help. maybe every patient should be tracked in some huge database that can then be trawled for correlations? but then the privacy (and insurance) implications are worrying - for me, it would not be such a hard choice, but others with more to lose would understandably object. in some ways medicine has advanced hugely (for ~50% of sufferers, ms is no longer a big problem, which is awesome). yet there are sudden borders, and when you cross them, you are in the unknown...
- tomfakes 13y ago
  Off the original topic, but I read something in the last week for MS treatment that seems to cure it completely. This is done by taking the patient's own bone marrow, and transplanting it back after killing off the existing bone marrow. Somehow, this has shown to be a cure, but the doctors that came up with it don't yet know why - the treatment is ahead of the knowledge in this case. Edit: Here's the story I read: http://www.ottawacitizen.com/health/Ottawa+doctors+behind+breakthrough+multiple+sclerosis+study/8189161/story.html http://www.ottawacitizen.com/health/Ottawa+doctors+behind+br...
  - andrewcooke 13y ago
    yeah, there are lots of new things coming through. but also, these things often are much riskier (or the risks are simply unknown because they are so new and, with chronic illness, you may be taking the drug for years). i think just this month something was approved (in the usa) that, for some people, apparently "cures" ms with just a few injections over two years. one of the options i face now (far down the list, thankfully) is only safe for 2 years - after that you hope something else has come along... [didn't want to hijack the thread; posted initially because i think articles like this can lead to attacks on doctors, when often they are aware of the possibility that they are wrong, and are simply doing the best they can with limited data]
simonsickboy 13y ago
REVOULUTIONARY THINKINING! Seriously, thank God we see some thoughts of this ilk actually voiced in mainstream media. Not on like...FOX or anything, but still. The trouble is reaching the sheeple, not the people who already "know" for the most part. But this is where it starts.
- bayesianhorse 13y ago
  Writing in caps does not make me extremely confident that you understood the medical issue discussed in the article. At least not beyond "stop using antipsychotics", which isn't actually the message at all...
deleted 13y ago
[deleted]
DanBC 13y ago
Some people might wonder what the problem with anti-psychotic meds is. "maybe they have some side effects, but surely that's better than being mad?" Anti-psychotic medication has a range of really unpleasant side effects. Weight gain is one. It's not just that the illness makes it hard to exercise and eat right, or that the meds are sedating. There's a weird mechanism on top of that which increases weight sometimes dramatically. This has all the other problems of weight (social stigma, ill health, cost, etc etc.) Anti psychotics are not just prescribed for people with a psychotic illness either. Sometimes they're used for people with personality disorder (often against best current practice guidance) or similar. See the example of the anti-epileptic drug, given a tweak and re-released as a mood stabiliser. This drug was later found to increase risk of PCOS. Thus, a bunch of women given a med against BCP guidance (because it probably wasn't that useful for them) had all the side effects of that med, and little benefit from it, and were then told that they were at higher risk of Poly Cystic Ovarian Syndrome. You don't have to hear too many stories from people on meds like that before you wonder just what this handful of drugs you've been given are. In the past many people were sedated beyond the point of useful life, because we had asylums to keep these people warehoused for many years. Obviously that's bad. But now we (at least, the UK) don't really have decent enough community support, or better meds, and in-patient stays are rightfully kept for people who are a risk to themselves or others. There is great work happening with FEP - first episode of psychosis. Early intervention can make a significant difference. And we've stopped saying that psychosis is invented by the family of the relative too.
- manicbovine 13y ago
  I've met people who take anti-psychotics for mild OCD. The cost/benefit ratio doesn't make any sense.
- harvestmoon 13y ago
  Anti-psychotic meds can be lifesavers for people with psychosis. We're talking hearing voices, thinking the government is taping your phone calls (bad example, I know!), and so on, to being able to live somewhat normally if things go well. That said, they are nasty, nasty meds. And they are being used more frequently for pretty much anything. Abilify sells itself for treating depression. Seroquel for bipolar. Downsides of them? Can stunt you mentally, causing lack of concentration and motivation Sedation Potential for huge weight gain Increased risk of diabetes Reduced lifespan in general Possible permanent movement disorder Akathisa, or horrible anxiety is possible and more.
stiff 13y ago
My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the patient, than to help the patient itself. Our understanding of the brain is still very basic, so, even with the best intentions of the doctors, all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic, "solving" the problem for everyone but the patient. The dilemma described in the article is all the more difficult given that suicide is so common in many of those diseases, and not administering drugs (or using the wrong ones) might, on the other hand, cost the patient their life.
- bayesianhorse 13y ago
  Schizophrenic patients do suffer, both from the symptoms themselves as well as from the consequences on their life and relationships. And yes, that's a dilemma.
- MarkPNeyer 13y ago
  this is absolutely correct. i had a psychotic break last year, really bad. i was put on intensive medications, which made it easier to fit into normal every day interaction, but also made me tired, depressed and, ultimately, more psychotic. all of the times i've experienced psychosis, it's been a defensive mechanism that my mind uses to explain why i'm feeling so shitty - so taking medicine that is exhausting, makes me gain weight and have trouble focusing just made the problem worse. the meds stopped the immediately frighting and bizzare imagines my mind presented to me, but they didn't go away - they just changed into longer term, ultimately more frighting images that still scared me, but in a way that was more conducive to my behaving in a way that everybody else expected. i would believe i was trapped inside something like the matrix, where everything i did on the inside had intense consequences for people outside my reality; failing to wash my hands after using the restroom would cause millions to die far away. one of the 'rules' the psychosis imposed on me was that i could never talk about what i was struggling with because that would break the matrix and cause even worse problems. it's pretty easy to see in retrospect that it was entirely metaphorical; the 'matrix' stands for the world of social convention, and small risks that add up over time (i.e. not washing hands or brushing teeth) were presented as catastrophic nightmares in order to make sure i focused on resolving them. over the course of the past year i've slowly reduced the usage of these psychotropic medications - with approval from my psychiatrist - and with increased amounts of energy and happiness, i no longer have as much of the psychosis. the issue i can see with all of this is that treatment for mental health issues requires love, patience and careful attention from a lot of people over a long time; if you ask me, our society does not want to give that to people for fear of being taken advantage by some unscrupulous people who would feign mental illness to get out of work. i don't know what a solution would be, but i agree with you - these meds do more to help everybody else than the patients themselves.
bafjohnson 13y ago
As someone who takes an antipsychotic (300mg of Quetiapine XR once daily for bipolar) I can completely understand why these drugs don't suit everyone. The sedating nature of them (at least the ones I have personal experience of) is huge. The side effect I find most interesting is the often mooted suggestion of weight gain. It hit me very hard in the first six months but was more a matter of retraining my mind to ignore hunger pangs for endless sugar filled snacks at 11pm.
bayesianhorse 13y ago
The current system of drug development is broken. The pharmaceutic industry did a great job in the past, and reduced a lot of suffering. But currently drug development takes too long and has become too expensive to make bigger strides again. A lot of the criticism the industry receives is a direct consequence of "paying billions to perhaps earn billions". This kind of risk structure necessitates big companies that can stomach several billion-dollar failures while still turning a profit...
- javert 13y ago
  There are almost always alternative ways forward when an existing market structure stops working. For instance, maybe drug development needs to be more bazaar and less cathedral? More open source, more distributed, less decentralized? Of course, existing laws probably make it illegal in the US to work in this area at all if you aren't one of the hand-picked big names (i.e. cathedrals).
  - bayesianhorse 13y ago
    That is sort of the knee-jerk reaction I'd expect from the startup world. It has been tried. For that matter the "healing technology" community has departed somewhat from small-molecules into using more technology or biologicals. It doesn't solve the problems all that much though. For one thing, clinical trials still are expensive and can't usually be scaled down, partly for regulatory issues but also because it's sort of frowned upon to take wild risks with the health of humans (or animals for that matter). On the other hand the failure rate still persists. If a dozen startups invest several millions each befor failing a few years down the road, the capital still has to come from somewhere, and the experience and institutional knowledge of pharmaceutical industry can't easily be transferred to these small startups anyway.
    - javert 13y ago
      Thanks. Maybe one way forward would be more medium-sized companies instead of a few larger ones. (But as an outsider, maybe I'm mischaracterizing the situation.) As for expensive clinical trials---I bet nobody has tried crowdfunding them. Surely that would be illegal, but I think crowdfunding has the potential, today, to be what the joint stock company was at the dawn of global trade (e.g. the Virginia Company and the like).
brownbat 13y ago
There is an inmate on death row who is not fit to face execution without medication. The state has offered antipsychotics so that he can be put to death. His attorney and he have naturally refused the treatment. His case was discussed by the authors of "Murder at the Supreme Court" on CSPAN, but I'm not sure offhand the name of the case or where it took place. I think they might have said he now gets a whole wing of Joliet to himself, not sure exactly. So yes, at least one guy out there is better off without the drugs.
- dobbsbob 13y ago
  The Tuscon AZ spree shooter was forcibly given anti psych drugs so he would be competent for trial. If not he would have been found insane seems odd to make somebody sane so you can punish them for acts committed while barking mad
  - meowface 13y ago
    "Competent to stand trial" and "not guilty by reason of insanity" are two entirely separate things. They are not mutually exclusive. Someone who is competent to stand trial upon arrest, or weeks or months after arrest, could still very well plead insanity and be found not guilty. I don't know the specifics of this case, but given just those facts he could still very well be found to have been insane.
do_re 13y ago
"Those who remained on the drug were less likely to return to work or develop meaningful relationships."
joeldidit 13y ago
I think someone did this to me (probably to get revenge). There is no history of mental illness in my family, and I showed no signs at all, then I randomly start getting harassed with the same thoughts and the same bad memories over and over again, and I randomly lose all higher cognitive functions stopping my career and my life dead in their tracks. And this all happened right around when I quit a job due to harassment of much the same form. And to top it off, I, at the same time, also lose my ability to get and maintain an erection, and my ability to ejaculate (now nothing comes out). Who are you kidding? And then I realize that supplements, medication, etc (especially ones that previously worked) now have no effect on me whatsoever. I, against my will, and then out of desperation have tried many many anti-psychotics, and nothing makes this torture go away. And yet all I hear from these people is that I should stay on the medication, that it takes time to find the right combo that works, that this is all in my head, and that I should accept that the shit happening is just a part of who I am. Everyday more excuses, more runaround, and more bullshit. And now I just sit around watching my life rot away due to all this torture/harassment, and the only thing medication seems to bring are more side-effects (some of these drugs cause depression, suicidal thoughts, etc (the very fucking problems that are to be avoided and the very reason people get put on medication) in addition to the "usual" weight gain, diabetes, tremors, twitches, sleepiness, zombification, restlessness, loss of higher cognitive function, etc). This is the biggest bag of bullshit I have ever seen. And then they try to use the medication working for one or a few people to justify forcing everyone else to go through this hell. The hell only begins with the torture. The medication steps in and makes it worse, then the idiots forcing the medication onto me and everyone around me step in to drive the final nail into the coffin. I'm surrounded by a group of people who fully intend on seeing me driven mad and who seem willing to die trying to make me just another run-of-the-mill human being. But it's not that, it's that "they are here for me, and want to see me do my best." Oh please. Any talent or potential of mine must be destroyed, and everyday there's another excuse. Take the medication, take the medication, take the medication, take the medication, take the medication, take the medication. All I hear chanted, all day long. They don't care that the medication doesn't work, they don't care that it doesn't help me, they don't care that there are side-effects, they just care that I keep taking it, and that I sit and waste my life away, and that I blindly and continuously do as I'm told. That is their obsession, getting me to do as I'm told. And they care about nothing else. And sometimes it's almost like they get off on saying that what's happening to me is who I am, and that no one is doing this to me but me. I'm am absolutely shocked that psychiatrists say this garbage to their patients. Why would you want the patient to accept this torturous existence, then just sit there in it? Why waste their time, and waste/end their life with medication that is as ineffective as it is side-effect ridden? I'm always left speechless. By the way, people always approach the side-effects of these medications as though they present themselves while the medication works to relieve symptoms of the illness, but this is stupid. In most cases, the medication prescribed does nothing to help with the symptoms, and instead just brings side-effects which makes life even more unbearable. And then there is the stupidity, depression, and suicidal thoughts that come as a result of some medications, but "it's not the medication, it's the illness." What a joke.
zw123456 13y ago
This is some really great discussion here about this issue. I am very glad to see it, I wish the main stream press would pick up on this issue, I think there needs to be more study of the side effects of psychotherapeutic drugs, they do so much good for so many but I am think more research is needed. If it does turn out to be that these drugs are causing people to have violent episodes we need to learn why.
lettergram 13y ago
I have had a friend on antipsychotics, she basically told me that the side effects match the disease. She has since stopped taking the drugs and has focused pretty much entirely on simply "ignoring" her disease. For the most part she seems alright, she is a loner and doesn't leave the house much, but has and is working so she seems alright... Further, one interesting story is that of John Nash [1], he essentially just lives with his disease and managed to suppress it almost entirely. [1] http://en.wikipedia.org/wiki/John_Forbes_Nash,_Jr http://en.wikipedia.org/wiki/John_Forbes_Nash,_Jr.
vacri 13y ago
Balancing potential benefits from antipsychotics against problematic side-effects is news to exactly zero people in the mental health field. Not everyone gets better when put on antipsychotics, but this doesn't mean a given individual has no hope. Antipsychotics, like any medication, need to be monitored and modified as time goes on. Not working? Change course. Building up an immunity? Perhaps increase dose, perhaps change drug. Side effects worse than the ailment? Perhaps try alternate therapies (or use them in conjunction), perhaps assign another drug to control the side effects.
- gruseom 13y ago
  You make it sound as if the author's stance is trivial, but I have the impression that it's controversial and that she has taken a professional risk in publishing it.
squirejons 13y ago
the real story behind this is how americans and american social and political policy is being manipulated by corporations. We swim in a sea of propaganda. We need to wake up to that fact.
drdoppler 13y ago
http://pastebin.ca/2498765 http://pastebin.ca/2498765
marincounty 13y ago
Psychiatry is still an Art. I don't blame MD's. I blame the drug companies who fudged the studies; there is no excuse to pick on society's most vulnerable. I myself had to drop out of graduate school because of a horrid case of anxiety. The daily anxiety stayed with me for years. It's hard to remain cheerful when the person you thought you were suddenly disappears. I don't have Schizophrenia--which I'm grateful. The only advise I can give is that, at least in my case, time did help my disorder. To any Psychiatrist out there; If your patient is stable. There's no need to drag them into endless office visits, especially if they don't have insurance. A prescription lasts one year. Don't become part of your patients problem. If you don't have a better business model--that's life. Yes--your patients know the game.
bane 13y ago
This is such a complicated problem, probably like many people here, I have family members with various psychiatric issues. One person who was incredibly informative to me was a dear late uncle who suffered from severe Paranoid-Schizophrenia. Over the years he ended up with a small case of maybe a dozen medicines he had to carefully administer to himself so he could keep in tangential touch with reality. The side effect was that many of the medicines caused him to sleep through most of the day and night. I have an inkling that some of his perpetual drowsiness was a way for the psychiatrist to also help alleviate the difficulties of the family with managing him and may have had nothing to do with supplying effective antipsychotics. Something that's very interesting to me growing up was my uncle's intense awareness of that names, purposes, dosage and side effects of dozens of different medicines he had taken over the decades. When I'm sick with something, the doctor gives me some pills, I barely remember what they are, I half-forget to take them but eventually I get through the course and usually feel better. My uncle, who on a good day could hold a partially connected conversation for a few minutes without veering off into his personal psychosis, knew the cornucopia of drugs he was taking at any one time cold. There's an intensity to the kind of treatment he was receiving on a daily basis that I hope I never have to encounter for any particular disease in my life. Would he have been better off without antipsychotics? Definitely not. He once overslept through the time he was to take a dose of something during a family get together and tried to attack my sister thinking she was the source of the blood and insects that were coming out of the walls and insisting that my long dead Grandfather would rise from the grave a la Jesus Christ and bring about the salvation of the Earth with his disciples, my Uncles. I heard other similar accounts from my relatives over the years before he finally died. I also know a friend with less severe psychiatric issues, who spent most of her growing up years in and out of psychiatric hospitals and welfare. She used to have "episodes" every year or so and go completely loony, and often try and kill herself in various ways and end up under supervised care for a bit - on various antipsychotics for a while. At some point, she got married, had a couple kids and somewhere along the way just stopped taking the drugs. The "episodes" completely stopped. She had some very high stress issues in her marriage and still has yet to have an "episode". Is this related? I have no idea, but it seems to be working for her and she's living a better life, relatively speaking, than when she was under professional care.
kiep 13y ago
slowpokes.. "Insanity - a perfectly rational adjustment to an insane world." R. D. Laing
etanazir 13y ago
In the past, people were 'possessed by demons' and a priest was brought in to help. Now, psychiatry is the institutionalized national religion.

79 points by gruseom 13y ago

What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace? For historical perspective, the author of the opinion piece kindly submitted here has been practicing medicine for about as long as I have been an adult. At the beginning of his practice, the Freudian paradigm of "treatment" was just beginning its long decline into the ash heap of history, after decades of not working for patients. The current use of antipsychotic drugs to treat schizophrenia is imperfect, to be sure, but it is much better than what came before.

jcampbell1 13y ago
Are you commenting purely from the headline? It doesn't seem like you read the article. > Half remained on drugs continuously; the others stopped taking drugs when they became well but restarted them if symptoms emerged. After seven years, the researchers found that those who were not continuously on drugs had a much greater likelihood of getting a job and resuming their regular life activities than those who remained on medications. Remember that people who stop drugs have a higher rate of relapse? It turns out that over the seven years, those who remained on the drugs relapsed as often as the others.
wissler 13y ago
"What does he propose to do to demonstrate that some new way of treatment has greater safety and effectiveness than the way he desires to replace?" His point is that they are evidently not safe. There's good old fashioned self-discipline available for most people. I mean, just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control.
- DanBC 13y ago
  This is a bizarre post. How exactly does someone who is having auditory or visual hallucinations exert self-discipline? I'd certainly agree that some people know the voices they hear are hallucinations, and that some of those people live happily with those voices and don't need meds. Is that what you're trying to say? Because it sounds like you're saying "pull yourself together", or "try harder" or similar. Someone who has a severely broken leg needs to have a cast and needs to do the physiotherapy, and both of those need some self discipline. But after that discipline isn't going to make the bone knit faster. Many people with "mental issues" can't just think themselves better.
  - wissler 13y ago
    Judging from the downvotes, looks like I've run into an institutional dogma here. To a large degree and for many people, mental health issues are something the individual can deal with on his own. To the extent that one can he should be urged to do so, not be put on drugs which we simply do not know all the unintended consequences of. I know that is an unpopular sentiment in our culture but it's the truth. To be more specific: often it's bad ideas and habits that lead to most mental health problems. E.g. if you sit around all day watching TV that's not good for your mental health. Everyone can choose to not do that, on their own, without drugs.
  - wissler 13y ago
    It's really bizarre, and telling, that in this culture you're not permitted to suggest that mental health problems can be caused -- and therefore, remedied -- by personal choices. It's not only bizarre, it's perverse and sick. No wonder mental issues are running rampant.
- deleted 13y ago
  [deleted]
- MarkPNeyer 13y ago
  > just because you're having mental issues doesn't necessarily mean you can't step outside yourself and understand and assert self control. is this sarcasm?
gruseom 13y ago
How reflexive a dismissal this is can be seen in how you pooh-pooh the author's 30 years of experience, yet don't pay enough attention to read her name. Edit: I'm afraid the "historical perspective" you supply is not very historical. The decline of Freudianism began long before the 1980s, and pharmaceutical psychiatry has a much longer history than you imply. The antipsychotics that Steingard writes about were discovered about 60 years ago—something you might have learned from the fifth paragraph of her article. It is highly unlikely that she was trained as a Freudian; she says she spent 20 years routinely prescribing antipsychotics.
deleted 13y ago
[deleted]
tokenadult 13y ago
I am past my edit window, so I can neither delete the post above or edit it, but the replies that suggested I read the article kindly submitted here too hurriedly are correct. Sorry about that. On second reading, I think the doctor who wrote this article is trying to assimilate the latest research on long-term effects of antipsychotic drugs. The headline writer indeed didn't do her argument justice. I should have looked past the framing of the argument from the headline and dug more into the details before replying. I agree with her that it is a good idea to have a direct conversation with patients and ask, "Now that you've been on your medications for a while, and you are aware of the difference between your thought processes when you weren't treated, and your thought processes now, do you dare to reduce your medication dose, or stop it entirely, in view of the side effects from the medication you are experiencing?" That is a reasonable question for a physician to ask, and doesn't presuppose an answer from the patient. Thanks to the participants here who openly disagreed with me and prompted me to read the article a second time when I didn't have an appointment rushing me out the door.

losethos 13y ago

God is perfectly just, nigger. That's all you need to know. bastard Knock_you_upside_the_head bickering rich Yo horrendous lifes_like_chocolates joyful voodoo humongous why_is_it

andrewcooke 13y ago

it's really hard being a doctor. i have recently been trying to work out what is the best treatment with two doctors. both are decent, smart people who understand the current literature and who care about me. yet they came to quite different conclusions, and the arguments for either side are clear. there's just too little known about many illnesses (in my case, it's not mental, but ms) and you are left balancing risks and unknowns. i am not sure what the answer is. i wonder if casting a much broader net, and collecting much more data, would help. maybe every patient should be tracked in some huge database that can then be trawled for correlations? but then the privacy (and insurance) implications are worrying - for me, it would not be such a hard choice, but others with more to lose would understandably object. in some ways medicine has advanced hugely (for ~50% of sufferers, ms is no longer a big problem, which is awesome). yet there are sudden borders, and when you cross them, you are in the unknown...

tomfakes 13y ago
Off the original topic, but I read something in the last week for MS treatment that seems to cure it completely. This is done by taking the patient's own bone marrow, and transplanting it back after killing off the existing bone marrow. Somehow, this has shown to be a cure, but the doctors that came up with it don't yet know why - the treatment is ahead of the knowledge in this case. Edit: Here's the story I read: http://www.ottawacitizen.com/health/Ottawa+doctors+behind+breakthrough+multiple+sclerosis+study/8189161/story.html http://www.ottawacitizen.com/health/Ottawa+doctors+behind+br...
- andrewcooke 13y ago
  yeah, there are lots of new things coming through. but also, these things often are much riskier (or the risks are simply unknown because they are so new and, with chronic illness, you may be taking the drug for years). i think just this month something was approved (in the usa) that, for some people, apparently "cures" ms with just a few injections over two years. one of the options i face now (far down the list, thankfully) is only safe for 2 years - after that you hope something else has come along... [didn't want to hijack the thread; posted initially because i think articles like this can lead to attacks on doctors, when often they are aware of the possibility that they are wrong, and are simply doing the best they can with limited data]

simonsickboy 13y ago

REVOULUTIONARY THINKINING! Seriously, thank God we see some thoughts of this ilk actually voiced in mainstream media. Not on like...FOX or anything, but still. The trouble is reaching the sheeple, not the people who already "know" for the most part. But this is where it starts.

bayesianhorse 13y ago
Writing in caps does not make me extremely confident that you understood the medical issue discussed in the article. At least not beyond "stop using antipsychotics", which isn't actually the message at all...

deleted 13y ago

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DanBC 13y ago

Some people might wonder what the problem with anti-psychotic meds is. "maybe they have some side effects, but surely that's better than being mad?" Anti-psychotic medication has a range of really unpleasant side effects. Weight gain is one. It's not just that the illness makes it hard to exercise and eat right, or that the meds are sedating. There's a weird mechanism on top of that which increases weight sometimes dramatically. This has all the other problems of weight (social stigma, ill health, cost, etc etc.) Anti psychotics are not just prescribed for people with a psychotic illness either. Sometimes they're used for people with personality disorder (often against best current practice guidance) or similar. See the example of the anti-epileptic drug, given a tweak and re-released as a mood stabiliser. This drug was later found to increase risk of PCOS. Thus, a bunch of women given a med against BCP guidance (because it probably wasn't that useful for them) had all the side effects of that med, and little benefit from it, and were then told that they were at higher risk of Poly Cystic Ovarian Syndrome. You don't have to hear too many stories from people on meds like that before you wonder just what this handful of drugs you've been given are. In the past many people were sedated beyond the point of useful life, because we had asylums to keep these people warehoused for many years. Obviously that's bad. But now we (at least, the UK) don't really have decent enough community support, or better meds, and in-patient stays are rightfully kept for people who are a risk to themselves or others. There is great work happening with FEP - first episode of psychosis. Early intervention can make a significant difference. And we've stopped saying that psychosis is invented by the family of the relative too.

manicbovine 13y ago
I've met people who take anti-psychotics for mild OCD. The cost/benefit ratio doesn't make any sense.
harvestmoon 13y ago
Anti-psychotic meds can be lifesavers for people with psychosis. We're talking hearing voices, thinking the government is taping your phone calls (bad example, I know!), and so on, to being able to live somewhat normally if things go well. That said, they are nasty, nasty meds. And they are being used more frequently for pretty much anything. Abilify sells itself for treating depression. Seroquel for bipolar. Downsides of them? Can stunt you mentally, causing lack of concentration and motivation Sedation Potential for huge weight gain Increased risk of diabetes Reduced lifespan in general Possible permanent movement disorder Akathisa, or horrible anxiety is possible and more.

stiff 13y ago

My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the patient, than to help the patient itself. Our understanding of the brain is still very basic, so, even with the best intentions of the doctors, all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic, "solving" the problem for everyone but the patient. The dilemma described in the article is all the more difficult given that suicide is so common in many of those diseases, and not administering drugs (or using the wrong ones) might, on the other hand, cost the patient their life.

bayesianhorse 13y ago
Schizophrenic patients do suffer, both from the symptoms themselves as well as from the consequences on their life and relationships. And yes, that's a dilemma.
MarkPNeyer 13y ago
this is absolutely correct. i had a psychotic break last year, really bad. i was put on intensive medications, which made it easier to fit into normal every day interaction, but also made me tired, depressed and, ultimately, more psychotic. all of the times i've experienced psychosis, it's been a defensive mechanism that my mind uses to explain why i'm feeling so shitty - so taking medicine that is exhausting, makes me gain weight and have trouble focusing just made the problem worse. the meds stopped the immediately frighting and bizzare imagines my mind presented to me, but they didn't go away - they just changed into longer term, ultimately more frighting images that still scared me, but in a way that was more conducive to my behaving in a way that everybody else expected. i would believe i was trapped inside something like the matrix, where everything i did on the inside had intense consequences for people outside my reality; failing to wash my hands after using the restroom would cause millions to die far away. one of the 'rules' the psychosis imposed on me was that i could never talk about what i was struggling with because that would break the matrix and cause even worse problems. it's pretty easy to see in retrospect that it was entirely metaphorical; the 'matrix' stands for the world of social convention, and small risks that add up over time (i.e. not washing hands or brushing teeth) were presented as catastrophic nightmares in order to make sure i focused on resolving them. over the course of the past year i've slowly reduced the usage of these psychotropic medications - with approval from my psychiatrist - and with increased amounts of energy and happiness, i no longer have as much of the psychosis. the issue i can see with all of this is that treatment for mental health issues requires love, patience and careful attention from a lot of people over a long time; if you ask me, our society does not want to give that to people for fear of being taken advantage by some unscrupulous people who would feign mental illness to get out of work. i don't know what a solution would be, but i agree with you - these meds do more to help everybody else than the patients themselves.

bafjohnson 13y ago

As someone who takes an antipsychotic (300mg of Quetiapine XR once daily for bipolar) I can completely understand why these drugs don't suit everyone. The sedating nature of them (at least the ones I have personal experience of) is huge. The side effect I find most interesting is the often mooted suggestion of weight gain. It hit me very hard in the first six months but was more a matter of retraining my mind to ignore hunger pangs for endless sugar filled snacks at 11pm.

bayesianhorse 13y ago

The current system of drug development is broken. The pharmaceutic industry did a great job in the past, and reduced a lot of suffering. But currently drug development takes too long and has become too expensive to make bigger strides again. A lot of the criticism the industry receives is a direct consequence of "paying billions to perhaps earn billions". This kind of risk structure necessitates big companies that can stomach several billion-dollar failures while still turning a profit...

javert 13y ago
There are almost always alternative ways forward when an existing market structure stops working. For instance, maybe drug development needs to be more bazaar and less cathedral? More open source, more distributed, less decentralized? Of course, existing laws probably make it illegal in the US to work in this area at all if you aren't one of the hand-picked big names (i.e. cathedrals).
- bayesianhorse 13y ago
  That is sort of the knee-jerk reaction I'd expect from the startup world. It has been tried. For that matter the "healing technology" community has departed somewhat from small-molecules into using more technology or biologicals. It doesn't solve the problems all that much though. For one thing, clinical trials still are expensive and can't usually be scaled down, partly for regulatory issues but also because it's sort of frowned upon to take wild risks with the health of humans (or animals for that matter). On the other hand the failure rate still persists. If a dozen startups invest several millions each befor failing a few years down the road, the capital still has to come from somewhere, and the experience and institutional knowledge of pharmaceutical industry can't easily be transferred to these small startups anyway.
  - javert 13y ago
    Thanks. Maybe one way forward would be more medium-sized companies instead of a few larger ones. (But as an outsider, maybe I'm mischaracterizing the situation.) As for expensive clinical trials---I bet nobody has tried crowdfunding them. Surely that would be illegal, but I think crowdfunding has the potential, today, to be what the joint stock company was at the dawn of global trade (e.g. the Virginia Company and the like).

brownbat 13y ago

There is an inmate on death row who is not fit to face execution without medication. The state has offered antipsychotics so that he can be put to death. His attorney and he have naturally refused the treatment. His case was discussed by the authors of "Murder at the Supreme Court" on CSPAN, but I'm not sure offhand the name of the case or where it took place. I think they might have said he now gets a whole wing of Joliet to himself, not sure exactly. So yes, at least one guy out there is better off without the drugs.

dobbsbob 13y ago
The Tuscon AZ spree shooter was forcibly given anti psych drugs so he would be competent for trial. If not he would have been found insane seems odd to make somebody sane so you can punish them for acts committed while barking mad
- meowface 13y ago
  "Competent to stand trial" and "not guilty by reason of insanity" are two entirely separate things. They are not mutually exclusive. Someone who is competent to stand trial upon arrest, or weeks or months after arrest, could still very well plead insanity and be found not guilty. I don't know the specifics of this case, but given just those facts he could still very well be found to have been insane.

do_re 13y ago

"Those who remained on the drug were less likely to return to work or develop meaningful relationships."

joeldidit 13y ago

I think someone did this to me (probably to get revenge). There is no history of mental illness in my family, and I showed no signs at all, then I randomly start getting harassed with the same thoughts and the same bad memories over and over again, and I randomly lose all higher cognitive functions stopping my career and my life dead in their tracks. And this all happened right around when I quit a job due to harassment of much the same form. And to top it off, I, at the same time, also lose my ability to get and maintain an erection, and my ability to ejaculate (now nothing comes out). Who are you kidding? And then I realize that supplements, medication, etc (especially ones that previously worked) now have no effect on me whatsoever. I, against my will, and then out of desperation have tried many many anti-psychotics, and nothing makes this torture go away. And yet all I hear from these people is that I should stay on the medication, that it takes time to find the right combo that works, that this is all in my head, and that I should accept that the shit happening is just a part of who I am. Everyday more excuses, more runaround, and more bullshit. And now I just sit around watching my life rot away due to all this torture/harassment, and the only thing medication seems to bring are more side-effects (some of these drugs cause depression, suicidal thoughts, etc (the very fucking problems that are to be avoided and the very reason people get put on medication) in addition to the "usual" weight gain, diabetes, tremors, twitches, sleepiness, zombification, restlessness, loss of higher cognitive function, etc). This is the biggest bag of bullshit I have ever seen. And then they try to use the medication working for one or a few people to justify forcing everyone else to go through this hell. The hell only begins with the torture. The medication steps in and makes it worse, then the idiots forcing the medication onto me and everyone around me step in to drive the final nail into the coffin. I'm surrounded by a group of people who fully intend on seeing me driven mad and who seem willing to die trying to make me just another run-of-the-mill human being. But it's not that, it's that "they are here for me, and want to see me do my best." Oh please. Any talent or potential of mine must be destroyed, and everyday there's another excuse. Take the medication, take the medication, take the medication, take the medication, take the medication, take the medication. All I hear chanted, all day long. They don't care that the medication doesn't work, they don't care that it doesn't help me, they don't care that there are side-effects, they just care that I keep taking it, and that I sit and waste my life away, and that I blindly and continuously do as I'm told. That is their obsession, getting me to do as I'm told. And they care about nothing else. And sometimes it's almost like they get off on saying that what's happening to me is who I am, and that no one is doing this to me but me. I'm am absolutely shocked that psychiatrists say this garbage to their patients. Why would you want the patient to accept this torturous existence, then just sit there in it? Why waste their time, and waste/end their life with medication that is as ineffective as it is side-effect ridden? I'm always left speechless. By the way, people always approach the side-effects of these medications as though they present themselves while the medication works to relieve symptoms of the illness, but this is stupid. In most cases, the medication prescribed does nothing to help with the symptoms, and instead just brings side-effects which makes life even more unbearable. And then there is the stupidity, depression, and suicidal thoughts that come as a result of some medications, but "it's not the medication, it's the illness." What a joke.

zw123456 13y ago

This is some really great discussion here about this issue. I am very glad to see it, I wish the main stream press would pick up on this issue, I think there needs to be more study of the side effects of psychotherapeutic drugs, they do so much good for so many but I am think more research is needed. If it does turn out to be that these drugs are causing people to have violent episodes we need to learn why.

lettergram 13y ago

I have had a friend on antipsychotics, she basically told me that the side effects match the disease. She has since stopped taking the drugs and has focused pretty much entirely on simply "ignoring" her disease. For the most part she seems alright, she is a loner and doesn't leave the house much, but has and is working so she seems alright... Further, one interesting story is that of John Nash [1], he essentially just lives with his disease and managed to suppress it almost entirely. [1] http://en.wikipedia.org/wiki/John_Forbes_Nash,_Jr http://en.wikipedia.org/wiki/John_Forbes_Nash,_Jr.

vacri 13y ago

Balancing potential benefits from antipsychotics against problematic side-effects is news to exactly zero people in the mental health field. Not everyone gets better when put on antipsychotics, but this doesn't mean a given individual has no hope. Antipsychotics, like any medication, need to be monitored and modified as time goes on. Not working? Change course. Building up an immunity? Perhaps increase dose, perhaps change drug. Side effects worse than the ailment? Perhaps try alternate therapies (or use them in conjunction), perhaps assign another drug to control the side effects.

gruseom 13y ago
You make it sound as if the author's stance is trivial, but I have the impression that it's controversial and that she has taken a professional risk in publishing it.

squirejons 13y ago

the real story behind this is how americans and american social and political policy is being manipulated by corporations. We swim in a sea of propaganda. We need to wake up to that fact.

drdoppler 13y ago

http://pastebin.ca/2498765 http://pastebin.ca/2498765

marincounty 13y ago

Psychiatry is still an Art. I don't blame MD's. I blame the drug companies who fudged the studies; there is no excuse to pick on society's most vulnerable. I myself had to drop out of graduate school because of a horrid case of anxiety. The daily anxiety stayed with me for years. It's hard to remain cheerful when the person you thought you were suddenly disappears. I don't have Schizophrenia--which I'm grateful. The only advise I can give is that, at least in my case, time did help my disorder. To any Psychiatrist out there; If your patient is stable. There's no need to drag them into endless office visits, especially if they don't have insurance. A prescription lasts one year. Don't become part of your patients problem. If you don't have a better business model--that's life. Yes--your patients know the game.

bane 13y ago

This is such a complicated problem, probably like many people here, I have family members with various psychiatric issues. One person who was incredibly informative to me was a dear late uncle who suffered from severe Paranoid-Schizophrenia. Over the years he ended up with a small case of maybe a dozen medicines he had to carefully administer to himself so he could keep in tangential touch with reality. The side effect was that many of the medicines caused him to sleep through most of the day and night. I have an inkling that some of his perpetual drowsiness was a way for the psychiatrist to also help alleviate the difficulties of the family with managing him and may have had nothing to do with supplying effective antipsychotics. Something that's very interesting to me growing up was my uncle's intense awareness of that names, purposes, dosage and side effects of dozens of different medicines he had taken over the decades. When I'm sick with something, the doctor gives me some pills, I barely remember what they are, I half-forget to take them but eventually I get through the course and usually feel better. My uncle, who on a good day could hold a partially connected conversation for a few minutes without veering off into his personal psychosis, knew the cornucopia of drugs he was taking at any one time cold. There's an intensity to the kind of treatment he was receiving on a daily basis that I hope I never have to encounter for any particular disease in my life. Would he have been better off without antipsychotics? Definitely not. He once overslept through the time he was to take a dose of something during a family get together and tried to attack my sister thinking she was the source of the blood and insects that were coming out of the walls and insisting that my long dead Grandfather would rise from the grave a la Jesus Christ and bring about the salvation of the Earth with his disciples, my Uncles. I heard other similar accounts from my relatives over the years before he finally died. I also know a friend with less severe psychiatric issues, who spent most of her growing up years in and out of psychiatric hospitals and welfare. She used to have "episodes" every year or so and go completely loony, and often try and kill herself in various ways and end up under supervised care for a bit - on various antipsychotics for a while. At some point, she got married, had a couple kids and somewhere along the way just stopped taking the drugs. The "episodes" completely stopped. She had some very high stress issues in her marriage and still has yet to have an "episode". Is this related? I have no idea, but it seems to be working for her and she's living a better life, relatively speaking, than when she was under professional care.

kiep 13y ago

slowpokes.. "Insanity - a perfectly rational adjustment to an insane world." R. D. Laing

etanazir 13y ago

In the past, people were 'possessed by demons' and a priest was brought in to help. Now, psychiatry is the institutionalized national religion.