Reduction/Discontinuation of Antipsychotics Produces Higher Long-Term Recovery

Kermit Cole
20
2325

A study published today in the American Medical Association’s journal JAMA Psychiatry reports that patients whose antipsychotic treatment was reduced or discontinued (DR) experienced a recovery rate twice that of patients maintained on antipsychotics (MT). “To our knowledge, this study is the first to identify major advantages of a DR strategy over MT in patients with remission of FEP,” the authors write. “Benefits that were not evident in short-term evaluations, such as functional gains, only appeared during long-term monitoring.”

Abstract →

Of further interest:
Antipsychotic Medication During the Critical Period Following Remission From First-Episode Psychosis (JAMA Editorial)

Wunderink, L., Dose Reduction/Discontinuation Strategy Associated with Higher Long-Term Recovery Rates for Remitted First-Episode Psychosis Patients. JAMA Psychiatry. Published online July 3, 2013. doi:10.1001/jamapsychiatry.2013.19

From the press release:

JAMA Psychiatry Study Highlights Dose Reduction/Discontinuation Strategy Associated with Higher Long-Term Recovery Rates for Remitted First-Episode Psychosis Patients

Dose reduction/discontinuation (DR) of antipsychotics during the early stages of remitted first-episode psychosis (FEP) shows higher long-term recovery rates compared with the rates achieved with maintenance treatment (MT), according to a study by Lex Wunderink, M.D., Ph.D., of Friesland Mental Health Services, Leeuwarden, the Netherlands, and colleagues.

This study was a follow up study of 128 patients who had participated in a two-year open randomized clinical trial comparing MT and DR from October 2001 to December 2002. After six months of remission, patients were randomly assigned to DR strategy or MT for 18 months, and after the trial, treatment was at the discretion of the physician. Researchers contacted patients 5 years after the trial had ended, and 103 patients consented to participate in a follow up interview about the course and outcomes of psychosis.

The DR patients (n=52) experienced twice the recovery rate of the MT patients (n=51) (40.4 percent versus 17.6 percent). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates, according to the study results.

“To our knowledge, this study is the first to identify major advantages of a DR strategy over MT in patients with remission of FEP.” The authors write, “the results of this study lead to the following conclusions: schizophrenia treatment strategy trials should include recovery or functional remission rates as their primary outcome and should also include long-term follow-up for more than 2 years, even up to 7 years or longer…benefits that were not evident in short-term evaluations, such as functional gains, only appeared during long-term monitoring.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

20 COMMENTS

  1. I do hope, given this finding, the medical community works hard to wean every child and every adult misdiagnosed as bipolar, due to antidepressant or ADHD drug induced mania, off these horrible drugs. As well as anyone who wants to be weaned off them. Making people sick for profit is inhumane.

    • I hope so too but my expectations are low.

      From the abstract:

      “To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice.”

      I don’t think any amount of additional studies would change general practice. The whole system is predicated on an assumption (rather than an inference) that mental illness equals brain disease. They’ll keep pumping that until it’s made illegal and we all know that’s not going to happen.

  2. All I know is that my son wouldn’t be where he is now if he hadn’t taken himself off the antipsychotic medication against doctors advice and behind their backs. The antipsychotics were actually stopping him to thinking clearly and to reason out his problems. They turned him into a gibbering wreck.

  3. That is their intended effect. I was forced to take them by doctors trying to cover up a “bad fix” on a broken bone and other sins. Harming patients, while hypocrically claiming to be a doctor there to help you, is sick. But I don’t know if the antipsychotics are beneficial to those who actually suffer from psychosis or not. And I’m certain most within the psychiatric industry were deluded by big Pharma false claims.

    • Even that “psychosis” would be some sort of distinct entity, clearly distinguishable from — uh, what? “No psychosis”? “Normal”?… — by some sort of clearly discernible pathology, which, in case, would make for a valid diagnosis, is a false claim. “Antipsychotics” are about as beneficial to those labeled with “psychosis” (or “schizophrenia”) as they are to anybody else. I.e. if you wish to be turned into a gibbering wreck, they are beneficial. Whether you have a psych label, or not. However, most people experience other drugs as doing the job in a far more pleasant way, why they prefer these to neuroleptics. The exception are those who prefer to escape from the unpleasantness of life not into the pleasantness of a drug, but into its unpleasantness.

      • “The exception are those who prefer to escape from the unpleasantness of life not into the pleasantness of a drug, but into its unpleasantness.”

        Marian,

        Many people (including, tragically, many kids) are *coerced* into taking so-called “antipsychotic” drugs; they cannot choose to stop taking them without facing threats of “hospitalization” and, hence, threats of being *forced* back onto them.

        Therefore, they ‘choose’ to take such drugs, daily (or else, they go to a ‘clinic’ for periodic injections).

        Surely, it would be unfair to suggest that they’re doing so because they are preferring to “escape from the unpleasantness of life” into the unpleasantness of neuroleptics.

        (Note: I fully presume you’d agree with what I’m saying, but I say it, as I think the conclusion of your comment could be misread.)

        Respectfully,

        ~Jonah

        • Jonah, thanks. Yes, I totally agree. I was only and solely referring to grown-up people who, even when they have a choice, still choose the greater misery over the lesser one. And I maybe also should add that “choice” isn’t quite the right word here, as it usually isn’t the person herself making that choice, consciously, but the victim inside who derives a sense of identity and legitimacy from the experience of misery, and for whom therefor misery becomes the desirable.

  4. Ah, what is psychosis? My supposed “psychosis” was asking what a dream about being “moved by the Holy Spirit” meant after the night of 9.11.2001. According to most Christian belief, it merely means you’ve been chosen to help God do His work on the planet. But my “Christian” therapist (who was actually the personification of undeserved hatred, hypocritically calling herself Grace), according to her medical records, claimed the “Holy Spirit voice” was the one and only “voice” that proved psychosis. It was a dream query, not psychosis, and it’s actually illegal to drug people up for belief in God in the US. And defamation of the Holy Spirit is the one and only unforgivable sin in the bible. What if i’m right, as are all of you, to believe God does not actually approve of Dr. Joseph Beiderman’s inappropriate expanding of the bipolar criteria. And the inappropriateness of putting children on antipsychotics?

    • “What if i’m right, as are all of you, to believe God does not actually approve of Dr. Joseph Beiderman’s inappropriate expanding of the bipolar criteria. And the inappropriateness of putting children on antipsychotics?”

      Someone Else,

      IMO it is totally, totally, totally inappropriate to put children on so-called “antipsychotic” drugs.

      (And, note: IMO this word “antipsychotic” should be kept sandwiched in quotation marks, as these drugs have effects that can — and often do — actually *cause* effects that can reasonably be called “psychosis”.)

      IMO, Biederman should be in jail.

      I find the following video encouraging (“12 year old Testifies in U S Senate Hearing – YouTube”):

      http://www.youtube.com/watch?feature=player_embedded&v=Td7X3yk2UTg#

      (That vid shows the testimony of a boy who, as a foster child, was placed on various psychiatric drugs.)

      Thanks for sharing your experiences with bad therapy and bad medicine; you are in good company here, on this site, where many commenters have been harmed by psychiatry; like others here, your tale serves as a caution to those who may not yet realize the dangers of psychiatry (and the dangers of therapists who chose to defer to psychiatry).

      As for your question, “Ah, what is psychosis?” IMO, that’s a great question; many people have their own views of what ‘psychosis’ is; though I believe some answer that question better than others, no one has a perfect answer IMO.

      I like your story of dreaming about being “moved by the Holy Spirit” after the night of 9.11.2001. (Of course, that’s not to say I’m glad that you wound up having your dream subjected to the ignorance of a therapist who obviously shouldn’t be in the business of interpreting dreams.)

      I relate to your having been misinterpreted…

      Perhaps, if/when you have the time, you might check the following link to part of my own tale…

      https://www.madinamerica.com/2013/03/spirituality-and-recoveryfaith-and-mental-illness/#comment-22117

      Respectfully,

      ~Jonah

      • Jonah,

        Thanks for the link to the video. Yes, drugging up the foster children is criminal (often done, I’ve read, so the foster parents can get SSDI benefits). And I agree with what you implied in your pesonal story, that what is so sad is our society’s belief in the fraudulent psychiatric system itself.

        A friend of mine from high school, brilliant lady, Stanford grad, had to give up her foster daughter because she couldn’t handle her “due to the ADHD.” I have no doubt the drugs caused the child’s mania or psychosis or whatever behavior problems. I know this because I was made sick with these drugs. But my brilliant friend believed that ADHD was a real disease and the drugs cure it. I did recommend she read “Anatomy,” to help her understand why her child was so upset. But what’s incomprehensible to society as a whole is the absolute and complete hypocrisy of the psychiatric system – they give patients drugs that CAUSE the DSM disorders. The psychiatric industry spent the last 50 years documenting the mental illnesses their drug CAUSE. Of course sadist lobotomists would be so stupid.

        And I, too, was drugged up for belief in God, and telling psychiatrists that they should learn to treat as others as they would like to be treated after (according to my medical records) doctors tried to cause a “chronic airway obstruction” because I was an “organ donor,” and had dealt with prior malpractice (a “bad fix” on a broken bone and a “Foul up” with drugs mandated to cover up the “bad fix.”). When the “chronic airway obstruction” didn’t result in brain death, it magically turned into “bipolar.”

        What the psychiatric industry does is so evil, people can’t believe doctors would behave that way. But then they’re dumb enough to hand over the written proof, but no one polices this type of medical crime. Psychiatry is nothing but abuse of patients for profit.

        I do so hope and pray for change. What happened to me was deplorable, but to destroy the lives of millions of children (and millions more adults) with these drugs makes me so sick I can’t tell you.

        And think about it, I was drugged up to cover up malpractice, not because I had a mental illness, in 2001. The medical community covers up their malpractice by putting people on antidepressants, which causes mania, thus “bipolar.” Then puts people on antipsychotics, which cause psychosis. The medical evidence was all available proving this pathway to bipolar in 2001.

        http://books.google.com/books?id=KMapbFl0ZZMC&pg=PA59&lpg=PA59&dq=iatrogenic+bipolar&source=bl&ots=wcP_ee7V-k&sig=t2xEHJHWHylwaa23kidO9DLOjgU&hl=en&sa=X&ei=pOi8UY6ZEoq89QSt84DYCQ&ved=0CCcQ6AEwADgU

        So how can the medical community still claim these drugs are beneficial to people? The hypocrisy is staggering. Especially now that the long run studies are out proving the antipsychotics cause atrophy of the brain, exactly as seen in long run medicated schizophrenics. Psychiatry is nothing but social control for the unethical and incompetent in our society.

        Forgive me, I know some (hopefully many) in the industry have good intentions. But no one should ever be allowed to force medicate anyone else who is neither a threat to themself, nor anyone else, other than doctors paranoid of a malpractice suit. We need a return of ethics in mainstream medicine.

          • I know most doctors are good. But it’s wrong for psychiatrists to hypocritically claim to be doctors, and it’s wrong that the entire medical community is still standing in support of the pseudoscience of psychiatry, for less than ethical reasons. And what happened to me is proof of those less than ethical reasons.

        • I have seen first hand in my work (with the CASA program) how many foster kids have “bipolar disorder” diagnosed following “treatment” of “ADHD” with stimulants, and sometimes following SSRI prescriptions. I’ve also seen many “recover” when they stopped these drugs on their own. It is a common occurrence.

          I agree, it is criminal, and Biederman and others who knowingly perpetrate this nonsense for personal financial gain should be jailed.

          —- Steve

          • It’s heartbreaking, and criminal, over a million American children have been turned into bipolar patients with drugs. I agree. And it is malpractice, according to the DSM-IV-TR. But the medical industry is claiming all over the Internet that antidepressants “unmask” bipolar.

            That’s a blatant lie, they cause “mania” in many who take them. I had iatrogenic “bipolar” caused via a “smoking cessation” med, I suffered from drug induced mania, but I’ve never suffered from depressed. That’s not bipolar. I hope the lawyers will start taking these easily provable malpractices cases soon, because it doesn’t seem like the doctors will stop this type malpractice until they start getting sued.

  5. Note this interesting comment.

    “Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates.”

    Apparently, some people with obvious (to the trained eye) “symptoms of schizophrenia” can function at high levels in society, but might well be rendered dysfunctional and or disabled by “treatment”. Ain’t that a Catch 22?

    What if similar studies on other “disorders” and their drugs of choice produced similar results?

  6. I wrote a blog after I attend Robert Whitaker’s lecture at the NAMI Conference last week about the use of antipsychotics. My son, who has bipolar disorder, and I were part of a packed audience. So many of those in the audience with mental illness and those who love them were confused about what we were hearing and so afraid that we had put our trust in the wrong hands. Read about at: http://kathybrandtauthor.com/mental-health/the-case-against-excessive-use-of-antipsychotics

    • Hi Kathy,

      I am a mental health advocate and a volunteer for several nonprofit organizations, including the International Society for Ethical Psychology and Psychiatry (ISEPP).

      Robert Whitaker has been a past conference presenter for ISEPP and will be presenting at ISEPP’s upcoming conference in November.

      I attended my first, and last NAMI convention in 1999.

      While it was one of the most impressive events I have ever been to in my life and I appreciated the chance to meet William Styron, I did not like the fact one of the psychiatrists who presented falsified the information and admitted to it. The audience thought nothing of it and he even made a joke about it. I walked out of the conference extremely disappointed as there is such a need for a strong, unified alliance to help those in our mental health system.

      As a parent, I can certainly understand your fears.

      I have been in the position of a caretaker for loved ones suffering from symptoms of mental illness. I can also relate to your son’s experiences, as I have also been a person who suffered from symptoms of severe mental illness and needed to be cared for. I also know what it is like to suffer severe side effects from medications and the costs involved in being in our mental health care system.

      I know what it is like to feel that you have put your trust in the wrong hands and I know what it is like to find information and professionals you can trust implicitly.

      After suffering an acute manic episode in 1996, I put my trust and faith in the main stream medical model.

      I was labeled with bipolar disorder and lead to believe it was a hereditary condition.

      I was 33 years-old at the time and had no prior symptoms of either mania/depression.

      After a second manic episode in less than one year, I started became more proactive in searching for information. I put my trust in higher powers and put my faith into my ability to seek out and find answers to my many questions.

      The first step I took was signing up for night courses in Abnormal Psychology and Anatomy and Physiology, as well as attending support groups to learn from others.

      I approached the situation with an open-mind and a blank slate.

      While it might seem like a Pandora’s Box situation, in reality it is a matter of taking off our blinders.

      Mental health advocates are in a “Seven Blind Men and an Elephant” situation.

      Many of Bob’s lectures are available online. The one on C-SPAN is very good and Bob makes his concluding statements very clear.

      My interpretation (summarized) of Bob’s beliefs regarding the treatment of psychosis are:

      – the research supports short-term efficacy of antipsychotics and long-term chronicity

      – the comparison research from 1945-55 involved treating psychotic episodes with hospitalizations that lasted between 12 months and five years.

      – his book is not a medical advice book and does not encourage patients to go off of medications (although some psychiatric patients have gone off medications after reading Anatomy)

      – he believes psychiatric medications have a place in mental health care

      – Anatomy of an Epidemic does not take an anti-medication position and is in fact a “pro-med”, best use practice

      – when considering psychotic patients, some will do better off meds, while others do better on meds

      – he believes the psychophramacology paradigm is a failed revolution

      – psychotic episodes have flu-like characteristics of coming and going on their own, treatment with medication is the best approach to quickly stabilize

      – his appeal is to create a national discussion that incorporates the long-term data

      What I found the most surprising about Bob’s invitation from NAMI was the fact Pete Earley offered bloggers money to write about his presentation.

      In his blog, Pete changed the title of Bob’s lecture from the “selective use of antipsychotics” to “against” antipsychotics. This simply is not true and in my opinion is an attempt at a “shoot the messenger”.

      As an investigative reporter himself, why doesn’t Pete read Mad in America and Anatomy of an Epidemic himself, listen to Bob’s lectures online and write his own opinions.

      I’ve written extensively to Pete and have gotten no response. He has blocked my ability to comment on both his site and his Facebook Fan page. He is an individual who I do not trust.

      His perspective is extremely limited. He rushed to write a book without first taking the time to find the best approach to help his own son.

      He strongly promotes the use of antipsychotic medications, and downplays the serious, harmful side effects. He fails to warn his readers and presents a very misleading dialogue on his blog.

      In his book he researched and wrote about the life of Deidra Sanbourne, yet failed to recognize it may have been a medication that caused her death.

      http://isepp.wordpress.com/2011/09/16/florida-plaintiff-deidra-sanbourne-was-her-death-caused-by-clozipine-induced-bowel-obstruction-readers-of-the-book-crazy-deserve-to-know-about-the-harm-psychiatric-drugs-can-cause/

      When it comes to symptoms of psychosis or mania, all individuals have the right to be tested and treated for underlying medical conditions/substances that are known to cause these symptoms.

      Medical and mental health professionals commonly do very little testing and literally use a “Chinese Menu” approach in diagnosing patients with symptoms of severe mental illness

      We become rubber stamped with either bipolar disorder or schizophrenia and are told we need medication the rest of our lives.

      Whether you are a member of NAMI or CCHR, all mental health advocates should form an alliance to ensure patients in our mental health care system are assess using the Best Practice Assessment guidelines as published in the British Medical Journal.

      http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

      Mental health advocates need to find common grounds to build upon. Advocates spend more time fighting amongst each other than fighting for the needs of those in our mental health care system.

      Many individuals in our mental health care system are among a marginalized population. Because of incarceration, hospitalization, low-income or homelessness, they may not have access to the internet.

      The internet is now a powerful tool for mental health advocates, but it excludes the voice of those being advocated for.

      All individuals who consider themselves “mental health advocates” should consider, if they were suffering from mania/psychosis, would they want to be tested for underlying causes?

      If so, then this is what we should all be fighting for together under a unified advocacy agenda.

      Kind Regards,
      Maria Mangicaro

    • The original drugs used as antipsychotics were haldol and thorazine. At the beginning of their use they are called what they truly are, tranquilizers. The big drug companies came along and started touting them as “medications” for mental illness and the rest is history.

      They never were true medications in any sense of the word; they do not cure the supposed “illness” they only damp down the symptoms. The newer so-called “antipsychotics” are no better and in many cases are even worse due to the fact that they cause so many heaoth problems. They’re even causing people to die twenty-five years earlier than people who haven’t taken the drugs.

      Then the drug companies started the “broken brain” ill for life business, saying that mental illness is a problem with peoples’ brains. This is an out and out lie, it has no basis in fact or science, and has never been proven. But the drug companies and psychiatry keep perpetuating the myth of the “chemical imbalance” which causes so-called “mental illness.”

      Read Bob Whitaker’s book Anatomy of an Epidemic. He tells the story much better than I do and he can back up what he says with real scientific studies, not the pseudo-scientific tripe that the drug companies fund and publish. The drug comapnies and psychiatry have gotten into bed with one another and formed the most unholy of alliances and have pulled one of the biggest con jobs ever on the people of the world.

  7. Kathy,

    I’m so sorry for what your family is going through, please tell your son I know exactly how angry he feels, and he has a right to be angry. However, I have been researching the psycho / pharmaceutical industries (and what happened to me) for eight years now. And many, including the government were snowed, it wasn’t until 2011 that they started restricting antipsychotic prescriptions for the military. The doctors were misled, and the pharmaceutical industry has been largely controlling what’s even been put into the medical journals for decades, so they’re now of dubious scientific relevance. Society was misled. But most were hoping the drugs were the “wonder drugs” they were advertised to be. But they aren’t.

    As it turns out, at least based on my research, the “new wonder drugs” were not actually that different than the old psychiatric drugs. And it seems to me that the psychiatric professionals unwittingly spent the last 50 years writing a DSM that describes the mental illnesses caused by their drugs. The antideppressants and ADHD drugs cause the bipolar symptoms, and the medical evidence is now coming in showing the antipsychotics cause atrophy of the brain, exactly as seen in long run medicated schizophrenics. And I will tell you based on my unfortunate experience on these meds, that is a 100% accurate description of their effects. Plus, of course, the DSM included a bunch of new disorders (not diseases) which medicalized normal human emotions and behavior in order to railroad people (especially children) onto the psychiatric drugs. It’s shameful, and unfathomable betrayal, I know. I’m still trying to digest it all myself, as it seems are people in the industry itself. Imagine paying to get an education, then later learning it was all misinformation. I’m certain that’d be hard to swallow.

    Here are some links backing up my opinion, and showing that for the most part, it was not individual doctors or even our government, that was to blame. I believe we need a return of the democracy to fix this one, but that’s a philosophical debate for another day.

    Bipolar is almost, if not completely, a drug induced disorder in this county:

    http://ssristories.com/show.php?item=4162

    Read all seven or so pages of this book excerpt:

    http://books.google.com/books?id=KMapbFl0ZZMC&pg=PA59&lpg=PA59&dq=iatrogenic+bipolar&source=bl&ots=wcP_ee7V-k&sig=t2xEHJHWHylwaa23kidO9DLOjgU&hl=en&sa=X&ei=pOi8UY6ZEoq89QSt84DYCQ&ved=0CCcQ6AEwADgU

    And the long run effects of the antipsychotic meds are coming in:

    http://m.psychologytoday.com/blog/mad-in-america/201102/andreasen-drops-bombshell-antipsychotics-shrink-the-brain

    http://www.ahrp.org/cms/content/view/772/9/

    No one’s quite certain how to cope with this gigantic mistake:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474133/

    http://m.psychologytoday.com/blog/dsm5-in-distress/201004/psychiatric-diagnosis-gone-wild-the-epidemic-childhood-bipolar-disorder

    http://www.narpa.org/UN-forced%20treatment%20is%20torture.htm

    But the US is the only country that put lots of children on ADHD drugs and antidepressants, and the only one to mass label children as bipolar. Read Robert’s book “Anatomy of an Epidemic,” it explains it all quite rationally.

    And this expresses concerns from the former editor of the JAMA regarding the medical industry as a whole:

    http://www.freegrab.net/sicksell2.htm

    As to your son going off the meds, make sure he does so with a doctor’s assistance, please. Based on my experience, and there were recent blogs on this site that showed other findings of such, the withdrawal symptoms from the meds can occur much later than the DSM states, which confuses psychiatric professionals, as much as 6 months to a year after going off the meds. So if (or more likely when) withdrawal induced mania and/or psychosis occurs, short run medication may be necissary, but long run should no longer be considered wise, at least in my opinion. Personally, I was weaned off 6 drugs, all with major drug interaction issues according to the FDA drug interaction checker at drugs.com, over 2 years, then weaned off lithium.

    I, obviously, am not a doctor and am only giving advise based on my experience. But according 40 hours of unbiased psychiatric career counceling, I am supposed to be a judge and have an IQ in the gifted range. So take my opinions, based on eight years worth of research, for what you will. And I am so heart broken for what happened to your son, please give him a hug for me and tell him I’m sorry.

    By the way, I only read “Anatomy of an Epidemic” several months ago, and am a new follower of this website. Most my research is from other authors and the Internet. Although Robert Whitaker synopsized the unfathomable truth extraordinarily well. My heart goes out to you, and best to you and your family.