Who Will Guard the Guardians of Psychiatry?

The assertion that the so-called antidepressants are being over-prescribed implies that there is a correct and appropriate level of prescribing and that depression is a chronic illness (just like diabetes). It has been an integral part of psychiatry’s message that although depression might have been triggered by an external event, it is essentially an illness residing within the person’s neurochemistry. The issue is not whether people should or shouldn’t take pills. The issue is psychiatry pushing these dangerous serotonin-disruptive chemicals on people, under the pretense that they have an illness.
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The Psychiatry Sandcastle Continues to Crumble

Psychiatry would long since have gone the way of phrenology and mesmerism but for the financial support it receives from the pharmaceutical industry. But the truth has a way of trickling out. Here are five recent stories that buck the psychiatry-friendly stance that has characterized the mainstream media for at least the past 50 years.
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“B.C. Care Homes Provide Antidepressants Without Diagnoses”

New data reveals that the majority of care homes in British Columbia, Canada are giving out prescriptions for antidepressants and antipsychotics without a diagnosis. According to a report by the Times Colonist, “there are a whopping 54 homes in which 40 percent of the residents are taking antipsychotics without a diagnosis.”

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In Search of an Evidence-based Role for Psychiatry

A dilemma for all of us who are struggling to broaden our understanding of human distress beyond simplistic, pessimistic, bio-genetic ideology, and to improve our mental health services accordingly, is whether or not to soften our criticisms of psychiatry in the hope of reaching those psychiatrists whose minds are not totally closed. But doing so rests on the assumption that change can come from within the profession. For the last few decades examples of that are few and far between.
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Testifying in Vermont: Forced Drugs

Vermont Governor Shumlin recently suggested a change to state law that would accelerate the process under which a person could be forced to take antipsychotic drugs against her will. The House Human Services Committee reviewed this proposal and I was asked to testify. What follows are my comments.

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Family Oriented, Home-Based Treatment Best for Youth with Symptoms of Psychosis

A pathbreaking new study out of Finland suggests that early intervention programs for youth experiencing psychotic-like symptoms may see the greatest improvement when treatment works within the home rather than in a hospital setting. The research, to be published in next month’s issue of Psychiatry Research, found greater improvement in functioning, depression, and hopelessness among teens in a new need-adapted Family and Community oriented Integrative Treatment Model (FCTM) program.

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Timberrr! Psychiatry’s Evidence Base For Antipsychotics Comes Crashing to the Ground

When I wrote Anatomy of an Epidemic, one of my foremost hopes was that it would prompt mainstream researchers to revisit the scientific literature. Was there evidence that any class of psychiatric medications—antipsychotics, antidepressants, stimulants, benzodiazepines, and so forth—provided a long-term benefit? Now epidemiologists at Columbia University and City College of New York have reported that they have done such an investigation about antipsychotics, and their bottom-line finding can be summed up in this way: Psychiatry’s “evidence base” for long-term use of these drugs does not exist.
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J&J Loses $1.75 Million in Risperdal Male Breast Trial; Thousands of Cases Pending

In the third major verdict of its kind, drug giant Johnson & Johnson was ordered to pay Nicholas Murray, a 21-year-old Maryland man who grew female breasts while taking the antipsychotic Risperdal. The company failed to warn doctors, patients, and regulators of the risk of abnormal breast development in young males and now faces about 5,400 lawsuits involving the drug.

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“Drugs, Greed and a Dead Boy”

New York Times columnist, Nicholas Kristof, relates the story of Andrew Francesco, a boy who began taking Ritalin at age five and died from complications with Seroquel when he was fifteen. His father, a former pharmaceutical industry executive, reveals the industry’s greed in his memoir “Overmedicated and Undertreated.”  Now the industry is pushing for a first-amendment right to market its drugs for off-label uses.

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The Recovery After an Initial Schizophrenia Episode (RAISE) Study: Notes from the Trenches

I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the positive headlines that heralded the study’s results, the reports left me with mixed feelings. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
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RAISE Study Out Of Sync With Media Reports

Writing on his 1 Boring Old Man blog, Dr. Mickey Nardo reflects on the media frenzy around the RAISE study and asks why the prescription data has not been released. He adds skepticism about the political motives of the potentially overblown results, which he sees as a clear push for increased mental health funding.

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Confusion Over Antipsychotic Dosing Data in RAISE Study

Yesterday, the New York Times reported that schizophrenia patients in an experimental treatment program (RAISE) who experienced better outcomes had been on lower doses of antipsychotics than normal. However, the article published in the American Journal of Psychiatry on Tuesday did not divulge any data on the varying antipsychotic drug doses in the different study groups.

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“Treating Parkinson’s Psychosis With Antipsychotics May Boost Death Risk”

The Psychiatric Advisor reports on new research from King’s College London that suggests that antipsychotics can cause serious harm to people with Parkinson’s.  According to the research: “The group that was treated with antipsychotics were four times more likely to have died following three to six months of treatment than those who did not receive any antipsychotic medication, the researchers reported in the Journal of Medical Directors Association. In addition, those on antipsychotics were also more likely to experience cognitive decline, worsening of Parkinson’s symptoms, stroke, infections, and falls.”

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Infants Exposed to Psychotropic Drugs During Pregnancy At Risk

New research published in the July issue of The Journal of Clinical Psychiatry found that the use of mood stabilizers, antipsychotics, antidepressants, and hypnotics during pregnancy is associated with increased health risks to the infant.

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The Use of Antipsychotic Medications in Children

Since the mid-1990s antipsychotic medications have been increasingly prescribed for children, adolescents, and adults. The most recent report finds an increase in use for older children from 2006 to 2008. Most of the prescriptions of antipsychotics for children reported by the study were for conditions which had not been approved by the FDA (called off-label use).
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Pennsylvania Foster Kids Prescribed Too Many Psychotropic Drugs

Amid growing criticism about the over-prescription of psychotropic medication in foster care, Pennsylvania commissioned PolicyLab to conduct an analysis of the use of psychiatric drugs among all of the state’s Medicaid-enrolled children.  The report, released in June, found that the rates of psychotropic prescriptions among youth in Medicaid and foster care are higher than previous estimates.

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Meta-Analysis Ties Gray Matter Loss to Antipsychotic Dose

Antipsychotics are currently the predominant treatment for individuals diagnosed with schizophrenia, but there is an accumulating body of research that links the use of these drugs to structural abnormalities in the brain. A recent meta-analysis suggests that gray matter loss in the brain may depend on the dose and class of the antipsychotic.

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Antipsychotics Prescribed Off-Label for Challenging Behaviors

Antipsychotics are being prescribed to people who may have challenging behaviors but no mental disorder, according to new research published in this month’s issue of BMJ.  In people without intellectual disability, approximately 50% of prescriptions for antipsychotics are given in the absence of a diagnosis of severe mental illness.   According to the new analysis, an even higher proportion (71%) of those with intellectual disabilities receive antipsychotics without such a diagnosis.

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“More Evidence that Antipsychotics Shrink the Brain”

A review of 18 imaging studies finds that brain matter loss in patients diagnosed with schizophrenia is correlated with antipsychotic use, according to Psych Central.  The analysis suggests that the continued use of antipsychotics is linked with progressive cortical gray matter loss.

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“Antipsychotics May Be Pushed On Those with Intellectual Disabilities”

Psych Central covers findings published in BMJ revealing that many people in the U.K. with intellectual disabilities are being prescribed antipsychotic drugs.  The study’s lead author comments: “People who show problem behaviors, along with older people with intellectual disability or those with co-existing autism or dementia, are significantly more likely to be given an antipsychotic drug, despite this being against clinical guidelines and risking possible harm.”

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“Fears That Antipsychotic Drugs Being Used as ‘Chemical Cosh’ in Disability Care”

An editorial in the Guardian discusses the fact that the number of people with intellectual or learning disabilities “who are being treated with psychotropic drugs far exceeds those with mental illness.”  The authors of a new study examining the overuse of psychotropic drugs on people with learning disabilities, published this month in BMJ, argue: “If people without mental illness are given psychotropic drugs… it is probably to control their behavior.”

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“The FDA Is Basically Approving Everything. Here’s The Data To Prove It”

Writing for Forbes, Matthew Herper documents the FDA’s increasing drug approval rates. “In 2008, BioMedTracker says the FDA approved 20 new molecular entities (NMEs) and rejected 20, for an approval rate of 50%.”  So far this year, he writes, “the FDA approval rate is more like 96%.”

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Omega-3 Fatty Acids May Help Prevent Transition to Psychosis

“When people with early-stage symptoms took omega-3 supplements for three months, they had much lower rates of progression than those who did not,” according to research out of Australia covered in this month’s issue of the New ScientistMore →

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Majority of Youth Prescribed Antipsychotics Have No Psychiatric Diagnosis

The majority of children, adolescents and young adults prescribed antipsychotic medications have not been diagnosed with a mental disorder, according to a recent study published in JAMA Psychiatry.  The study, led by Mark Olfson from Columbia University, examined trends in the treatment of young people with antipsychotics in the United States between 2006 and 2010 and raised concerns about the safety and efficacy of prescription practices.

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“Study: Kids with ADHD taking strong drugs with major side effects”

Fox 5 Atlanta featured a back to school story about the growing percentage of preteens and teens being prescribed antipsychotic medication for ADHD.  They report:  "Nobody, whether you're a mom trying to advocate for your child, or you're a physician trying to decide what's best for the child, nobody wants a child on a medication with long-term side effects that may even affect their development. Nobody wants that. We have to create a system that really digs and looks for other options for these kids."

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