This is the headline of an editorial in the most recent edition of Current Psychiatry. It is written by Henry A. Nasrallah, MD, a prominent psychiatric researcher. This is one of the free journals sent to, I assume, every psychiatrist in the US. Although it says it has a subscription cost of $113/year, I know I have never been asked to pay. I assume it is supported by its advertisements, 18 pages of which in this 54 page journal were from drug companies.
This was a powerful and unequivocal editorial. Dr. Nasrallah writes,
“The FDA would never approve haloperidol today, given the serious harm it can do to the brain, despite its efficacy for psychosis. (It’s interesting how the FDA bans a drug immediately if it causes tragic birth defects, such as thalidomide, but not if a drug is destructive to the brain tissue of a disabled adult patient.)”
His target is all of the first generation neuroleptics but he focuses on haloperidol because it is the one most often-studied. The neurotoxicity he cites includes a number of findings suggesting that haloperidol promotes cell death. This could provide an explanation for the findings of brain atrophy after long-term exposure to these drugs, as well as the findings of worse functional outcomes in those who remain on neuroleptics.
But Dr. Nasrallah has another message. The newer neuroleptics – the so-called second-generation antipsychotics (SGAs) – do not share these problems. He cites one review paper that reports on the neuroprotective properties of these drugs. While I am aware of research suggesting that clozapine and perhaps olanzapine have neuroprotective qualities, I was not aware that this advantage is conferred to all second-generation drugs. The studies on outcome and brain atrophy were conducted over the past two decades when the SGA’s quickly became the most commonly prescribed neuroleptics.
However, if what Dr. Nasrallah says is correct, this is important for many reasons. First of all, it is an admission from a prominent research psychiatrist of the limitations of the neuroleptic drugs. It also suggests a strong reason for prescribing the second-generation neuroleptics rather than the older ones.
People on this site wonder how psychiatrists learn new information and what influences their thinking. A journal like Current Psychiatry has an impact. It often has review papers that are easy to read. Most of us are busy all day, and having quick review papers from respected academicians is helpful. It would be easy to read this editorial and walk away with the new ‘knowledge’ that haloperidol is bad but the newer drugs are good.
However, the time has long since passed that I could read a review article such as this and accept it at face value. There was no conflict of interest report for Dr. Nasrallah attached to this article, but just editing a journal that is largely supported by Big Pharma is, to me, conflict of interest.
It is concerning to me that in this same journal, there is an article about shared decision making. The article describes an approach that the author calls “Participatory Pharmacotherapy: 10 Strategies for Enhancing Adherence.” While I have no objection to what he writes – in fact I am not sure how else one could practice – I do wonder at the bolded comment that “Patients with psychosis, cognitive impairment, below-average intelligence and substance use disorders, are not good candidates” for this approach. If it is true that the SGA’s have neuroprotective value, this needs to be considered against their considerable impact on weight gain and the consequent risk of metabolic syndrome. Since the indications for these drugs are “patients with psychosis”, wouldn’t we want to be be discussing these risks with them and at the very least follow guideline number 1, to “Encourage patients to share their opinion of what a desirable treatment outcome should be” and number 3, “Engage patients in choosing the best medication for them”?
The current evidence suggests there is no differential efficacy between the older and newer neuroleptics (Leucht et al). Most of the new drugs are now available off-label so the costs have come down. Of note, the ad just after this editorial was for Abilify Maintenna – the injectable long acting version of aripiprazole. The main market competition these days between branded and generic neuroleptics is among the long-acting injectables (LAI). The only generic LAI on the market is haloperidol (mysteriously, fluphenazine decanoate recently went out of production). Olanzapine, risperidone, and now aripiprazole are all available in the long-acting form. The timing of this editorial is suspect.
At the same time, I am not going to dismiss what Dr. Nasrallah has to say. If he is correct this should influence practice. I plan to spend some time researching this on my own.
I was going to wait to write what I learn – this is complex material and it will take me a few months. But I decided to post this part now for this reason: many of you are highly knowledgeable. I decided to tap into your expertise to help me with my research. Please let me know of any articles you think I should read. I will get back to you with what I learn.
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Thanks Sandra. I’ll also try to go deeper to the article and references, provided I find the references. I’m not a neuroscientist but I’ve studied some neuroscience, and especially my passion has been a more network or algorithmic level view of the brain (by what logic neurons communicate and create connections, etc) and type of computational neuroscience (Jeff Hawkins, Hecht-Nielsen, etc). My thinking still is that the D2 antagonism between cells causes the brain atrophy seen in those monkeys, etc. Of course there are then other downstream cellular mechanisms, etc, which actually cause the cells to die and of which I don’t know too much. The receptor affinities of haloperidol is such that it very strongly blocks the dopamine receptors, but this is of course dose dependent. The newer neuroleptics such as Seroquel at lower doses block other receptors such as H1 and 5HT2A and at higher doses they start to block D2, and you can’t block D2 as much with them as you can with high doses of haloperidol.
Many of those older studies which have found that, for instance, that Seroquel is neuroprotective or improves cognitive skills, have given perhaps one group 400 mg of Seroquel and other 15 mg of haloperidol. At those doses the haloperidol group has been getting hugely more D2 blocking.
There are also other older neuroleptics which have a wider receptor profile and less affinity to D2.
About the 5HT2A antagonism being protective, in our discussion forums there’s a post where the research has noticed that 5HT2A turn dopamine reseptors to a HI-state, meaning it works against the dopamine blocking effects of atypical neuroleptics. They were thinking about new drugs which prevent this process. But maybe this thing works against the dopamine antogonist thing of the same drugs and therefore increases the dopaminergic activity and therefore reduces the negative effects of dopamine blocking.
I don’t know, but I’ll try to go through this path of thinking. Thanks for another puzzle, I learn so much going through them.
Thanks, Hermes. I think most of the stuides will be in animal and I agree that we need to pay careful attention to dose equivalents. I look forward to hearing more from you.
Thanks. In what I wrote, I was mostly reading the reference to this recent paper in my comments instead of the recent editorial: http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol24_sup1/dnb_vol24_sup1_95.pdf
I also agree that most of those studies he referenced are from the promotional phase of those atypicals. Unfortunately I can’t get to most of the actual papers, only the abstracts. I don’t know how they decided to measure the dose between those two drugs they gave to the rats, but one important thing to look would be how much dopamine receptors the given amount of drug molecules block. To do this even roughly, you’d need to do some math with receptor affinities, etc. That is, an easy trick is to give haloperidol in a dose where it blocks lots of dopamine to one group and another group a new drug in a level where it blocks less dopamine. Haloperidol causes bad things and the new drug causes less of the bad things, then they say the new drug causes increase of BDNF, etc.
By the way, I just noticed in the famous monkey study which found that both haloperidol and olanzapine “in a manner that mimics clinical use” cause brain shrinkage used the amount of D2 blockage to determine the doses of drug to each group of non-psychotic monkeys just as I suggested it should be done.
However, more recent imaging studies of dopamine D2 receptor occupancy suggest that antipsychotic efficacy, without pronounced extrapyramidal symptoms or hyperprolactinemia, occurs when 65–72% of striatal dopamine D2 receptor are occupied.
Consequently, in this study, we sought to obtain plasma levels of 1–1.5 ng/ml for
haloperidol and of 10–25 ng/ml for olanzapine.
That there are no consistent differences between atypicals and typicals, SGAs and FGAs, has been confirmed in a recent meta-analysis of 150 trials of these drugs: in 95 of these trials the FGA comparator was a high-potency FGA – haloperidol – frequently at high doses.14
An example of the promotional studies, there are many similar:
These preliminary results support the potential value of quetiapine for improving cognitive impairment in pa- tients with schizophrenia and emphasize the importance of further research with this promising atypical antipsychotic.
Patients were then administered a series of neuropsychological tests and randomly assigned to double-blind treatment with quetiapine (300-600 mg/day) or haloperidol (10-20 mg/day) within a flexible dose schedule (determined by the clinician at each centre).
Another study with a *low* dose of haloperidol (5 mg) compared to Risperidone:
This study examined the neurocognitive effects of low-dose haloperidol compared with risperidone over a 2-year period.
This study did not provide support for neurocognitive advantages of a newer antipsychotic med- ication over a low-dose conventional medication. We speculate that conventional medications may have neuro- cognitive benefits at low doses that are neutralized or reversed at higher doses.
In any case, in that newer article from 2012, I couldn’t read the older references. It may well be that they’re now aware of this haloperidol trick and they’ve picked articles where it isn’t prominent. I can’t check it. They often just make claims but don’t explain why it is so, maybe the referenced article has some reasoning, but I don’t know.
How does one tell a psychotic monkey from a non-psychotic monkey???????
Hehe. That was an inside joke. In an earlier blog post Sandy talked about the monkey study and added “The monkeys were not psychotic.” I noted about it and Sandy put it on the title of the post. 🙂
By the way, one interesting thing about schizophrenia and psychosis is that there is no really convincing animal equivalent of them.
I am confused by your latest post. I think the brain damage and shrinkage “side effects” of ALL antipsychotics has been well established by even the most highly recognized experts in psychiatry.
Donna, I think Sandy in part wanted us to comment about parts where the reasoning of this article might be wrong, etc. She clearly was sceptical of its claims and even pointed out how there was those commercials for Abilify injection in the next page. Maybe there’s some promotional attempts again going behind the scenes. If there are, it may be useful to further understand how it happens. (See Ben Goldacre, etc)
Hermes and Sandy,
I certainly got the point Sandy was making that the author of this seeming BIG PHARMA publication seemed to be writing an ad for the new depot drugs with the pretense that these drugs are neuro-protective while demonizing the off patent older drugs.
I guess it seemed that Sandy was still questioning if the second generation drugs caused brain shrinkage/damage, which I thought was pretty well proven.
Perhaps I misunderstood? I certainly wasn’t trying to be sarcastic or unfairly critical. Rather, I was just puzzled given articles like the one I posted by Dr. Moncrieff and others on MIA.
Please enlighten me if possible. I applaud Sandy for her usual skepticism here and when she shared a BIG PHARMA ploy by Dr. Jeffrey Lieberman before we had the misfortune of reading his lament of psychiatry suffering unfair stigma after the DSM was debunked by Dr. Insel.
I can’t talk for Sandy, but I like to go deeper into these articles and see how they’re manufactured. After you do it a while, sometimes you can spot good science from bad science almost from the style of writing. Maybe she is open to the idea that the newer drugs cause less damage than the older ones. I think it may often be a question of dose and amount of dopamine blockage.
The data on brain atrophy – based on human imaging studies – is not entirely the same as the data on the potential neuroprotective/neurotoxic properties of these drugs – based on animal laboratory studies. One might expect them to be related but they are not the same thing.
I am also not saying that what Dr. Nasrallah is writing is pretense. I do not believe he is lying. I just suspect the story is more complex but at this point, I do not know enough to form a conclusion.
I am reporting on an editorial by Dr. Nasrallah in which he states that the newer drugs have been demonstrated to have neuroprotective qualities. These are animal studies.
As I noted, the Andreasen was done in the past two decades and the SGA’s were used and not found to confer any advantage.
Even if Nasrallah is correct, it does not change my opinion that we need to moderate the use of these drugs.
Thanks for reading and commenting.
I got caught up in the article and other links and missed the link for the actual editorial, which may be why my initial response seemed to be a non sequitor:
I’ll have to study the post more carefully to make sure I pick up all the links.
I disagree with the editorial because I believe many doctors were well aware that these toxic older and even newer neuroleptics “worked” via brain damage/disabling or chemical lobotomies per Dr. Breggin, Bob Whitaker and many others.
Here is a very interesting article about the so called new SGA “wonder drugs:”
I must say I’ve done tons of research and reading on this topic for many years as well as reading many articles by Bob Whitaker and others on MIA, so I must say that my opinion on this topic has been highly influenced by such research already as well as Sandy’s past articles here.
Thanks for this article. As always, I’m so appreciative of your voice and contributions to MIA, and for your openness and humility. I really enjoy reading your posts and the subsequent dialogue.
I wanted to link you to one of Joanna Moncrieff’s articles, which challenges the “neuroprotective” story you mention re: second generation antipsychotics. To me, this is a very concerning narrative that is simply not founded in valid science. She sums up the (lack of) science behind such claims here:
I am certainly glad that the older antipsychotics are being called into question more and more, and I thank you for bringing our attention to this article. However, I of course am greatly concerned about the push to use newer ones in their place.
Thanks for your kind and supportive comments, Laura. This is helpful.
I wasn’t able to respond to your question on your last post about your sharing my story about being refused antibiotics for regular bouts of bronchitis.
I don’t have a problem with your sharing this story, but would prefer to remain anonymous for obvious reasons.
I’m not sure that the over or under prescribing of antibiotics is equivalent to biopsychiatry prescribing lethal, brain/body damaging neuroleptics or any other useless, toxic drugs like SSRI’s or Ritalin for unproven, voted in DSM stigmas now admitted to be invalid with no evidence or science to back them up, which many have known for a long time.
I did have bronchitis and some doctors do argue for immediate treatment with antibiotics to avoid pneumonia, further lung damage, etc. Plus, I usually only had bronchitis about once a year over the holidays when exposed to lots of sick people/kids. One problem is that doctors don’t know if a virus or bacteria is the cause and I wonder if tests could determine this?
When all is said and done, that doctor who wouldn’t give me antibiotics due to the risks of overuse of such drugs was right in her own way from one point of view, but others would disagree with her. The truth is both sides may be right and/or wrong in some ways, so it’s not easy as you say. I guess it depends on the unique individual involved and their history, current health, etc.?
The reason I say this is I had a bronchitis attack this past winter and resisted going for antibiotics and the attack lasted for what seemed like forever and it really took a huge toll on me for quite some time, so I’m not sure that was the right thing to do. You are a doctor. What do you think? You don’t have to answer because that could be seen as giving free medical advice.
I am agreeing with you that medicine is not so black and white as we would like to think and I can imagine the dilemmas you must face in your own unique cases when just a simple cold/flu turning into bronchitis can become so complex and difficult to decide on the best course. And no I don’t smoke!
So, as I said on another comment on one of your posts, what really matters is if one is dealing with an ethical, honest, dedicated doctor who tries to keep up with all the latest research and drug effects to recommend the best treatments for people to provide informed consent so the patient and doctor can make the best decision based on the real evidence known at the time. I also said that if the golden rule is applied by a doctor, a patient or client should fare much better. At the same time, I think people must realize that with managed care, doctors are very busy, stressed and granted only limited time to spend on each patient, so people have to take responsibility for doing their own homework on their illnesses, drug effects, symptoms, prevention and health in general to act more as a partner with their doctors. In the case of children or psychotic people, parents or families may have to play that role as long at they are not narcissists scapegoating their victims.
I must say that I am very much against all neuroleptics and I think there are other drugs that can be used temporarily like benzos to temporarily calm people down to the point that trained peers or others can help them with their extreme states as with Open Dialog, Soteria, etc.
At the same time, I have not walked in your shoes, so from what you have shared, I do get the impression that you continue to do your best to learn as much as possible to help those you encounter in your work while doing the least amount of harm in a very challenging field/job. Unfortunately, such a goal includes debunking the junk science promoted in the above article as you’ve done and that of the Dr. Jeffrey Lieberman’s and Dr. Charles Nemeroff’s in your field.
One final question has come to mind. You speak of using low doses of neuroleptics to minimize their harm. In your search for possible brain damage and other toxic effects of these drugs, do you know of or can you find any evidence of lower doses causing less brain/organ damage, relapse, disability, inability to function/work, etc.?
I will be trying to check that out too along with your original question.
Sorry it took me so long to get back to you. The issue you cited turned out to be more challenging than I originally thought concerning what seemed to be my seemingly simple bronchitis dilemma still proving your point about the complexity and difficulty of such decisions.
I still vote for your refusing to do something you think/know is harmful to someone no matter how much they beg for it as with the ECT example you cited since people in crisis or extreme states aren’t inclined to make the best decisions all the time when feeling desperate. That also means they shouldn’t be given toxic medications in such states when they are so vulnerable either in my opinion.
I have appreciated our discussion because it brings up very challenging issues.
You are correct that I can’t comment on your bronchitis this winter (not because I do not want to give free advice but because I do not know enough to respond), but I think that doctors often feel the pull to “do something” even when the evidence does not support what it is they do.
I was just reading today (and now I can not remember where!) that many people are given injections into their backs for lower back pain. Recent studies suggest it does not help and it may make things worse in the long run. But many people probably are convinced they derive benefit and might be willing to take the short term relief and put aside concerns about long term problems. Sound familiar?
When my children were young I was convinced their ear infections resolved more quickly with antibiotics. I really wanted them even though I knew they were likely to be experiencg viral and not bacterial infections, rendering the antibiotics useless. But I wanted to get sleep at night and I did not want to miss work. The evidence is now clearer that antibiotics should not be used in these circumstances but I was pretty convinced that my kids needed them.
I think these delimmas are common in medicine.
I actually just read the Nasrallah editorial, earlier I was mostly reading through the linked article. 🙂
But in that editorial he’s clearly promoting the banning of haloperidol and use of newer drugs. He’s right about haloperidol possibly causing these problems, though he’s not really explaining why. There’s a huge list of molecular mechanisms by which haloperidol causes damage to impress the psychiatrists who don’t understand what they mean. Then there’s only this one sketchy reference which tries to prove by molecule level handwaving that the atypicals are actually neuroprotective. And he’s pretending that during the last 15 years there has suddenly become huge amount of evidence of neurotoxicity of haloperidol and *that* is the reason he has stopped using it during the last 15 years. And even if the newer neuroleptics cause less shrinkage (it probably depends on dose), it still doesn’t mean they’re neuroprotective! If any of those molecular mechanisms of haloperidol toxicity are true, it’s very possible they’re true also about new drugs.
But yeah, I’ll still have to go deeper to that Nandra study to see if I can find any convincing arguments in it.
Sandy, I agree with you and you have my full empathy for the many dilemmas you encounter on a daily basis.
I regret that I may have initially been confused by your above post because your combining the writer’s opinions with yours made if difficult at times to figure out the writer’s views versus your own.
I got the impression you were using this post to show the dilemma faced by doctors getting this type of informercial for new drugs on patent in a BIG PHARMA funded publication that could create conflicts of interest when doctors can be easily influenced since they are pressed for time. You also said that you are not so inclined to automatically accept such claims made by this author as you might have done in the past now that you are more informed. I was appalled by the author’s agenda for compliance while basically saying so called psychotic people should be given these depot drugs by force, which is nothing new. I applaud you for questioning such a fascist approach. Since many people don’t take some or all of these drugs because they are so toxic and horrific, if more people are forced on the new depot drugs, I think there will be much more brain/organ damage. I am not so inclined to be as generous and long suffering with this author as you I must say.
I guess you had a similar experience of wanting to get a quick fix for your children’s ear infections as was the case for my bronchitis when there may not be any quick fix. I feel much better knowing that a doctor or potential doctor like yourself faced the same dilemma.
However, due to what appear to be unsustainable costs of our health care system or lack thereof, I have been reading many articles about doctors increasingly recommending doing nothing and calling out unnecessary tests and procedures that do more harm than good:
Just because we have been brainwashed by BIG PHARMA acting as the latest snake oil sales people doesn’t mean we can’t be unbrainwashed with reality checks.
Finally, I do applaud your constant concern about minimizing the harm of your treatments with lower doses, judicious use and no treatment whenever possible for best outcomes as I have said many times, so I hope you don’t take blanket statements I make regarding the KOL’s of psychiatry like Jeffrey Lieberman as applying to you.
I skimmed that Nandra article which is also a review. It is open access. I agree with your summary and your thoughts on the dose response issues and I also agree that this will require some deeper digging.
Thanks for your thoughts on this,
I don’t understand why you’re being so cautious over whether or not second generation neuroleptics, particularly zyprexa, are neurotoxic or neuroprotective. If I’m not mistaken, you yourself have referred people to the study that Eli Lilly did which showed that zyprexa shrinked the brains of macaque monkeys. And of course second generation drugs cause neurologic problems just like the first and some studies have been linked here at MIA showing the rate at which they do is about the same as the old ones.
It is because this editorial challenges some of my views that I was interested in it and decided to do more research. It was because Whitaker challenged my views that I decided to do more research.
I agree that there is data suggesting that the SGA’s cause brain atrophy. We do know they can also causes neurologic side effects in both the short and long term.
For those of you who think there is NEVER a reason to recommend these drugs, this differential potential for damage is a moot point. I am not one of those people although I do want to prescribe in a way that does the least harm.
What is confusing is that there are different levels on which to do research- one at the level of imaging and one at a celluslar level.
Since I do prescribe but in a way that minimizes harm I need to learn about the differential effects of these drugs and that is my intention.
I wrote this in advance of my own research and I think that is what is confusing here. However, I wanted to tap into the experts on this site to help me.
Thanks for pointing out this article on Haldol.
I believe it is dishonest of the author, Nasrallah, to make excuses that somehow psychiatry did not have access to research about the brain damaging effects of neuroleptic drugs. Dr. Peter Breggin has been writing about this since the late 1980’s (Psychiatric Drugs: Hazards to the Brain). And if it is true that this information was only in the hands of certain neurologists, what does this say about their ethics by not immediately alerting all psychiatrists prescribing enormous amounts of these drugs to large numbers of psychiatric patients over the past 40-50 years. The medical ethics of this are incomprehensible.
It sounds like this article may be in response to the journal article that was posted here about a year ago and signed by the current president of the APA (I am sorry I don’t have the link at this time) which stated that the newer SGA’s prescribed to people age 40 and over were ineffective with any “psychopathology” and caused multiple side effects including many significant medically dangerous effects. Perhaps Biological Psychiatry was concerned that doctors might return to using more first generation neuroleptics which are much cheaper.
And finally, shouldn’t we all be questioning the use of the word “neuroprotective.” If some drugs were truly “neuroprotective” shouldn’t we all be taking them. The research noted in the article Laura referenced by Joanna Moncrief shows no evidence that a prolonged psychotic state (or that which gets labeled as schizophrenia) causes some type of brain deterioration.
I subscribe to the view that the psychological states of depression, anxiety, psychosis etc. are coping mechanisms that may be quite effective in the short run but counterproductive and often self defeating over a sustained period. The problem may be more that these psychological states can become habitual, with perhaps well traveled pathways developing in the brain that could also explain the tendency for relapse.
But all habits can be broken and newer pathways can develop over time (through neuroplasticity) which can become stronger and overwhelm the older pathways that represent dysfunctional habits, including psychosis. So yes, it may be beneficial for someone to disengage from a psychotic state sooner rather than later so that it won’t become a well established psychological pattern of viewing the world.
This way of viewing the symptoms of psychosis counters the theories of neurological damage or “brain disease” promoted by Biological Psychiatry. I believe we must expose AND oppose the unscientific use of the term “neuroprotective.”
Thank you for your comments.
“So yes, it may be beneficial for someone to disengage from a psychotic state sooner rather than later so that it won’t become a well established psychological pattern of viewing the world.”
Neuroleptics over some period of time may help in this way. I have an obligation to understand these drugs as much as I can if I am going to prescribe them (which I do).
That is an interesting point about the term neuroprotective. When I get back to this, I will attempt to address it.
These guys have no shame. I pulled the Nasrallah article. As evidence for a “neuroprotective” effect of atypical he cites Agius and Nandra. In the Agius and Nandra article they cite studies in mice, where they expose animals to atypical and then count the number of newly divided cells. They also looked at mRNA levels of NGF and BDNF. What struck me is the inconsistencies across atypicals and inconsistencies across brain areas. I was also struck by the lack of discussion of whether more dividing cells and/or BDNF is good or bad. I think for actual impact, the new cells need to differentiate and be integrated into new circuits. Moreover, BDNF levels may not have positive impact all over brain. (See Eric Nestler on BDNF in N. Accumbens being associated with more distress.) Further, in the discussion they mention glycogen synthase kinase and Bcl-2 increases, two proteins all over the cancer literature. The articles further did not discuss the articles on impact of atypicals on cortex volume levels or on number of glia where the drugs decrease number of cells(see Konopaske et al.) My take is that Nasrallah is probably collecting a fat compensation from the drug companies.
Thanks, Jill. I was hoping to hear from you. This supports my suspicions and confirms that this will need a deeper dive. But the unequivocal nature(FGAs – bad, SGAs – good) of his remarks seemed supect to me.
Hi Sandy-if you have any spare time, would you be available to help me read through and integrate the material on basket and chandelier cells. For schizophrenia, seems to me people are on to something here. I particularly like David A. Lewis’ approach. He’s got a web site at Pitt, where he lays out his inferential process. I trust him more because he also was involved in the Konopaske studies on decrement in glia cells with the antipsychotics. If you buy his argument about fast spiking GABA interneurons being a problem, then the cure will be N-acetyl-cysteine, which as far as I know is pretty benign. (Who doesn’t need more glutathione?) As a faculty member at GSU, I can get any article I want, which is a real advantage. I can send an electronic copy of anything you would like. My e-mail is [email protected]. Home phone is 770-939-7409.
You are probably giving me way more credit on being able to help you out than I deserve but I can try. I also can get access to articles through my univseristy affiliation. However, I have a problem with time over the next few months. Can you e-mail me?
I know David Lewis from my Pittsburgh days and he seemed to have great intellect and integrity. He wrote an honest appraisal of the Andreasen study in an accompanying editorial in the Archives.
I looked the the editorial and the Nandra article a bit more. One thing is that all of their references about the neurotoxicity are about haloperidol, yet without a problem they then claim all older neuroleptics are the same when they are not. And at the same time they widen their various references about different newer neuroleptics as if they apply to each newer drug, even though the newer drugs have quite different receptor affinities, etc. For instance:
This is convoluted. The largest “antipsychotic” mechanism of all neuroleptics in higher doses is D2 antagonism. Haloperidol happens to be a very “pure” neuroleptic in the sense that its molecules go largely to D2 receptors instead of also to other receptors. In CATIE study they used perphenazine which is a more medium potency neuroleptic in that in addition to dopamine receptors, its molecules go also to other receptors so there tends to be less dopamine blocking and more effects on other receptors. These change the way it feel and how it works in the brain. It’s a bit like taking a smaller dose of haloperidol and then small doses of some other drugs. Chlorpromazine has relatively low binding to D2 and plenty of binding to other receptors, such as histamine. Chlorpromazine and maybe perphenazine are also strong antagonists at 5HT and they could be called atypicals if they had been released at the same as atypicals.
One thing with haloperidol is that if you want lots of D2 blocking, then it’s quite possible to do it if you give a larger dose, and then you get lots of effects related to D2 blocking. Sometimes some patient might find a neuroleptic with lots of H1 blocking useful because of its highly sedating effect, someone might like more of just the D2 blocking. Etc.
BTW, if he says this and it can be shown that the newer neuroleptics cause the same thing, we can use the same argument to ban all neuroleptics! Except it wouldn’t work.
I think they were trying to suggest that the effects on the serotonin receptor mediates the effects on dopamine. I agree that one can not make assumptions about the “class” of SGA’s based on findings with respect on one of them since the drugs are so different.
Thanks for your ongoing research.
They were suggesting many different things in the same article.
But for example, typical chlorpromazine (Thorazine) is also an atypical by the suggested meanings of atypicality. You asked for articles to read:
Last Psychiatrist: The Rise And Fall Of Atypical Antipsychotics [sic]
“I think they were trying to suggest that the effects on the serotonin receptor mediates the effects on dopamine.”
Oh, and when I talked about 5HT, 5HT means serotonin. Perphenazine and chlorpromazine work in this system pretty much like the “atypicals” work. So what to make of the claims of Nasrallah, etc, that typicals are very bad and atypicals are actually beneficial? Is it crap or not?
Follow the money:
“Dr. Henry Nasrallah, a psychiatrist at the University of Cincinnati, netted $647,341 in speaking and consulting fees from drug companies, ranking him as Ohio’s top recipient of such payments over that four-year period.”
Thanks for being part of MIA!
Or, as they like to say in those Aflac commercials:
Thanks for this, Duane.
Thank you, Sandra – for all the time you put into research; for caring; and for being so willing to listen to what others have to say.
Here is a very good article by Grace Jackson on the topic.
She sites cancer researchers who see the potential for using neuroleptics to fight cancer since they are so toxic!
I was wondering if Bob Whitaker’s latest article and conclusions about neuroleptic drugs on the practice of psychiatry had any influence on you in terms of prescribing these drugs.
Bob and I are very much in agreement on this.
It’s good to know that you are in agreement with Bob Whitaker’s latest post. When I first read it I knew you had written about similar studies and conclusions per the post you included.
I guess Bob’s post was more dramatic and even angry over the idea that psychiatrists would not take such new information into account.
Anyway, you have confirmed what I had gathered in that even if you feel these dangerous drugs must be used in a crisis situation when you feel there are no good alternatives, you use them in a judicious, limited way to cause the least harm, which I think is the best practice Bob Whitaker recommends.
I asked in another comment about whether there is evidence that lower doses, judicious use and other ways you prescribe these drugs to avoid harm lower the risk of brain damage, disability, other side effects, etc. But, I don’t know if you saw it.
Do you agree with 1boringoldman about his use of Trilafon? Do you think Trilafon is safer/better than SGA’s?
Thanks for your response.
Most everything I read suggests that dose reduction reduces harm.
I am not sure I agree entirely with 1BOM about perphenazine (Trilafon). Every drug has side effects so it comes down to choosing which side effect is worse. There is some sugestion that tardive dyskinesia risk is higher with the FGA’s but weight gain is higher with the SGA’s.
However, I do think dose is very important – both in analyzing the studies and in using the drugs.
So a low dose of perphenazine may be safer than a higher dose of an SGA.
The message on dose was big in the early 90’s but with the marketing of the SGA’s people got the (mis)impression that hey were much safer so higher doses, broader indications, and polypharmacy became more common.
I guess I have a harm reduction approach towards my colleagues. I do not think people will stop prescribing neuroleptics but there are compelling reasons to moderate dose that if that message could get out, some good would come of it.
Here is an audio link to the Jackson file.
Henry A. Nasrallah, MD, a prominent psychiatric researcher is one of Americas best know leading proponents of “biological psychiatry”. He is a well known for “trolling” psychiatry articles…by that I mean trolling other pyschiatrists…one can’t take anything he writes seriously….
He is the editor of Current Psychiatry….
Look at the other rubbish he writes….
Nasrallah: The antipsychiatry movement: Who and why
“Finally, the antipsychiatry movement aggressively criticizes the pharmaceutical indus- try’s research, tactics, and influence on psychiatry. Also included in the attacks are academ- ic psychiatrists who conduct FDA clinical trials for new drugs and educate practitioners about the efficacy/safety and indications of new FDA-approved drugs. Although industry research grants are deposited at the investigators’ universities, critics mistakenly assume these psychiatrists personally benefit. The content of all educational programs about psy- chiatric drugs is strictly restricted to the FDA-approved product label, but critics assume that expert speakers, who are compensated for their time and effort, are promoting the drug rather than educating practitioners about the efficacy, safety, tolerability, and proper use of new medications. Part of the motive for attacking this collaboration is the tenet held by many in the antipsychiatry movement that medications are ineffective, unnecessary, or even dangerous. I wish antipsychiatrists would spend a week on an acute psychiatric unit to witness the need for and benefit from psychotropic medications for psychotic, manic, or depressed patients. Although psychiatric patients experience side effects, they are no worse than those experienced by cancer, arthritis, or diabetes patients.”
“”Part of the motive for attacking this collaboration is the tenet held by many in the antipsychiatry movement that medications are ineffective, unnecessary, or even dangerous. I wish antipsychiatrists would spend a week on an acute psychiatric unit to witness the need for and benefit from psychotropic medications for psychotic, manic, or depressed patients. Although psychiatric patients experience side effects, they are no worse than those experienced by cancer, arthritis, or diabetes patients.””
Boy, what I wish I could say in this comment as these points greatly anger me.
Once again, the side effects that people experience on psych meds are being minimized. Having an “MI” label wouldn’t have something to do with it, would it?
All sarcasm aside, it is irrelevant if the side effects I experience from a med are no worse than on other meds. If the side effects of the med are worse than the benefits, that needs attention. If that means another med, a reduction, or no med, that needs to be explored. Arrogantly telling me that it is no worse than others is wrong, wrong, wrong.
And if the medications are effective, where are the studies not supported by pharma? Show us the scientific evidence. Sorry, claiming they work based on clinical experience is anecdotal evidence and nothing more.
Henry Nasrallah has major financial links to Big Pharma. See ProPublica’s Dollars for Docs: The Top Earners. Also, many of Current Psychiatry’s other people also have similar conflicts of interest. I did a post on this earlier this year.
I have been somewhat bothered by claims by you and Jill Littrell that you believe that neuroleptics are not just major tranquillizers, but rather, drugs that specifically target psychosis, hallucinations, etc.
Given my knowledge of these drugs and others’ experience, this paragraph in Bob Whitaker’s latest post caught my attention:
In conclusion, Wunderink and his colleagues made two important points. The first was that antipsychotics could be hampering long-term functional recovery. “Antipsychotic postsynaptic blockade of the dopamine signaling system, particularly of the mesocortical and mesolimbic tracts, not only might prevent and redress psychotic derangements but also might compromise important mental functions, such as alertness, curiosity, drive, and activity levels, and aspects of executive functional capacity to some extent.”
Thus, as this paragraph suggests, though neuroleptics may seem to redress so called psychotic symptoms, they seem to do so by a seeming sledgehammer effect on all other mental functions causing those so drugged to be totally incapacitated and dysfunctional/disabled though they may meet psychiatry’s/others’ dubious standard of less symptoms with an overall drugged zombie effect. Thus, I don’t believe that these drugs target any particular areas of the brain of specific symptoms, but rather, seem to have their effect via a chemical straight jacket or lobotomy of the brain. Perhaps smaller doses of these drugs may work differently?
I’ve also noted that you’ve said many people you treat with psychotic symptoms had histories of substance abuse. Was this marijuana? Alcohol? Other drugs? Could it be more dangerous to combine psychiatric drugs with their drugs of abuse if these people are unable to refrain from their usual drug abuse?
Is it possible that such people could recover from their psychosis by abstaining from their recreational drugs for a period of time without neuroleptics? I assume you discuss that with them?
These questions are not a critique. I am very curious because I’ve read other experts who say that marijuana and other drugs can precipitate psychosis. Plus, since these drugs are illegal, one can never be sure what they are getting or if the pot is laced with other more dangerous drugs/substances, etc.
It appears you have had a great influence on Bob Whitaker just as he has influenced you.
I know that this is disputed – whether neurolpetics are only tranquilzers or whether they have some more specific effect. I am reading Joanna Moncrieff now and I think she argues that they do not impact specific symptoms. That has just not been my experience, although the impact is highly variable. There seem to be people who are midly sedated but experience dramatic reductions in voices, for example, or dramatic improvements in the clarity of their thoughts processes.
I agree that it is very important to pay attention to substance use. However, abstinences from substances does not always result in the resolution of the problem.
Joanna Moncrieff has been on the side of the survivor movement since she was an undergraduate and has stood shoulder to shoulder with survivors demonstrating outside the Royal College of Psychiatrists.
Rhetorical question. How can you have any experience to speak of unless you have experienced the so called symptoms and taken the drugs?
I am speaking based on my observations of others.
Sandra, your reasoning here implies that there would be no such thing as the placebo effect. The thing is, the placebo effect is real, very real. Especially with psych drugs. And some people have more faith in the magic powers of a pill than others — who probably end up labeled “treatment resistant”.
I am not discounting placebo effects. I am not saying these drugs are helpful to everyone. I also know that there are older studies that reported that benzodiazepines (undisputed tranquilizers) reduced psychotic symptoms as compared to placebo. There does seem to be consistent findings of a (modest) advantage for these drugs over placebo.
In any give person, however, it is impossible to know what is placebo effect and what is a drug effect.
What I am saying is that I have observed individuals who appear to experience reduced voices, improved organization of thoughts and/or reduced salience of views that do not comport with consensual reality and this improvement occured when the person was fully alert. It appears to me to be more than an effect of tranquilization.
I would be interested in the results of a study that compared a benzodiazepine to a SGA to placebo but no one is going to do that.
“In any given person, however, it is impossible to know what is placebo effect and what is a drug effect.” Exactly. I’d think that whenever you give somebody who experiences extreme states of mind any substance with especially tranquilizing properties, they may experience more of a reduction of their “symptoms” than if you give them a pill with no active substance at all, or even with something like caffeine for instance. Simply because the substance does something, and the something it does is that it slows/shuts down the higher brain functioning necessary to stay alert and keep thinking (creatively, on one’s own, as opposed to more or less indifferently engaging in parroting conventional “wisdom”). Quite a few people use alcohol and recreational drugs to calm themselves down (so-called “self-medicalization”). But we don’t refer to alcohol and recreational drugs as “antipsychotics”, do we?
Personally, I have a hard time imagining that any of the chemical substances we know would be able to read the mind of a psychiatrist and target specifically the thoughts s/he views as “symptoms”, while leaving all others intact. The only way of drug action that, if it was possible, then would make for a specific antipsychotic effect. I have a hard time imagining it, and I must say, I haven’t seen it happen yet with any of the people on “antipsychotics” I know. All I see is in fact “tranquilization”, i.e. generally slowed/shut down ability to think.
This is my comment to your comment of 7/23/13 @ 2:31 am.
I am not disagreeing with most of what you write. In any given person, I do not know what mediates change. It is my obligation to keep this in mind.
I also agree that the drugs are not entirly specific; they do not target just a particular “symptom”.
What I have observed is that they seem, for some people, to be helpful with certain problems that I named above. This is not to say they do not also have effects that were neither intended nor desired.
As noted, I would be very interested in having all drug studies include an active placebo arm, i.e., a drug that had some effect but not the intended one. For antipscyhotics, this would mean including a benzodiazepine.
As I mentioned above to Donna, I think much good can come out of
1)understanding that these drugs have highly variable effects and in the studies that have been done the effect size is small,
2) moderating dose, and
3) not assuming that everyone will require them or if they are started will need to remain on them.
So even if you and I disagree on whether they have any value, I think there is still much on which we probably agree.
Sandra, where I have the impression, upon reading this post and the comments, that we disagree is in our respective fundamental approach to the subject, and maybe even in our view of what life is all about in general. I’ve been looking at D2 receptors, GABA, and whatnot of the kind, me too in the past, and I still sometimes look at it, although my neuroscientific/psychopharmacological knowledge isn’t as profound as yours, or some of the commenters here. I must admit that right from the start I didn’t expect that looking at these things alone could give any satisfactory answers to the questions that are most important to me, and which I believe differ slightly from the questions that seem to be most important to you.
I usually tell people who come to me asking for help with their existential problems, many of whom (unfortunately) assume that they have something wrong with their brains, their D2 receptors, or their GABA, or whatnot of that kind (because they’ve heard about brain diseases and chemical imbalances somewhere in the media), that I am willing to try and help them learn how to navigate life, the painful aspects of it included, but that, in case they for some reason don’t think they can learn this, or don’t want to learn it, I unfortunately can’t help them, and they’d have to go see someone else. Now, I’m not a medical professional, and don’t have prescribing rights, so even if I believed psych drugs to be a solution, I couldn’t help people who asked for the quick fix — or, as I see it, in many cases for just another way to remain the victim in their lives, and to self-harm — and would have to send them to go and see someone else to get some. On the other hand, even if I was a medical professional with prescribing rights, I would prescribe psych drugs as much as I would recommend a bottle of whiskey (or two) daily to people in emotional distress. I’d rather go back to working as a stable manager. Honestly (although some people have this romanticized idea that it’s all about stroking and hugging horses all day, it’s hard physical work, nothing much romantic about it, believe me!). What made me arrive at such a, probably in your view rather radical, stance towards psych drugs isn’t that much knowledge about their effects on D2 receptors, GABA, and whatnot, as it is simply seeing what they do to people on an existential level, and what they, in a wider perspective, do to mankind’s self-understanding, and to the world.
So, while I agree that it is of importance that we learn about these drugs’ effects on our physiology/neurology, to me the more important question is what do they do to us in existential terms. That’s why I would like to see more qualitative research done that goes (far) beyond just asking people whether they feel helped by these drugs, or not. I’ve always been of the conviction that science without philosophy, while it may have some entertaining value, won’t get us anywhere. Especially not in a field like the mh one, which IMO primarily is a philosophical and political, not so much a scientific, one. I mean, upon Andreasen et al.’s “discovery” that neuroleptics cause brain shrinkage, we’ve seen researchers claim that maybe brain shrinkage is what’s needed to successfully treat “schizophrenia”. More quantitative research that shows these drugs to cause brain damage will hardly be able to counter that argument.
Why is it so important to force people to conform with “consensual reality?” If what they believe does not harm themselves or others why does psychiatry feel this great need to bludgeon them into consensual reality?
I know that this is not the point of your post but it always makes me wonder if controlling people is often more important than actually helping them to achieve what they truly need and not what someone else believes that they need.
These drugs may induce consensual reality but at the price of dying twenty-five years earlier, developing diabetes, huge weight gains, shrinking and atrophy of the frontal lobes of the brain, etc. I’m not so sure that the benefits actually outweigh the risks and actual results.
“What I am saying is that I have observed individuals who appear to experience reduced voices, improved organization of thoughts and/or reduced salience of views that do not comport with consensual reality and this improvement occured when the person was fully alert.“
I believe this kind of language conceals more than it reveals. To me this is so indicative of the unresolvable problem with status quo psychiatry. I do not know where to begin…I would just say this is highly problematic given the power differential in defining both the desired consensual reality and the “improvement“ toward that end, and given the (very often) non consensual meeting of the “patient“ and psychiatrist. I would also of course note that even when it is more consensual how truly consensual is it?: how much is internalized/external pressure from those around the identified “problem“ to stop being a “pain in the ass“ so to speak and get themselves to a psychiatrist pronto! I think it is very misleading to suggest that your above quoted statement occurs in the context of two consenting and equal parties…in fact that would surely be in a small minority of cases (speaking of psychiatry as a whole). In those cases perhaps the above quote would be fine and dandy and not concealing a larger wrong.
This language of “improved organization of thoughts and/or reduced salience of views that do not comport with consensual reality“ seems like the antiseptic prelude to the opening of the pandoras box that is bio psychiatry. How many horror stories occur under that anti septic rationale?
It’s often hard for me to argue about this tranquilizer thing. In high D2 blocking doses, I don’t don’t think it’s tranquilizer like benzos or alcohol. It doesn’t shut down the “anxiety axis” (amydala, etc) like they do. But it’s not specific either, it tunes down the dopamine pathways, which means it tunes down large part of higher brain areas such as frontal lobes.
Here is more evidence from the Loren Mosher web site bibliography I posted (Robert Whitaker helped compile it) that the supposed improvement in specific symptoms if really evidence of the brain damage/disabling the brain effects of these lethal drugs:
Raquel Gur, et. Al. A follow-up of magnetic resonance imaging study of schizophrenia. Archives of General Psychiatry, 55, 145-151, 1998. (Use of neuroleptics is associated with volume reduction (or atrophy) of frontal lobes and temporal lobes. As the brain atrophies in this way, here is said to be improvement in delusions and thought disorder (the brain-damaging principle at work). A greater rate of reduction in volume is associated with higher dose. At the same time, reduction in volume is associated with decline in some neurobehavioral functions.)
Al Madsen. Neuroleptics in progressive structural brain abnormalities in psychiatric illness. The Lancet, 352, 784-785. Sept. 5, 1998. (Neuroleptic use is associated with atrophy of cerebral cortex. The estimated risk of atrophy increases by 6.4% for each additional 10 grams of neuroleptic drug.)
Currently, no one is starting with haloperidol oral. New patients all start with Seroquel or Abilify or whatever. There are maybe some older people who have stabilised taking haloperidol orally. There’s no explicit need to ban haloperidol. The oral use will die quite soon. Except that haloperidol has been one of the most popular injection drugs and now there’s injections of Abilify, etc.
Just in case some of you didn’t get it, that’s why they’re making up those idiotic “scientific” statements. It’s not done from a neutral position. It’s not trying to find the “truth” or “meaning” or whatever. They just scrap whatever crap they find with their computer and create a scientific paper that satisfies what they were asked for.
I caught on right from the start! HA HA
Sandy, I was surprised to see that Dr. Joanna Moncrieff has written a new book, THE BITTEREST PILL: THE TROUBLING STORY OF ANTIPSYCHOTICS. Her lecture posted above includes a fairly long critique of these and other drugs.
Thought you might be interested at some point to add this to your pile of reading since you are reading one of her books now, which I own, if you are reading THE MYTH OF THE CHEMICAL CURE. I also have DE-MEDICALIZING MISERY by her and other authors. I think she and her colleagues in the Critical Psychiatry Network are very impressive. Looks like you could become a member.
Thanks, Donna. I also admire the UK Critical Psychiatrists and I try to follow their work. I live on the wrong side of the pond to be a member!
Let me help you…
The International Critical Psychiatry Network (ICPN)
he International Critical Psychiatry Network (ICPN) has been created by medical doctors as a forum (primarily for medical doctors) to discuss, critique, and publicise opinions, practices, literature, and events that support critical thinking and alternative approaches to psychiatry. Building on the work of the Critical Psychiatry Network (CPN) in Britain and motivated by a concern about the ‘global mental health’ movement’s approach of globalising Western models of psychiatry, the ICPN wishes to consider a greater variety of ways of thinking about psychic difference and suffering. Recognising that the current dominant models (the medical model) for thinking about psychiatric difficulties and helping sufferers are not the only ones, we hope that the ICPN can contribute toward an exchange of ideas that can promote more locally meaningful and effective practice.
Thanks. I am on their list serve.
Actually, when I said “you could be a member of the UK Critical Psychiatrists,” I meant it more as a compliment rather than literally in that you struggle with many of the same issues as they do and tend to share many of their reform and other ideas as with the Bracken paradigm shift article 1boringoldman posted, Moncrieff’s work and others.
However, I wonder if they do accept members from other countries. I don’t see why they wouldn’t/couldn’t, but I realize you probably have enough on your plate.
In my experience the atypical antipsychotics are just as neurotoxic as Haloperidol. Olanzapine and Risperdal in low doses had horrendous side effects in my son’s case. These drugs are extremely potent and disrupted all his endocrine system as well as his neurotransmitters of course.He didn’t get any placebo effect from them whatsoever. It took him over 2 years to recover from the physical effects of those drugs once he managed to get off them.
Thanks for the comments, Alix. This exchange has been interesting and helpful. I want at some point to pull all of this together to have a cogent reply to Dr. Nasrallah’s editorial. It is clear that all of these drugs have problems. One point that has been made is that it may come down to how one defines “neurotoxic” and “neuroprotective”.
RE: Neurotoxic vs Neuroprotective
Maybe psychiatry should have thought about that 50 years ago, when it first embarked on its mission – *before* so many people were hurt!
The profession *still* has nor a clue – whether it causes more harm than good. The consensus by those who have been on the receiving-side of treatment appears to be quite clear…. much more harm than good, for the overwhelming majority.
This is a response to Marion Golstein’s lastest comment.
I agree that qualitative studies are important. I also agree that science needs to be informed by philosophical concerns. I do not think I have a profound understanding of neuroscience. In fact, the more I try to understand modern neuroscience, the less I think I understand it.
I wrote about how I think neuroscience can inform our understanding of the mind in a recent post.
One of the points I tried to make is that I do not think we need to understand the brain functioning on a minute level to accept that brain functioning is important to cognition, mood, and mental experience. I also do not think that this understanding will address existential questions or resolve them. One can be curious without thinking this line of research will yield a particular treatment.
At the same time, I would like to be respectful of peoples’ experiences. If a person finds relief or benefit from a drug treatment, we should accept that. Just as we can not dismiss all benefits of drugs as due to placebo, we can not assign all delterious effects to nocebo (negative placebo effects).
We can all share in the collective humility of the limits of our knowledge about such complex topics.
Freedom of choice is the point, exactly. If people want to use the drugs and have been as informed about them as possible, then more power to them. If others decide that they do not want to pursue the drugs as an avenue of treatment then let them find other alternatives.
Unfortunately, this is not what is happening. Where I work there is only one so-called “treatment” and it’s the drugs, period. I also have very great suspicions that there is no real informed consent going on at all. The “patients” are told to take the drugs or their time in the hospital will be extended at the psychiatrist’s determination. Patients tell the psychiatrists the drugs that “work” for them and the ones that don’t and the psychiatrists totally ignore people and do exactly as they please, with the end result being that the “patient” often ends up on the drug that has terrible effects for them.
We partner with the state medical university. You can always tell when new interns are on the units because people are bouncing off the walls due to their drugs being changed at the drop of a hat. What it amounts to is experimentation without consent of the people being experimented on, which I thought was against the law as of the late 1960’s.
Yes, we need to be respectful of peoples’ experiences.
Stephen you asked above, “Why is it so important to force people to conform with “consensual reality?”
Not sharing consensual reality can make it hard to navigate in the world. Sometimes the idiosnycratic reality is scary and if someone can learn that the world -as scary as it is – may not be quite so terrifying as the person perceives it to be, then that can reduce suffering.
Consensual reality is a broad thing – look at how many views are held within this one somewhat narrow website. As I have told people many times over the years, I am not the thought police. I do not decide what is the one true reality. If people hold views that are different from mine, so be it.
It is when those views cause them pain or make it hard for them to carry on with their lives, that I think I can sometimes be of help.
No, you certainly aren’t the thought police. Thanks for answering.
You mention people “hearing voices” being helped by neuroleptics. Have you considered referring them to the “Hearing Voices Movement” to learn to cope with the voices with the harm reduction idea of trying to make peace with them that might ultimately eliminate them? From what I’ve read from those in this movement, fighting the voices or psychiatrists’ insistence they must be ignored, invalidated, drugged into submission causes more harm in the long run.
As psychiatrist Ron Lieffer pointed out, we all “hear voices,” but most of us know better than to acknowledge that out loud or speak to them publicly, etc. When I get upset or stressed, I occasionally realize I am muttering out loud and get embarrassed, knowing I need to stop it rather than call attention to myself, which I think is all too common among so called normal people. There is a saying that “if you want to talk to somebody intelligent, talk to yourself.” Actually, my father frequently said this jokingly when caught talking to himself and he was “normal.”
It’s my impression that those hearing angry, violent, critical voices are re-experiencing previous abuse, bullying, mobbing related trauma. Though I’ve had no direct experience with it, I have witnessed people in public or even neighbors having such angry conversations with themselves as if they are talking back to an angry, critical person. There have been some great posts by and about the Hearing Voices Movement and its members/experts.
Sandra, there’s one issue, related to what Stephen writes below, all of which I completely agree with, I would take with your comment above. If we are to be that respectful of people’s experiences, wouldn’t we then also have to respect it if someone chose alcohol, or recreational drugs above psych drugs? And why aren’t we, usually? Why do we even apply dual diagnosis, and double-up the psych drug ”treatment”, instead of saying, “Oh wonderful! This person has found a way to treat their problem all on their own”?
Your excellent point was/is driven home by the famous, noble Dr. Loren Mosher’s resignation letter in disgust from the APA whereby he cited theirs and society’s abject hypocrisy and “Marxist” approach to psychiatric drugs versus recreational or street drugs. The former drugs are good drugs from which the BIG PHARMA/psychiatry mob cartel can make a profit while the latter drugs are bad because they can’t profit from them or pretend they are medicine.
I was shocked to find out that the alcohol industry is the major proponent of demonizing so called alcoholics because it promotes the pretense that their deadly product only becomes problematic with this small number of horrible alcoholics who need treatment, etc. and are demonized by one and all. The truth is the liberal flow of alcohol anywhere creates massive problems for many people and society in general that the industry wants to cover up just like BIG PHARMA, the tobacco industry, the junk food industry and others wish to cover up the harm of their products by scapegoating certain drugs, people, etc.
I am not sure who the “we” is here. It seems that you are making assumptions about my practice that is not warranted.
Sandra, “we” as in “we as a society”.
OK. I understand. I like the component of Joanna Moncrieff’s notion of a drug centtered approach. All of these substances impact cognition, mood, beahvior. Most of them have at least some potential for benefit and harm. These potentials probably vary among individuals. We want to empower indivduals to make the best decision for themselves.
I share your skepticism about the concept of dual diagnosis. Given how shaky diagnosis is, to add mutiple labels seems especially treacherous.
To put things in proper perspective, doctors and the Bible in the past have recommended alcohol and/or wine for the suffering though they also warn against those imbibing too much alcohol and similar drugs or “medicines.” For that matter, doctors used to do ads recommending the healthiest cigarettes!
Gary Greenberg, who recently wrote The Book of Woe: The DSM and the Unmaking of Psychiatry, also wrote an interesting book called The Noble Lie about five years ago. Like others, he points out that our society having been influenced by a Protestant work ethic won’t tolerate people using drugs for escape or recreation. Thus, for Big Pharma and the medical profession to promote their drugs, they need to also promote diseases that their “medicines” are able to cure for society to accept their use. There have been many books written about disease mongering in recent times comparable to the snake oil sales men of the past. I’m not sure everyone thinks that way, but just like so called “mental illness” promoted as a brain disease has greatly increased stigma and vilification, so has promoting alcohol and other drug use for recreation or self medicating as a disease in the DSM caused increased stigma and demonizing of the addicted for those abusing substances. There was good reason for the folk wisdom of the past: “It’s enough to drive you to drink,” which biopsychiatry had done all in their power to hide and deny by refusing to acknowledge context and social/environmental stressors while blaming the victims for others’ abuse, exploitation, oppression and evil. Dr. Gabor Mate’s highly acclaimed book, In the Realm of the Hungry Ghosts and other works, demonstrate that “capitalism is making us crazy” and the marginalized living in poverty with whom he works have plenty of reason to want their drugs since all of us are addicted in one way or another in such an environment.
The book, The Noble Lie, is quite interesting and amusing at times like most of Greenberg’s writing. One of the chapters involves his contact with the Unibomber and his take on him. He also covers how so called alcoholism was made into a disease by an advertising expert, his participation in a “depression” study with questionable methods and results and other so called “noble lies.”
It’s not very logical, is it?
That’s how I feel also.
To clarify – your comment on recreational drugs, alcohol and the similarity with “treatment.”
This Nasrallah guy is clearly very angry towards haloperidol! When I googled for “haloperidol neurotoxicity”, the second result was a letter from Nasrallah: Does the Neurotoxicity of Haloperidol Explain the Higher Mortality in Dementia Patients Compared With the Second Generation Agents?
He had found a study where dementia patients in haloperidol group had higher mortality than in those who got an “atypical”. He says the original article didn’t consider the possible reasons for the higher mortality risk with haloperidol. Then he again says studies indicate atypicals are neuroprotective and haloperidol and perphenazine are neurotoxic. And suggests that haloperidol neurotoxicity caused those deaths in dementia patients.
He didn’t mention for instance:
“Haloperidol users were significantly older and sicker (as evidenced by the highest Charlson comorbidity index scores, highest rates of concurrent delirium, and more inpatient days in the preceding year) than users of the other study medications. A higher percentage of African American patients were treated with haloperidol compared with the other agents. Those taking haloperidol were also significantly more likely to have used opioids or benzodiazepines and less likely to have used antidepressants during the year preceding the new antipsychotic start.”
To me these seem much more plausible factors than haloperidol neurotoxicity somehow killing the patients.
Not to mention that there is a Black Box warning on the atypicals that it can cause early death in elderly dementia patients. So he’s mad at Haldol because it kills patients more quickly than the atypicals kill them? I suppose you wouldn’t get as much profit if they died sooner…
I always appreciate your wise, informed comments on any post because they resonate with the voice of much experience, wisdom, ethics and compassion! You’ve done much to help validate my reality on abuse related trauma being stigmatized as bipolar and other nasty things you’ve observed as well as pointing out other injustices in the mental health system.
Thought it was time I let you know that in case I haven’t in the past.
Thanks, Donna! I always enjoy your replies as well, factual with a good dose of passion and personal experience. I consider your stamp of approval to be a very high compliment, as I know you wouldn’t hesitate to tell me if I had my head in a dark and smelly place!
Ahahaha.. I found a reply from the authors of the original study:
“To the Editor: As Dr. Nasrallah notes, our data provide confirmation of the higher mortality associated with haloperidol when compared with atypical antipsychotics in patients with dementia (1). The main finding and unique contribution of our paper, however, is that there are mortality risk differences between atypical antipsychotics, with risperidone and olanzapine having higher mortality rates than quetiapine. Since the publication of our article, our findings of differential mortality among individual antipsychotics have been confirmed in another sample (2).
Dr. Nasrallah also brings his pilot study (3) to our attention. This retrospective study at a single center reported higher rates of 2-year mortality for patients taking haloperidol in comparison with those taking atypical antipsychotics. However, as noted in a letter to the editor regarding that paper (4), the study did not control for the known selection biases that occur in patients treated with haloperidol compared with atypical antipsychotics. Haloperidol tends to be prescribed for patients older and sicker than those treated with atypical antipsychotics (5). In our study, we analyzed a wide array of potential confounding factors in addition to using propensity methods to control for potential treatment-by-indication bias. In doing so, we observed the mortality action of haloperidol occurring within the first 30 days of treatment. Therefore, it is unclear that one could conclude that neurotoxicity is the mechanism of mortality risk.
In light of our data, the evidence from randomized controlled trials, and a number of retrospective database studies, we find no support for the idea that atypical antipsychotics are neuroprotective in patients with dementia. Randomized trials have shown atypical antipsychotics to have 1%–2% higher risk than placebo over 10- to 12-week study periods (6). Over the longer 6-month follow-up in our cohort, olanzapine and risperidone showed mortality rates of approximately 27 deaths per 100 person-years of treatment compared with 18.6–21 deaths per 100 person-years with quetiapine and valproic acid. In addition, we previously showed (7) that the absolute mortality risk over 12 months in patients taking atypical antipsychotics was 4.8% higher than in those not taking medication, which corresponds to a number needed to harm of 20.8. Therefore, if atypical antipsychotics are to be prescribed, then they should be used in conjunction with a risk-benefit approach taking into account the efficacy and safety evidence base for the agents under consideration.”
Isn’t he even ashamed that he’s taking credibility away from more serious researchers?
And again, I have to point out that these people are dispassionately talking about killing people, and arguing more about the mechanism than about whether they ought to just stop doing it. How do you do a risk/benefit analysis when 1/20 of your patients will die earlier as a result of your “treatment?” It seems very unlikely that the patient is conferred any benefit, unless they are already terminal and you’re providing palliative care. But anybody that considers an atypical antipsychotic as “palliative care” is delusional.
It disgusts me that these people can be so cold about the fact that they’re ending people’s lives prematurely!
That pretty well says it, alright.
It is what it is.
Here’s a recent video where Nasrallah claims with recurrent episodes of psychosis the patient goes all the time to a worser state. He stresses that patients should be kept on neuroleptics so that the second episode doesn’t occur. He says fortunately there are ways to prevent the relapse. He then tells how some patients in South Africa were given injections for two years. When they were switched to oral by another doctor, one in seven patients relapsed and never recovered.
Another obvious push from this guy for new injections. Everything I read and see from this guy is ridiculous. Maybe I should stop and start packing for my hiking trip.
At least in this case he’s more direct, instead of plain obvious, of what he’s trying to do:
“Dr. Nasrallah says that he advocates for depot injections to combat nonadherence to medications and repeated psychotic relapses, which may lead to a worse outcome.
Studies of FGA depots, although they show less relapses, do not show the improved functioning over time that SGA medications do. But, this may be due to the fact that studies using FGA depot injections are often done with patients who have already suffered repeated relapses and have a more severe illness course. Also, there is always the fear that the patients may get tardive dyskinesia from the FGA.
SGA depot injections, on the other hand, may show that they will both prevent relapse and improve function over time. That has been his experience with his patients.”
“Has psychiatrist Henry Nasrallah accurately reported his pharma income to the University of Cincinnati?”
I highly recommend Dr. Loren Mosher’s web site to show how these issues surrounding the bogus biomedical psychiatric paradigm have been going on all too long. Here is one of many bibliographies debunking the junk science brain disease or inherited VOTED IN DSM stigmas invented to push BIG PHARMA’s lethal drugs on those consequently rendered voiceless, stigmatized, ostracized, powerless, marginalized, unemployed, poverty-stricken by this evil paradigm that was not the case before those at the top of the food chain of the APA sold out to BIG PHARMA to create this massive human holocaust for greed, power and profit.
As many know, Dr. Mosher created the original non-drug paradigm he called Soteria for so called schizophrenia and he exposes the fraud that so called mental illness is a brain disease when real EVIDENCE shows that such emotional distress is caused by social/environmental stressors, abuse, toxic relationships, etc. Now that more and more people are catching on to the harm of the biomedical paradigm thanks to those like Robert Whitaker and many others, there is a greatly renewed interest in Dr. Mosher’s work and similar person/context centered approaches.
I don’t know if most people know this, but Robert Whitaker and Dr. Loren Mosher had a very close relationship with regard to the mental health system per the posts below:
Here is evidence that bipolar disorder has replaced schizophrenia as biopsychiatry’s new bogus “sacred symbol,” a term used by Dr. Thomas Szasz meaning such bogus stigmas justified psychiatry’s existence and pretense as a biomedical endeavor to push their lethal drugs and other tortures for huge BIG PHARMA/PSYCHIATRY profits:
“Just how flimsy are psychiatric diagnoses?
For an illustration of the “incredible shrinking validity” of psychiatric diagnoses, note that nowadays the diagnostic label “Bipolar Disorder” or “Manic-Depressive Illness” is gaining in popularity for the same constellation of symptoms that used to garner the label “Schizophrenia.” Many mental hospitals are now admitting mostly “Bipolar” patients. The problems haven’t changed; these are mostly the same people who would have been diagnosed with “Schizophrenia” a decade or two ago.
Bipolar Disorder has now even been popularized for very young children who are being put on powerful, dangerous neuroleptics. This incredibly lucrative, diagnostic fad was popularized by a leading psychiatrist who was hiding massive drug company payments in violation of research rules.
The incredible flimsiness of psychiatric diagnoses is demonstrated in the video, “Being Sane in Insane Places.” On the same page, you will find a 2008 PBS Frontline program on drugging children. And you can also take a look at the New York Times articles exposing the unethical behavior of the creator of the childhood bipolar fad.
Dr. Loren Mosher, Bob Whitaker and Dr. Dan Kriegman discuss the huge harm of the biopsychiatry paradigm below:
I remember seeing the video of these three several years ago.
Bob Whitaker was very emotional, as he described the historic injury and death that has taken place since neuroleptics were unleashed.
The formula goes like this:
25 years off each life x millions of people = historic rates of injury and death.
You must be familiar with Dr. Loren Mosher? He’s right up there with Dr. Peter Breggin and others who fought for the truth about biopsychiatry described on Dr. Mosher’s web site, the yoism web site and many others. Unfortunately, Dr. Mosher suffered greatly during his life time by being marginalized when the APA and NIMH sold out to BIG PHARMA, but like Dr. Breggin, he has been more than validated about the superiority of his non-drug Soteria paradigm for emotional distress. Amazing how so many including this web site, yoism, and Dr. Joanna Moncrieff still cite Dr. Peter Breggin though attempts have been made to marginalize him too via BIG PHARMA money. I was appalled to find out that NAMI tried to have his medical license taken away when he exposed the truth about the biopsychiatry paradigm on Oprah! So much for consensus reality!!
I was just reviewing many of the videos and articles on the yoism web site above about the dangers of biopsychiatry that are pretty up to date and equally true now and it’s quite amazing and complete in its excellent debunking of its biomythology or biobabble, terms coined by Dr. David Healy who needs to examine his own tendencies in these areas regarding ECT while doing a great job exposing the dangers of biopsychiatry’s bipolar mania/babble and toxic psych drugs.
Nice to have an old timer like you on board who recognizes that the truth has been out there for decades, but the psychiatry/BIG PHARMA/corrupt government hacks industrial cartel made sure such truth was suppressed for their own greed, power and fascism.
Yes, I’m familiar with Dr. Loren Mosher and his work with Soteria.
I agree that Dr. David Healy is right when it comes to psychiatric drugs, but *wrong* when it comes to ECT, and I appreciate your pointing it out to others – here, and elsewhere.
I am truly sorry for the exchange that took place a while back, and I hope you will accept my apologies. I hope we can move forward. It’s good to read your comments again, as always.
Thank your for your sharing as a fellow old timer who shares a history with me in the days of Dr. Breggin, Dr. Mosher and many others. Dr. Breggin will always be my hero as I’ve said constantly because his life saving information helped me save loved ones from having their lives destroyed by the bipolar fad fraud due to abuse related trauma.
I also appreciate your kind words and outreach to me. I felt really bad about our misunderstanding since we both share a Catholic background. I think people got offended/confused because Seth and I were talking about how certain religious ideas were perverted by Freud and others that led to the idea that EVERYBODY is mentally ill that carried over into biopsychiatry. Seth is very well informed about the history of psychiatry and psychology based on his own early background in psychoanalysis and is a well known author and expert who has done tons of research on the topic. So, I must say I’ve learned a lot from him about psychosis, R. D. Laing, Freud and other topics about which I had no knowledge or experience. We all have our own specific ordeals that brought us to MIA, but I like to try to understand and empathize with those of all people posting here though I have not experienced or suffered from them myself. We all have our crosses to bear.
Anyway, since we are two unique human beings and two different sexes with our own life experiences and histories, we can’t expect to agree on everything, but we do agree on a lot!!
I’m very glad you’re here too. Sometimes I take a break because I’m spending too much time on MIA and need to do other things. Other times I need a cooling off period when I find I have been triggered by my own past stressors. But, whether I comment or not, I always read MIA daily and enjoy reading the posts and everyone else’s comments.
I always enjoy your passion about constitutional and human rights and like you say there are some things that are black and white or simple that should not be compromised.
Thanks again for your kind words.
Glad you’re here, Donna.
Re: The Use of Force
When it comes to the use of force, it is *not* about consensual reality; whether the drugs “work” or don’t work; whether it’s the humane thing to do, etc…. It’s not about *any* of those things!
Nor is it about whether NAMI is behind the use of force or whether a boatload of police chiefs think it’s the next best thing since sliced bread.
It’s about the constitution.
If a family member or doctor or do-gooder thinks their daughter Susie or crazy uncle in the attic, Joe is in need of “treatment…. and Susie or Joe disagree, then the only way to force either to undergo such a barbaric ordeal is to have a trial. And to *prove* they are a danger. Prove it in a court of law!
It’s not up for a floor vote the APA; a referendum on a state ballot; a political decision by NAMI leadership.
It’s called the constitution.
We need to follow it.
Why is this so hard for doctors to understand?!
It’s really simple, docs… it goes like this:
You don’t get to decide that someone is in need of your help, if they don’t want your help, especially when the best you have to offer are toxic, neuroleptic drugs; and/or lock-up in a day room with strangers, watching Jerry Springer re-runs.
How freakin’ therapeutic!
typo – ‘consensus’ reality
Duane, I think even a trial proving someone is dangerous, would not be enough for that person to forfeit their right to own their own never-proven-diseased brain. Dangerous people have been contained by societies worldwide without resorting to forced drugging for hundreds of years until quackery based psychiatry came along.
That government is giving any psychiatrist the power to forcibly enter the brains of citizens, is a disgusting practice that needs to be abolished. For if drugging brains to control people is a bona fide ‘medical procedure’, maybe we should start prosecuting date rapists who slip drugs into womens’ drinks with practicing medicine without a license! that’s how ridiculous the pretense that forced neurotoxic brain disabling major tranquilizer drugging as bona fide medical procedure is.
Courts should be deciding which dangerous criminals go behind bars, not whether their own brain becomes state property to be drugged at will by the false authority of shrinks. The perpetrators of forced drugging are in denial of the vast human rights atrocities they have perpetrated because if they ever let the floodgates of truth open, they’d probably wind up in the looney bin themselves.
See the recent documentary ‘The act of killing’ about people in Indonesia who rationalize their violence against others.
A short video about this documentary, above. I try daily to figure out why forced drugging perpetrating psychiatrists are able to sleep at night. I think we can learn a lot from perpetrators of other human rights abuses and how they rationalize what they do away as being ‘necessary’.
“While I am aware of research suggesting that clozapine and perhaps olanzapine have neuroprotective qualities…”
Olanzapine withdrawal gave me a frightening psychosis from hell I never ever had before taking it. It was given to me for insomnia.
Neuroprotective ? I disagree.
Can you report this on Rxisk.org. This is important.
“People on this site wonder how psychiatrists learn new information and what influences their thinking.”
Sandy, some of us read everything you write on this website and then do our best to apply it to our practices.
If you are for real, thanks.
If you are pranking me, at least you have made my mother happy.
Sandy, you are most welcome. I practice psychiatry in a community hospital where I have the opportunity to teach medical students. Sometimes I give them articles by Andreasson and Harrow and others that I first encountered on this site.
I am honored to have you as a colleague.
I went through some of those neuroscience papers about haloperidol. It is true that there may be some techniques that haloperidol can cause some forms of neuronal damage or changes in ways I hadn’t heard of. For instance, haloperidol seems to also act on sigma2 receptor which may cause some kind of cell death. http://www.nature.com/tpj/journal/v6/n4/full/6500373a.html Another thing is that haloperidol may metabolize to neurotoxic pyridium metabolites. I don’t know further what type of damage they may do. I don’t know, for instance, which other neuroleptic drugs also bind to sigma2 or metabolise to pyridium. But in any case, it’s possible that haloperidol has these, ehm, possibly additional mechanisms of causing damage.
Note that these mechanisms may be additional to another types of damage or shrinkage. For instance, if the D2 antagonism causes the brain shrinkage via some unknown mechanism, then it’s potentially shared by all neuroleptics, depending on how much D2 antagonism you get. Or maybe they have other common ways to cause damage. As you know, in the monkey study both haloperidol and olanzapine (Zyprexa) groups got severe 8-11% reduction in brain mass in all major brain regions and most robust in frontal lobes and parietal lobes. http://www.ncbi.nlm.nih.gov/pubmed/15756305
I haven’t really gone through the references about the claims of atypical being neuroprotective, but many of them were of the type that they had seen increase of growth factor BDNF in some part of brain with some drug, etc. It’s hard to say what these mean in practice. They didn’t help the brains of those monkeys on olanzapine. Or maybe helped some particular part of the brain. Or not. But the thing about these claims is that when the general psychiatrist reads it, he gets the picture that haloperidol is very toxic and atypicals are the opposite, they’re actually neuroprotective. There are many different and often speculated mechanisms at play.
OK. I hope you get something out of that.
I do, Hermes. thanks for al of your research this week. I have not had time to get to it but that is my intention. What I will be looking for is whether the SGA’s were given the saem serious scrutiny as haloperidol. That is what one would expect. We would want to compare the drugs in head to head compariosns – with doses equivalents that mirror clinical use – in order to make claims about cmparative damage.
Yeah, I will still be looking at the 5HT thing when I get back from hiking. Earlier last year one person (Ed) brought about studies which said that the 5HT effect of SGAs increased the number of dopamine receptors in high-affinity state, and therefore it perhaps counteracted the dopamine antagonism effect of the same drug. In a way, some molecules of the drug would go to dopamine receptors and block them, while at the same time other molecules go to to 5HT which may cause effects which reverse some of the D2 antagonism. They said this may make SGAs less effective in treating psychosis and were thinking of a new drug which would prevent this effect of 5HT . .
They’re pulling these studies about haloperidol and at least implicitly say that this is true for all FGAs. In CATIE they took perphenazine and talked of it as if it represents all FGAs.
BTW, do you have any sense how in practice psychiatrists find the dose in clinical setting? Do they follow the official recommendations for doses, do they increase/decrease dose until they get a result they’re satisfied with, etc? I guess it’s a mix of these. They have the target doses and then test increasing/decreasing the dose, adding new drugs, etc.
For instance, some say that to reach an equivalent response for psychosis the drugs should be given in a dose where they roughly antagonise D2 in the same receptor occupancy. On the other hand, I don’t think it’s impossible that if someone gets lots of H1 sedation, adrenergic effects, etc, from quetiapine, he can cope with less of D2 antagonism.
In any case, it’s possible that for instance Abilify may cause less of some type of damage than “equivalent” (low enough but working) dose of haloperidol. I don’t know. In my opinion, from patient’s point of view more sinister thing is that these people are driving for increased use of injections which in many cases can be seen as increased coercion.
And note that I had never heard about haloperidol causing some kind of apoptosis through sigma2, and another idea is that it will metabolise to a toxic metabolite. I do not have any idea if these ideas are valid or crap or not practically applicable. It would take even more time from me and also most psychiatrists to determine this. Then there are all of those other studies. Nasrallah is not making any single argument, molecular mechanism, etc, about why haloperidol is neurotoxic and why “atypicals” fix this. He just throws at your face a huge number of papers which in different ways find adverse effect in haloperidol and via Nandra a bunch of papers which find beneficial effects of SGAs. One study finds SGAs increase BDNF in one part of brain, one finds that haloperidol metabolises to a toxic molecule, etc. These may not have anything to do with each other. It seems a mess and a smoke screen. But I’ll still go through what they claim in that Nandra paper about the beneficial effects of SGAs.
I earlier posted a YouTube link about Nasrallah’s talk published April 2013. http://www.youtube.com/watch?v=zn6BRne7AIk Listen with a clear mind the talk to the end. He who has ears, let him hear.
Nasrallah: Newer Atypical Antipsychotics Draw Praise (2010)
“It has placebo-level metabolic effects,” said Dr. Nasrallah, professor of psychiatry and neuroscience at the University of Cincinnati. “The metabolic profile is better than for Geodon [ziprasidone] or Abilify [aripiprazole], which are currently accepted as the least metabolically adverse atypical antipsychotics.”
I don’t see if this guy is anything more than a pharma-marketing goon.
And if he’s not that, he’s a new Torrey. Or maybe he’s both.
What I see you doing here, is using the idea that someone’s inability to “comport with consensual reality” as an excuse to not see that medications which are neurotoxins, that interfere with normal healthy brain functions; that stop dopamine from doing it’s natural function, that take years off of a person’s life, that cause tardive dyskenisia, that are highly addictive and cost not only much more than talk therapy but because they are addictive, this “therapy” is spread out over a long period of time, costing more and effecting the whole economic flow in “mental health” and what kind of “Treatment” is available – that you are using a scientific sounding statement about salience that comports or doesn’t comport with consensual reality to promote fear against a response that’s not only possible misunderstood but in general suppressed.
And to me to say someone has an inability to comport with consensual reality, and then say this causes them pain and suffering, and then keep it in the bag to subscribe “medications” that were already advertised so dishonesty that there have been billions of dollars of fines the drug companies have had to pay; to me this might add up as paranoia against someone simply expressing trauma, that this doesn’t remove them from “consensual reality,” but puts them in a reality (which at first might seem “non-consensual” but actually is more consensual at a level that doesn’t need to be acknowledged), that’s not based on disabling the brain, rather than being scared of their response, which seems to undermine the safer reality where they couldn’t express or acknowledge or let go of their trauma. The clinical use of words such as “lack of salience with consensual reality:” What’s the difference between that and the sociological terms used to portray poverty, minority status, etc.. That’s also inability to comply with statistical based norms. That’s also only a few steps from saying that there’s some malignant genetic component because of inability to “adapt” to statistical based norms. The problem REALLY may not be in supporting the idea that a person is in pain and suffering because they can’t “adapt,” but helping them to see that what is making them think they can’t adapt, when understood, would help them to adapt to a different “consensual reality” which is where they are meant to be, which doesn’t require interfering with natural brain functions, and which will make them truly happy in a way they don’t have to see beforehand to facilitate.
You also have to understand that you are asking people who have been through increased trauma in their life, and have had to deal with the whole intimidation that they are supposed to be on these “medications,” or are supposed to believe that others are supposed to be on these medications (and be told or are made to be aware that they are sticking out of the crowd if they have different beliefs, or that “their salience doesn’t comport with consensual reality”). Those the worst off have to deal with all of that instead of receiving the kind of emotional support which they weren’t given and had to search for someplace else (often while dealing with the added complication of having to get off of these “medications” while trying to find such support). You are asking these people to supply you with information links about said “medications,” when perhaps they already have more than enough to deal with. We don’t have the superhuman abilities to split into three or four different entities traversing linear time which all have 24 hours available to them, so that this is multiplied by four: one that looks for needed emotional support; one that does the therapy which wasn’t given; one which tends to basic needs as in money, food, clothing and “the pursuit of happiness”; and one that does this research into deciphering quite extensive propaganda and contorted ideology that tries to sound like science taking on it’s form but not it’s content. I’m quite amazed and humbled by the articulate ability of the people on this site to supply such very needed information, and maze through piles of confusing misleading statements excusing ideology and excusing excuses rather than being reality based.
It might be enough to simply know that they (these “medications”) are interfering with natural organic functions of the very sensitive human organism known as the brain, are known to disrupt said organism and cause chemical imbalance but aren’t known to address any chemical imbalance; are highly addictive; have a known list of horrible side effects, aren’t really acknowledged as the neurotoxins and brain altering substances that they are; are not a class of drugs that society in general supplies rehab centers and/or such information for and about, although this clearly effects all of society as much or even more than street drugs; have been falsely advertised and caused more than significant damage which would further think someone would be dissuaded from implementing their usage further. Etc. etc.
Have you truly thought about how much you are asking? Have you thought about how this can overload a person’s mind – those who have had to at an experiential level had to deal with all of this, rather than an “observer” – into becoming psychotic, just to try to attend to such questions and the litany behind it?
I myself am truly amazed, heartened and humbled by the ability, – despite ALL they have been through, – of the people on this site to attend to such often redundant fear based questions! And the patience they have! And the courage they show against being seen to stick out too much, or as has been expressed differently: lack salience in their consensual comportment.
Thank you for your comments.
I am not requiring anyone to supply me with information. I just was asking if any readers had some information or perspectives they wanted to share. I did not intent to stress anyone. If anything, my query was a reflection of my respect for this audience.
Sandy offered (as I understood it) that the reflections of all of us who have experienced the mind states that psychiatric drugs and the psychiatrists who prescribe them are intended to address, and the reflections of all of us who have actually taken these drugs, ought to be respected. This should not be controversial. We all have a lot at stake and a lot invested in decisions we’ve made, will make and have allowed others to make for us, and in opinions we’ve formed, will form and will allow others to form for us. What should unite people with first hand experience on this site in my view — whether we call ourselve patients and/or survivors and/or anything else. is not a common prescription to cure (or euthanize) psychiatry. but a common objective to reduce harm and increase healing for ourselves and for others who might learn from our wisdom and experience. The venom I have observed here that is brutally applied by some to anyone who even so much as a hints toward endorsement of the view that a drug has helped someome — even themselves! — is just disproportionate and wrong. I and others here who may believe that drugs have helped them and might in the future help them in some measure know too what it has meant to look back at the rubble that had been our lives and our minds in agony and anger, to want answers and heads to roll. But we all have a right to our own questions, to speak for ourselves, to not be judged or disparaged or infantilized, and to take and leave what we will from the answers that are offered. No one has a monopoly on knowledge or on pain or relevance or integrity in this tragic and complicated business. I believe that , for me, the grave risk of not taking certain drugs must be weighed against their grave costs, for a variety of reasons that I’ve determined are sound to me. And so I value highly Sandy”s appropriately dispassionate assessment of those risks.
Thanks for these comments. They are important and so articulate that I hesitate to add anything.
What psychiatrists label “psychosis” is in my opinion so highly variable and still so poorly understood that it is hard for me to make any blanket statements about how to help.
Respectig that variability seems hugely important to me.
You write about those who
“may believe that drugs have helped them and might in the future help them in some measure know too what it has meant to look back at the rubble that had been our lives and our minds in agony and anger, to want answers”
Thank you for sharing this perspective.
People should be allowed, after careful and real informed consent, to choose the treatment that they feel will benefit them the most. If this be the drugs then so be it and if something else, then so be it.
However, this is not what I observe happening on a daily basis in my place of employment. It is the drugs and only the drugs, no matter what the so-called “patient” states is helpful and harmful to them. The “patients” have no say so at all in the creation of their so-called “treatment plan,” which itself is nothing more than a promotion of the usual, the drugs. And, on top of everything else, very little informed consent is going on at all.
This is what angers me and prompts me to speak out. I choose not to use the drugs but I will support anyone who choses to use them. And I will also support anything else that someone states is helpful to them, no matter what I think about it. It is not for me to choose the form of treatment for anyone else. I also believe that it’s important to allow people to do with as they please what they want concerning their “voices,” whether that be to squash them or to carry on an on-going collaboration with them. It should be their choice, not the choice of some psychiatrist who paternalistically decides that they know what’s best for the so-called “patient.” They bombastically state in morning report that it’s not “theraputic” to respond to a person’s voices, that you’re only buying into their delusions. When asked if they’ve consulted patients as to whether it’s theraputic or not to deal with the voices they give you angry looks and fume and spout once again that it’s not theraputic! The psychiatrists decide what’s theraputic or not without ever once consulting with the so-called “patient.”
And if a person wants to believe that they need to meet aliens, or that the moon is made of cheese, or that they are God, then who am I to tell them that this is not true and that they won’t get out of the hospital until they get into consensual reality? As long as their so-called “delusion” doesn’t hurt them or others, why must I feel the huge need to force them to think and feel otherwise? If the delusion is difficult then why don’t we teach them some useful things to use in dealing with the delusions? James Brown beleived that the FBI watches people through the internet. This is a obviously a delusion, I hope, but did he end up in “treatment?” No, because he dealt with his “delusion” by never getting on the internet. Whose need is being met here when we’re determined to force people into our reality?
These are the things that anger me and force me to speak out. I see this being done to people on a daily basis, 24/7, and it’s all done under the guise of “good treatment!” Where is the choice that everyone speaks about as being so very important?
You have just proven a point I have made on Early’s blog that this isn’t about people in psychosis being unable to make a fully informed choice. The issue is that that anyone with an “MI” label is treated as falsely incapable of making one and should be deal with as a child and accept the treatment of a psychiatrist without question.
Regarding so called delusions,I know I am not remembering this exactly right but didn’t someone with an “MI” label ask her psychiatrist why it was ok for him to speak to god who was someone she couldn’t see while her delusion wasn’t acceptable? You’re right, if it isn’t hurting anything, who I am I to say otherwise?
You essentially got it right!
People can be given tools and ways of dealing with their “delusions” without drugging them, even in small amounts.
If someone wants to wear aluminum foil on their head to keep the rays from the television and radio from beaming “bad thoughts” into their heads, then why shouldn’t they be allowed to wear the aluminum foil? Who cares what they have on their heads? And if other people get upset that someone has aluminum foil on their heads whose problem is that? In the hospital where I work I’ve seen “patients” wear what could be called “strange” hats to keep the bad thoughts away. You’d be amazed at how many staff want them to quit wearing the “strange” hats because doing so proves that they are “delusional.” Who cares how strange the things are that people want to wear on their heads, as long as it helps them deal with their issue? Whose problem is it?
I ride the city bus since I don’t have a car and don’t drive. There’s a woman who dresses up in various costumes and rides the bus every day. I find her to be quite interesting and I always look forward to see the day’s costume but you’d be amazed at the number of people who think that she shouldn’t be doing what she’s doing. Who cares and whose problem is it? She’s decently dressed and covered, although she might look like Uncle Sam one day and the Statue of Liberty the next. She’s not hurting a thing and is not bothering anyone. If you don’t like seeing her costume then don’t look at her; it’s your choice about what you want to look at and what you’re going to be bent out of shape over. It’s not her problem that you don’t approve of her “dressing up.”
I just don’t buy into this idea that everyone needs to be in so-called “consensual reality.” Look where that got us in Iraq with the so-called “weapons of mass destruction.” Who was “delusional” but in consensual reality there? Why do we need to be in lock-step about everything; why must we all march to the beat of the same drummer? Consensual reality is just another attempt to narrow the human experience down to what one little particular group thinks should be the “acceptable reality” for the entire world. Excuse me for ranting and raving!
The issue of coercion is a very serious one; no issue is more serious in my view. If there exists insufficient scientific support for the safety and/or efficacy of a drug for a particular use — e.g. indefinite prescription of antipsychotics for “maintenance” therapy, or, worse, scientific proof that the use is unsafe and ineffective, then, yes, it is outrageous for that drug to be forced upon patients for that use. And, yes, there are also very real forms of coercion that fall short of physical force. As for the safety and efficacy of short term use of antipsychotics, I’m ambivalent given my sense that the positive conclusions I’ve drawn about my own personal experience must be weighed against some of the admittedly compelling evidence that has been presented on this site and elsewhere that is to the contrary. I’m weighing the evidence.
But I think what’s missing in this discussion is appreciation of what I believe is the fact that there are also legitimate reasons for a person to receive informed advice by a healthcare provider in favor of short term antipsychotic treatment or even long term antipsychotic treatment. This even if it’s true (and it’s debatable) that all the drug is doing is tranquilizing the patient, and this even if the patient doesn’t believe that the psychological experiences they’re having (short term) and the risk of them recurring (long term) are problematic.
The easy case is where a person — and this is not uncommon — paranoically believes that they are being persecuted by the government or other clandestine forces and operates in the world in accordance with those beliefs. After 9-11, at least, that person is at risk of being forcibly detained or worse by authorities seeking out criminal and/or terrorist activity. There is clear risk of harm to the person that cannot be questioned, in my view.
A tougher case is when a person acting out their unconventional beliefs about their psychological experiences is truly not physically or otherwise harming themselves or others in a concrete way. Here a different form of coercion is at work that arguably favors treatment with antipsychotics, in the short and perhaps even the long term. Here, yes, there does in fact exist a “consensual reality” that, even if not willingly embraced (and I do not believe that the vast majority of us who do embrace it should be judged), is itself coerced. That very real coercion, if an individual views it as such, may not be undone, regardless of whether a person ingests a drug or not. What this means is that somebody who doesn’t have a problem with hearing voices about innocuous things might not have the insight to know that these things might prevent them from being able to get a job and afford to support a family in the “consensual reality” to which we are all subject. Or, at least, the vast majority of us who depend upon people in this reality with power over our lives to provide us with the resources needed to live. James Brown didn’t need to worry about the conflict between his beliefs and “consensual reality” because being unconventional was part, indeed the very hallmark, of his job prescription. Wealthy or financially secure (retired or not) people also don’t need to worry about it because they don’t need others in the mainstream to opt in in order to be able to support themselves and their families. If that person hearing voices finds those voices so compelling that they don’t care that people with power over their lives will serve as an obstacle towards their being able to earn a living (arguably there are other needs that are more diffciultly met — successful social interaction with family and others, for instance — but lets stay with an uncontroversial one), then it is reasonable for that person to be advised by a healthcare professional that it may be important for something to be done to return them to the mainstream “consensus”. Likewise, in order to function in the mainstream — something that is necessary for most of us in able to subsist even if one doesn’t otherwise care about obtaining financial security for self and family — one must be free of the stress that our flawed society imposes upon us. The incompatibility of these psychological experiences with consensual reality — a reality that exists even to the extent it can be questioned — creates stress that makes it even more difficult than it already is to achieve subsistence or more. These are among the many things that any healthcare provider, including a psychiatrist, must weigh in advising a patient of their treatment options. One option is an unfortunate one given the scientifically evident problems with the drug (and any other objections), but it can help stop the psychological experiences, at least (and, indeed, perhaps only) in the short term.
Now if folks here believe that people hearing voices and perceiving things unconventionally (referred to in psychiatry, rightly or wrongly, as delusions) do have the insight to effectively weigh the benefits and risks of acting out the experiences given their life circumstances, and that the advice of a psychiatrist or other professional is extraneous or paternalistic, then that is another empirical question on which there may be further disagreement here.
I want to add that my conclusions about the safety and efficacy of short and long term use of neuroleptics are informed not only by my personal experience as a survivor/patient, but also based upon that scientific evidence that I am satisfied is uncorrupted by greed, insufficiently rigorous, politically motivated or otherwise unreliable. But I recognize that, on the science, I am a layperson because I am not adequately trained to engage in rigorous scientific inquiry. So I must rely in large part upon the conclusions drawn by others, as my own first hand experience, while invaluable and unavailable to most scientists and medical practitioners, does not provide me with all of the answers. I am equally unable, without training, to reliably assess the data whether by Pfizer or by Peter Breggin. Whom we trust should not depend only on what our values and subjective experiences are, but should also take into account experts in scientific inquiry whose reasonable and uncorrupted opinions might conflict with those of others we want to trust.
And I want (because I know my comments are controversial here) to add that treatment limited to, for instance, open dialogue and psychotherapy are options that might not be practical for someone impeded these same financial and life constraints I describe, at least in the short term. A person experiencing a psychological state while employed and supporting self and, perhaps, family, does not have the luxury of traveling to an open dialogue center or engage in talk therapy over a lengthy period if s/he wants to avoid disability discrimination from their (for most people, less than ideal, but nevertheless unavoidable, especially in a bad economy) employer. And as many of us know all too well, employers can engage in such discrimination with abandon, since those of us still in need of employment won’t commit career suicide by filing an action in open court which discloses a mental health diagnosis (which, to whatever extent improper, carries great meaning an force within consensual reality). It’s also unclear whether longer term remedies are the best option for a person and their co-parents confronted with the challenge of addressing the needs of children in the middle of a (consensual reality) crisis. So, lets make sure we are thinking about the other real , overarching problems of coercion facing the vast majority of us without power, apart from coercion imposed more narrowly by psychiatry.
Nasrallah: The case for long-acting antipsychotic agents in the post-CATIE era
“Conclusion: Long-acting agents represent a valuable tool for the management of schizophrenia and merit wider use, especially in light of emerging literature regarding the neuroprotective advantages of atypical antipsychotics over conventional agents in terms of regenerating brain tissue during maintenance therapy.
In summary, long-acting antipsychotic agents that ensure continuous drug delivery and the provision of appropriate psychosocial therapy have the potential to address issues of all-cause discontinuation and poor compliance. Further- more, it has been reported that some patients prefer long-acting formulations, thereby suggesting that physicians should more often recommend and prescribe a long-acting agent when antipsychotic maintenance therapy is indicated (58).
I didn’t even bother reading through that.
This guy wants more patients on injections, which apparently should not be ever stopped. Everything he says should be taken with that purpose of his in mind.
Nasrallah: The Cutting Edge of Schizophrenia Treatment: An Expert Interview With Henry A. Nasrallah, MD
Yeah, Nasrallah suggests you start giving schizophrenics chronic injections from the first episode. How do you even know if it’s psychosis or schizophrenia (basically chronic psychosis) in the first episode?
“Dr. Nasrallah: Yes, I have long advocated for depot medications, even before CATIE, because as a clinician and researcher, I have no doubt that one of the greatest problems in the treatment of schizophrenia is lack of adherence and repeated psychotic relapse. My opinion, which is shared by many researchers, is that recurrent relapses are neurotoxic and may account for the deteriorating course of patients with schizophrenia. It is of utmost importance to help patients with schizophrenia stay on their medications and avoid relapse.
In community and outpatient settings, 70%-80% of patients are either partially or totally noncompliant. This is unacceptable if the goal is to achieve recovery. Patients with schizophrenia would have much better outcomes than we usually achieve if they were protected from relapses by ensuring treatment adherence from the first episode. But we have no study of first-episode patients assigned to a guaranteed-adherence regimen, which would be depot medication, vs treatment as usual with oral medication.
Now we have risperidone depot, the first long-acting SGA, and I hope others come to the market in the near future. In my experience with risperidone depot, it not only protects against relapse, it also helps restore function, especially after about 1 year of use. Patients have to stick with it, and in the second year they may experience a restoration of social functioning, such as a capacity for part-time employment or school enrollment, which may become even more striking in the third year. I have had patients stay on it for 4 years, and it is amazing to me how much better these patients function.
Dr. Nasrallah: Cognition is the single most important area in schizophrenia right now, and cognitive deficits are a core feature of the illness, perhaps more than positive symptoms. Clinicians know how to eliminate or reduce positive symptoms — delusions and hallucinations — pretty quickly, yet are left with patients who cannot go back to school or work. Cognitive deficits are keeping patients from working and being socially adept. In fact, we have a whole body of literature now showing that patients with schizophrenia have cognitive deficits in several domains that place them at 1-2 standard deviations below the general population. They are not mentally retarded, but they are impaired in memory, attention, visuospatial abilities, learning abilities, and executive function.
Dr. Nasrallah: Yes, I analyzed data from CATIE as part of the metabolic working group and am presenting the findings at the 2007 Society of Biological Psychiatry and American Psychiatric Association meetings.[13,14] Because several investigators had found that patients who gain weight seem to respond better, a statistician and I examined the relationship between weight gain and therapeutic response. We found a strong relationship between weight gain and improvement on PANSS positive-symptom and total scores across all the medications prescribed in CATIE, whether FGA or SGA. In each case, the more the weight gain, the lower the psychosis score at the end of the study.
This finding suggests that weight gain is part and parcel of improvement, although excessive weight gain, which happens with some of the SGAs, is not necessary. We know that patients with schizophrenia already have high risk for metabolic syndrome with and without antipsychotic treatment, and they tend to be poorly treated for diabetes, hyperlipidemia, and hypertension.
Wow, this is just fascinating! Weight gain is indicative of improvement (more weight gain is better), and cognitive impairment, which is clearly caused and/or exacerbated by SGA “treatment,” is the biggest problem he wants to solve by more SGA “treatment.”
When 70-80% of your treatment recipients discontinue treatment, it’s time to reconsider if your treatment is all that helpful.
I think he has a delusional disorder, and needs a depot injection himself!
That’s just what I was thinking when this horrible man spoke of so called schizophrenics being disabled, unable to work, having cognitive impairment and other life destroying “side effects” from the toxic drugs all blamed on the so called “mental illness” to push even worse depot drugs the victims can’t escape that will most likely make them all the more permanently disabled and living a vegetable, isolated life.
It’s been pretty much proven it’s the drugs causing the brain shrinkage and damage and not the bogus, imagined brain disease for which there is not a shred of evidence by Dr. Insel’s own admission.
Thanks for your recent kind response to me and your usual good insights.
“”They are not mentally retarded, but they are impaired in memory, attention, visuospatial abilities, learning abilities, and executive function.””
Yeah, antipsychotics are the perfect solution for this. And yes I am being sarcastic.
You’re right, our “friend” is delusional big time.
I was LOL at your description of the woman who appears with a different costume each day. God, people are so monotonous in wanting everyone to be the same and have no one be different.
By the way, even hospital staff thinks that wearing weird hats is a bad idea, didn’t they learn power stuggle 101 which is the more you make an issue of something, the more other person resists.
In the hospital where I work it’s against policy to try to make someone wear anything other than their own clothes, which they’re expected to wash and dry with the facilities on the unit. It’s also against policy to try to strip people naked. We are still using seclusion, unfortunately, but you must remain clothed. However, everything else is as you describe; the people being detained and drugged against their will. We change some things for “window dressing,” and they are important; but the truly important thing is never changed and that’s controlling people at all costs. It’s sad and disgusting and very distressing to me as I watch it happen every day right in front of me.
The interesting thing is that this particular hospital was once an unlocked facility. People used to go in the afternoons in their pajamas to the bar down the street and smoke cigs and have a beer or two! I didn’t believe this when I was first told about it but verified it for myself!
If they don’t perpetrate forced nakedness, how do they butt cheeks to stab needles into?
What are you telling me they inject through clothes?
No, they pull the person’s pants down in the back but they’re not allowed to do anything else, on pain of being fired. It’s still terrible.
In 1970-72 I was trained in a large psychiatric hospital run by a religious order of nuns. When you were forced into seclusion and restrained there you were stripped naked and tied spread eagled and face down on a bare mattress of a bed. The doors of every room had a window and staff and “patients” were then encouraged to go and look at the person being restrained. I couldn’t believe it and complained about such “treatment” but got absolutely nowhere.
I was doing clinical pastoral training as a chaplain at the time and wasn’t part of hospital staff.
I think forced buttock nakedness constitutes my definition of forced nakedness and most people’s definition of forced nakedness.
If it’s a part of the body disrobed by force, that I’d be charged with lewd conduct for displaying on the street, then it’s forced nakedness. But what’s a little forced nakedness when every neuron in your nervous system has become the government’s property to meddle with right?
I’d like to hear from you on this. What do you think of depot drugs and do you use them? How do people react to that? Do you think the effects of depot drugs are more toxic in that I believe I read that the amounts released into the body can go haywire and even cause death as a result?
Also, Sandy, I was wondering if you could throw Bob Whitaker a life line and comment on some of the horrible articles like Huffington Post and Early’s that you as a (highly regarded – my opinion) psychiatrist agree completely with Bob’s position on the judicious use of drugs with psychosis as you cited on this post to me. I tried to post such a comment on Huffington Post with that ignorant journalist (1boringoldman), but didn’t have a way to sign in. I’m hoping you could cite the latest studies based on the real science and evidence you and Bob have used to come to your conclusions about the judicious, more limited use of psych drugs in smaller doses. The ignorance from these people is amazing and very sad while also dangerous. You’ve done several posts debunking many of their absurd claims including anosognosia, which isn’t even relevant to psychiatry. Your sharing such insights could be very helpful from a somewhat mainstream psychiatrist doing much admired work to improve your practice.
I appeal to your compassion and empathy to help rescue Bob from this lynch mob/witch hunt when they obviously don’t have a clue!
Please and thank you.
I do not think the long acting injectables are more harmful so I would suggest the same judicious use of this formulation. One problem wiht LAI risperidone is that the dose is fixed so you can not reduce it to very samll amounts as you can wiht haloperidol decanoate.
I am not sure Bob needs a life line from me but honestly many people have already made up thier minds so comments are not likely to have much of an influence.
I see that here as well.
I also have heard that injectibles cause death, simply because they are injected and there is a toxic abundance of the drug found in the person when the autopsy is done. These are injections that are supposed to be long acting. When this could happen to anyone, how is there any “judicious” use!? This has happened repeatedly, and since it ALSO happens in psychiatric practice more than often that such deaths are misreported or not reported at all, this probably has happened more than we are told. There’s also deaths now from many other “side effects” that all of us who are in the circle to share such reports read about.
As I have already stated, whether you intend it that way or not, this is stress inducing to be confronted with such responses, and then to even be requested to share links to information about clearly highly dangerous medications, you are questioning (and clearly, although you are a professional administering those drugs aren’t in a circle to get the information you would need). And then you state that people have already made up their minds so comments are likely to have no influence, which you have also seen in this site (WHILE YOU ARE ASKING, IN COMMENTS FROM PEOPLE, INFORMATION YOU AS A PROFESSIONAL SHOULD HAVE ALREADY FREELY AVAILABLE IN A RESPONSIBLE ENVIRONMENT REGARDING YOUR PROFESSION). There are more than a few of us who have spent an incredible amount of time trying to share information that most people dismiss because of mainstream brainwashing, and know pretty much most people have made up their minds about, but we care enough about that fraction of a possibility that someone might be questioning what they are told; and we might save ONE LIFE out of hundreds, thousands or millions. Yet you discourage that because you say most people have already made up their mind. To me, such advice does go along with holding onto the need for prescribing brain disabling medications, I must say! And requesting others to find information you should have had to begin. And who actually has made up their mind already? What would be the difference in not being fearful whether people have made up their minds or not, what would the difference in regards treatment?
What someone shared (possibly on this site) is that injectables use oil in the skin to cause a place where the “medications” stay and are slowly let loose into the body, and this can dissolve too soon or something like that. Whether that’s the case with older forms of injectables or both new and older, or it’s something else; there ARE cases where a person clearly dies because they were injected. And death occured because of the nature of what might happen when injected NOT because it was injected improperly. Where this falls under: “I do not think the long acting injectables are more harmful so I would suggest the same judicious use of this formulation.” is again only an example that there’s not clear information, damage is overlooked and it’s the habit!
This is a response to Abbot from 7/25/13-
I suspect we are at an impasse. I think that some people feel better when they take these drugs and I think that effect goes beyond tranquilization. This belief is based on the results of many studies as well as what people tell me. I do not think they help everyone and I think they should be used as judiciously as possible.
Now I do understand that each person’s experience is complex and no one can never know for sure what mediates the response in any one person. However, I am not a cheerleader for these drugs and I am often having talks with people about the need to minimze exposure to them. You and others here seem to be insistent that any experienced positive response is due to coercion, society expectations, placebo or some other factor. For me this is similar to the alternative view that considers any long term decline in function in someone who has taken the drugs for many years is due to the underlying “illness” rather than the drug.
From a pragmatic point of view, I think that advocates will be more successful in arguing for moderation rather than for banning the use of these drugs. I do not argue for that only due to pragmatics – it is what I believe at this point – but I am just suggesting that it is another factor to b econsidered.
Thanks for your response.
A while back, you wrote a post about how MIA members have changed you.
Despite what you say about people having made up their minds with comments or new evidence possibly having little impact, people like you and Bob Whitaker have had a great deal of influence on me and lots of other people.
I know when you first came here I was unfairly painting you with the same brush as some very dishonest, abusive psychiatrists who caused huge harm to loved ones suffering abuse related trauma, making things so much worse as acknowledged by many trauma and other experts. As I told you later, after reading many of your posts and dialog on this web site, I became very impressed by your great efforts to consider different view points, learn new things in your work, being open to new research Bob Whitaker presented, dialog with survivors here and your obvious struggle in dealing with very difficult and challenging life and death situations while remaining humble about the state of knowledge in psychiatry.
Though I still get very upset by the overall dishonest and corrupt paradigm of biopsychiatry inflicted by the KOL’s who sold out to BIG PHARMA and continue to do so by constant lying, junk science and the destruction of countless lives like the subject of this post, I know that there are many decent people like you struggling to do your best to help people and minimize harm despite this overall crisis in psychiatry and medicine in general.
Sadly, the problem when seeking such help is finding people like you when so many have felt forced to go along to get along to survive in the mental “health” profession not to mention the truly corrupt psychopathic drug company shills like Joseph Biederman willing to destroy the lives of millions of children for greed, power and status. Biederman astonished reporters with his obvious narcissism when he made it clear he saw himself as next to God in his status and position.
A good example of psychiatrists like you struggling with such issues is Phillip Sinaikin, the author of PSYCHIATRYLAND.
Though I still may not agree with him about some issues like so called bipolar, Jill Littrell has said on this site that Dr. Sinaikin is pretty discouraged about the state of biopsychiatry, but is not in a position to change fields or retire now.
Another psychiatrist struggling with these issues and providing helpful information is Dr. Timothy Scott, author of AMERICA FOOLED.
Also, you spoke of being impressed by the book, THINKING FAST AND SLOW, and how it shows how our ways of thinking can cause bias.
I’ve read many books on that type of subject including how people change and/or change their minds in terms of bad habits or changing paradigms. Such change does not usually come about immediately, but rather, it comes by first being exposed to a new way of thinking or acting and going through different stages of changed thinking to the point that the new behaviors or beliefs finally are accepted and create change. For example, most people want to stop smoking and those that do go through a contemplative stage where they think about doing so based on information about the harm of smoking while suffering cognitive dissonance about not wanting to give up the habit or face the difficulty of quitting. Finally, those who quit get to the point that the harm of smoking and other negatives outweigh any illusions of its good points as Alan Carr exposes in his great book, THE EASY WAY TO QUIT SMOKING. The same is true of all bad habits like overeating, drinking, drugging, etc.
Therefore, though you and others may think people aren’t being influenced when they initially resist new information, as new information becomes more and more credible, it does ultimately cause many people to change their way of seeing things. Of course, there are some people who will be influenced immediately and some people who will resist obvious facts, so we are all very unique in how we react to new information.
So, I hope you won’t get discouraged when you end up being a scapegoat for the horrible actions of others in the mental “health” profession that caused some people so much harm, trauma, resentment and seemingly permanent ill will toward psychiatry. I still share some of those feelings toward the truly evil people who have deliberately perpetrated many scams for very self serving purposes, but getting to know a decent, caring, compassionate person like you trying to do your best in a very challenging, dangerous situation has definitely changed my mind about you and the very difficult dilemmas you face daily. So, if somebody like me who wrote those horrible posts to you when you first joined MIA could change her mind and come to respect and admire you despite our differences of opinion in some areas, you can rest assured, the situation is not hopeless.
Have a nice day!
Speaking of the devil, I found the following in my email late this afternoon after posting the above email this morning.
I don’t know about you, but it’s nice to know I’m not alone in my concerns.
Thank you for passing along Dr. Sinaikin’s information. I am a volunteer for the International Society of Ethical Psychology and Psychiatry (ISEPP) and met Phil through the organization.
Phil presented twice at the ISEPP conferences, unfortunately, there were so many sessions going on only 30 people came to the first one and last year only 1 person had interest in his presentation, so he didn’t bother even presenting. He left the conference very discouraged.
Dr. Gary Kohls presented at the 2009 conference and felt the same way. His presentation (on Orthomolecular/nutrition) was the main reason why I made an effort to attend. Sadly, even among the minority agenda, important voices get lost.
Phil’s book PSYCHIATRYLAND is a labor of love and a gift to anyone looking for empowerment concepts. Literally a gift because he wants people to have it and would give it away to anyone who asks.
Phil works at a very busy VA hospital that is overwhelmed with an influx of veterans being admitted with mental health issues. A very serious and sad situation to deal with. The stories are horrific. My sister-in-law works at the other local VA psych ward. Patients are overmedicated and given ECT.
Phil’s book is self-published and got little exposure. As a courtesy to ISEPP members who need help on the internet, I offer to help them with their websites or set up blogs. I’m glad Phil took me up on the offer because it is always an honor to help someone who is willing to stick their professional neck out on the line.
That is why I chose to volunteer for ISEPP, rather than CCHR. If I didn’t feel an obligation to somehow help protect the professionals who are in the position to help others who suffer from underlying medical conditions and are misdiagnosed with “mental illness”, I’d be doing more hands on work to help others.
My own doctor stuck his neck on the line for his patients and he ended up having his license suspended. Over 1000 people came to a rally in support of him and another local doctor who also had her license suspended and used Functional/Orthomolecular/Complimentary Medicine. The testimonies were incredible and they were buried in legal fees getting their licenses back.
Phil’s presentation exposes Big Pharma information that he obtained “back in the day”. It’s unfortunate that no key member of ISEPP attended it. It is really very shocking.
Personally, I like Phil’s book and love the analogies in PSYCHIATRYLAND. He hits the nail on the head of a Disneyland-train-of-thought why people turn to psychiatry in the first place. We were taught to play follow-the-leader as kids and we still do it today.
The content comes from his insights as a seasoned professional whose education as a psychiatrist was immersed in many disciplines and not just how to drug your patients.
Back in the day, where he was educated, Orthomolecular Psychiatry and all of the various branches of psychology and philosophy were part of the core curriculum.
His book is written from his personal perspective, so of course others are going to think he is wrong.
Phil lives about an hour away and a few years ago we met up for lunch.
I asked him the same question CCHR videos ask, are there any test to determine someone has a mental disorder?
He gave the same response as all of the CCHR interviews, no.
I pulled out a copy of his book and pointed out to him what he wrote about Bipolar Disorder in his book:
“I don’t think and neither would you have any problem identifying Bipolar I Disorder in someone currently suffering from a manic episode. They truly act crazy. A number of my Bipolar I patients had a tendency to take all their cloths off in public when manic. Some love to ‘spread the word’. I pointed out in his book where he states: A true Type I manic can rarely escape public notice….”
My next question was, so if you have a patient who is clearly in a manic state, there are no tests that you would run?
He immediately knew what I was getting at and started with, well, umm, of course we would run a thyroid test, and it would be nice if everyone had an MRI, but we don’t do that….
I rephrased his answers and said
So, there are no tests to diagnose a mental disorder, but there are tests to determine a person does not have a mental disorder, but we just don’t do them, correct?
“Well, yes, that’s true” was his answer.
“Psychosis Due to General Medical Conditions”,
and “Substance Induced Psychosis”
They aren’t new to the DSM, they just don’t get used much and no one seems to care about them.
Despite its really good efficacy for psychosis, using best practice assessment standards to test for and treat the underlying medical condition seems like a waste of time to most medical doctors.
All-in-all, Phil really is a great guy, with a big heart and a very talented musician.
He is one of our unsung heroes and a diamond in the rough. Phil is a close friend of an Executive Producer at 60 Minutes. Phil contacted him about the Rebecca Riley case and that is how Rebecca’s death captured the attention of our main stream media. Unfortunately, the national alliance claiming to be mental health advocates are oblivious to these tragic incidents.
Although I was not on it very long, my memories of the scathing effect of Haloperidol-induced Parkinsonslike Syndrome are still quite vivid in my mind. Sure would have been nice to have a bit of Cogentin with that crap.
Here’s a video that points out our prominent psychiatric researchers and mental health advocates suck.
Another aspect of medicating symptoms is that fact many individuals work in industries that involve long-term exposure to organic solvents like hexane, or heavy metals like lead that also have neurotoxic effects.
In those “more drug reactive” patients, doctors should consider taking an occupational history, or suggesting a hair analysis.
It doesn’t matter how nice the Brave New World Funny Farms are, ya can’t cure “mad” or “crazy” without getting the lead out.
While some are making money writing books about the treatment of “mental illness”, others got “mental illness” from printing them.
We really do live in a backwards dlrow.
Neurotoxic effects of n-hexane on the human central nervous system: evoked potential abnormalities in n-hexane polyneuropathy.
An outbreak of n-hexane polyneuropathy as a result of industrial exposure occurred in printing factories in Taipei area from December 1983 to February 1985. Multimodality evoked potentials study was performed on 22 of the polyneuropathy cases, five of the subclinical cases, and seven of the unaffected workers. The absolute and interpeak latencies of patterned visual evoked potential (pVEP) in both the polyneuropathy and subclinical groups were longer than in the normal controls. The pVEP interpeak amplitude was also decreased in the polyneuropathy cases. Brainstem auditory evoked potentials (BAEP), showed no difference of wave I latency between factory workers and normal controls, but prolongation of the wave I-V interpeak latencies was noted, corresponding with the severity of the polyneuropathy. In somatosensory evoked potentials (SEPs), both the absolute latencies and central conduction time (CCT) were longer in subclinical and polyneuropathy cases than in the unaffected workers and normal controls. From this evoked potentials study, chronic toxic effects of n-hexane on the central nervous system were shown.
Am J Ind Med. 1986;10(2):111-8.
An outbreak of N-hexane induced polyneuropathy among press proofing workers in Taipei.
Wang JD, Chang YC, Kao KP, Huang CC, Lin CC, Yeh WY.
The objective of this study was to determine the prevalence and the etiology of polyneuropathy observed among press proofing workers in Taipei. Neurological examinations of 59 workers, from 16 press proofing factories, were conducted. Fifty-four of those workers subsequently underwent studies of nerve conduction velocities. Samples of bulk solvent from the involved factories were analyzed for their contents using gas chromatography. Fifteen (25%) of the study group were found to have polyneuropathy. All 15 patients with polyneuropathy were from factories in which solvents containing n-hexane were regularly used, and there was a significant association between n-hexane concentration in the bulk samples and prevalence of polyneuropathy. The air concentration of n-hexane in one factory in which all six employees developed polyneuropathy was 190 ppm. Workers who were exposed to n-hexane at air levels of less than 100 ppm but who frequently worked overtime showed a significant slowing of motor nerve conduction velocities on median, ulnar, and peroneal nerves. Of 13 workers who regularly slept in the factory, 12 (92%) had polyneuropathy compared to three (7%) of 46 workers who did not sleep in the factory. The outbreak of polyneuropathy was attributed to a combination of the use of solvents with high contents of n-hexane, poor ventilation, and the practice of sleeping in the factories between shifts.
Thanks for this enlightening post and your encouragement for my alerting people about Dr. Sinaikin’s new book, Psychiatryland.
At first, I was a bit reluctant to recommend it because I think it was you who called it to my attention that Dr. Sinaikin still pushes the bipolar fad fraud, the current “sacred symbol of psychiatry,” replacing schizophrenia for the most part used for the same purpose as shown above in my posts about Dr. Loren Mosher and his close relationship with Robert Whitaker.
But, as I read about Dr. Sinaikin’s book, his own publicity about it and many reviews, I felt that Dr. Sinaikin is trying hard to bring some sanity back into psychiatry though he feels he must medicate what he sees as the most extreme cases of so called severe mental illness you cite like “bipolar.” Except for that, his book is an excellent guide to those considering taking psych drugs and/or visiting a psychiatrist. He exposes much of the shoddy science and Big Pharma’s hijacking of psychiatry while steering those with normal life problems and traumas to other better sources of help instead of being stigmatized and drugged with subjective labels and dangerous drugs.
So, though I may not agree with the book, Psychiatryland totally, I do agree with much of what this long term, very experienced, well rounded psychiatrist has to say. Thus, I think it’s worth reading despite the bipolar fraud because he also cites cases that have been wrongly diagnosed with bipolar as with the case of a man suffering greatly from a divorce only to be overmedicated and ultimately stigmatized as bipolar, which is all too common for people suffering great losses, crises, trauma, etc. Fortunately, Dr. Sinaikin rescued this man and many others from a very typical fate of a destroyed, shortened life, which this book can do for anyone who reads it too.
I appreciate your constantly keeping us on our toes that many things can cause such extreme symptoms in people including physical illness, life crises, excess recreational and other drugs and others. That’s all the more reason that psych stigmas are deadly since the causes are merely suppressed and denied while using toxic drugs to eliminate supposed symptoms that are nature’s way of warning us we are in deep trouble as with anxiety/stress. Thus, suppressing such symptoms is very dangerous indeed when it disempowers people in dangerous, abusive situations or ignores serious medical illnesses. The books, A Dose of Sanity, Blaming the Brain and many others cover this issue.
Finally, in my post to Sandy, I also highly recommended the book, America Fooled, by Dr. Timothy Scott, which has gotten great reviews.
I just visited Dr. Scott’s site again and read the long list of very high recommendations for this book, which reads like a list of many of the greatest known experts challenging biopsychiatry at MIA, ISEPP, Critical Psychiatry and many others including Dr. Joanna Moncrieff, Robert Whitaker and many others:
Thanks again for all you do to help spread the message of the desperate need for reform for biopsychiatry.
Thank you again for raising this topic. I also find Hermes postings here in the discussion to be quite educational. Even though they are quite technical I read every word and am gradually learning more about neurochemistry.
Slightly off topic I’d like to ask you to address a couple of other questions related to psychiatric drug prescribing.
As you may know from my other postings I also work in community mental health in a neighboring state. I observe the fact that many patients are currently prescribed 3 to 7 (sometimes more) different psychiatric drugs at one time. Also huge amounts of Benzos are prescribed for long periods of time. I know overall you advocate the judicious use of all psychiatric drugs.
What are your thoughts (briefly) on the issue of “polypharmacy” in psychiatry and the use of Benzos?
Yesterday someone asked me how I would design the “system” if I had that authority. I have been asked this before and I do not have a ready answer since I am not sure how to resolve some of the problems. What I did say was that I wished that everyone had a shared appreciation of the limits of our knowledge about these drugs and that everyone used them with caution. This would include limiting poly pharmacy. There is increasing concern about the long term effects of benzodiazepines. Combining that with the fact that in the short term, they pose a risk of addiction and diversion and that people tend to quickly accomodate to their effects, I try to avoid prescibing them.
There are many people who come to me with the conviction that these drugs are essential to their recovery and that is a challenge. There are people who are as adamant and passionate about their need for these drugs as there are people who are passionate and adament that they have done them great damage.
If first and foremost, one wants to be centered on the wishes and preferences of the person seeking care, this is a challenge for a psychiatrist who takes a cautious approach to prescribing.
Thank you so much for this:
For some reason, psychiatrists have never been publishing numerous studies about adherence, treatment compliancy, anosognosia, etc, with drugs such as benzodiazepines, opiates, etc. “He doesn’t understand that he has a disease and therefore he doesn’t eat these benzos I prescribed him!” 😉
Given how benzos have been demonized suspiciously now that they are off patent (? like the Haldol of this post), I was pleasantly surprised to see that Dr. David Allen, Psychiatrist, has debunked much of the hypocrisy and pretense that benzos are supposedly so dangerous when compared to the horrors of neuroleptics and other drugs increasingly being pushed for insomnia and anxiety no less. Dr. Allen goes into this in more detail in his book on dysfunctional families causing mental disorders.
Here is an article about benzos on Dr. Allen’s web site:
Other articles have argued that it is critical that psychiatrists warn patients of the potential for tolerance, addiction and even blackouts with extended, regular use in too high of doses. It seems to be these can be must helpful to use situationally for temporary severe stressors in limited doses rather than taking them regularly. Perhaps patients could be persuaded to use them in more limited ways like this if they are informed that long term use and increasing tolerance can make the drugs ineffective and dangerous over the long term. Yet, Dr. Allen points out that he has never seen the crises with other psych drugs happen with benzos in the above article.
Sadly, many people suffering anxiety, trauma, extreme stress and other impermanent symptoms are routinely stigmatized with bipolar disorder to push toxic neuroleptics, SSRI’s, Xanax, Depakote, beta blockers and other drugs altogether in a lethal cocktail just about guaranteed to result in a near death experience at the hospital; that is if one makes it there in time. I am describing an actual case inflicted by one despicable psychiatrist.
Thus, as I said in another post, I still think the temporary use of a benzo like Xanax with a limited time and dose while the person is helped through their crisis is far better than neuroleptics often combined with a bogus bipolar stigma updiagnosed for increased insurance payments, to promote the latest fad, etc.
All this talk about injectables. Very upsetting. Injectable forms of psychiatry’s major tranquilizer drugs are probably the most degrading and inhuman thing in any ‘hospital’ pharmacy. They exist only to bypass human agency and choice, and to treat the ‘mental patient body’ as a dehumanized organism that floats around in the world to be shot up and drugged. They exist because trust doesn’t exist in this unholy forcibly established ‘doctor/patient’ relationship. How any physician thinks a legitimate doctor/patient relationship can exist without trust, is just another symptom of psychiatry’s delusional stance on the Hippocratic oath. If I was ever targeted for community commitment again with injections, I’d actually take out a knife, and slice the globule of neuroleptic crap out of my flesh, and go into hiding. Being scarred for life would be tiny price to pay to get my body back. To have one of these hardened globules of drugs sticking up from one’s flesh, is to be reminded that society doesn’t consider you human. It’s as inhuman as perhaps targeting a minority and forcing depo provera on them to temporarily sterilize them. It’s an atrocity. Nobody who has decided consent doesn’t matter is fit to call themselves a healer. Physicians who treat human bodies while ignoring the word NO coming out of the mouth of the alleged owner of that body, have crossed a moral and ethical line that there is never any going back from.
I have grave concerns about these injectable drugs too and I am sorry you are so upset based on your past experience.
I agree that most people should not have these drugs forcibly injected into their bodies because it seems when life threatening “side effects” occur like malignant neuroleptic syndrome and others, it would be all the more difficult to deal with the offending drug and save the person’s life through some drastic measure to remove the toxic substance.
Sadly, it does appear that Henry A. Nasrallah, MD, who is the subject of this post in a sense, is pushing the new SGA depot drugs on patent for more profit since their pill forms are going off patent. This is despicable in my opinion.
I’d have to do more research on other risks of so called depot drugs, but they seem very dangerous to me and a violation of human rights and safety.
I do know about some people who have almost died from neuroleptics in pill form necessitating having their whole bodies pumped out putting their lives at great risk and resulting in long term grave illness, so I’m sure it would certainly happen with depot drugs.
Anonymous, unfortunately, there are some very dangerous, violent people out there that psychiatry avoids for the most part if possible. See book, Stalking The Soul: Emotional Abuse and the Erosion of Identity by Dr. Marie-France Hirigoyen, Psychiatrist. Dr. Robert Hare, world authority on the topic, calls them psychopaths in his great books Without Conscience: The Disturbing World of the Psychopaths Among Us and Snakes in Suits: When Psychopaths Go to Work. Though many believe these charming intraspecies predators are all serial killers, most ply their trade by hiding in plain sight with their Mask of Sanity (book) per Dr. Hervey Cleckley as The Sociopath Next Door(book) as bosses, politicians, lawyers, doctors and other powerful people per Dr. Martha Stout. Dr. Robert Hare said the best place to find and study psychopaths would be on Wall Street since many believe it is thanks to them we had the economic meltdown and much of the injustice and criminal greed by those at the top. Of course, others with a more spiritual world view, would simply call them evil as does Dr. M. Scott Peck, Psychiatrist, in his best selling books including The People of the Lie about such evil people. In fact, Dr. Peck believes that psychiatry should consider evil as part of their diagnostic system. The terms “psychopath” and “malignant narcissist” do a pretty good job conveying that idea in my opinion, but it tends to muddle the truth and danger in my opinion.
Anyway, anyone faced with having to deal with a psychopath with no conscience, empathy, remorse, ethics, decency, ability to refrain from harming others even if psychologically and emotinally and many of the traits that define humanity, might be well served to have a depot drug on hand. Some psychopaths are being “diagnosed” with bipolar disorder to show what a garbage can label that is. God help the psychiatrist or anyone making that diagnosis. However, for the most part, psychiatry has forced the victims of psychopaths and/or malignant narcissists to face the enormous wake of shock, abuse, trauma, emotional and financial destruction psychopaths typically leave in their wake not only alone and unsupported, but blamed and stigmatized while aiding and abetting these predators.
There is a great deal of information about this topic on the web that biopsychiatry has ignored for the most part especially in America while Britain has been trying to pass draconian laws to deal with them. It amazes me that there is so much concern in Britain about protecting the rights of psychopaths while they couldn’t care less about huge rights violations of others they label “mentally ill.” Sadly, it is their victims who are in the best and possibly only position to “diagnose” psychopaths since they only show their true colors to their targets for the most part while conning, manipulating and charming everyone else per Dr. Hare’s book, Snakes in Suits and Dr. Reid Melloy’s The Psychopathic Mind. These experts admit that even they have been conned and fooled by psychopaths.
Sandy any thoughts on this topic and how biopsychiatry deals with psychopaths since I have not seen much about treating them by the profession?
Injections are usually used as a coercive way to give the drugs to patients who don’t want to take them. They last maybe two weeks and the psychiatrist can be sure that the patient has taken the drug. If the patient doesn’t arrive to have a new injection, the psychiatrist knows there’s a “problem”. That is, they are usually used by one party against one person’s will.
For instance, the language in this paper from BJPsych is much more subtle than the trolling statements Nasrallah makes, but you can see what they say if you have ears and read it with a clear mind.
“The concept of `recovery’ stresses the importance of working towards goals that are defined by the patient and not by the clinician.9 To achieve this, mental health professionals need to work in a patient-centred way to enable the patients to make choices that will help them to achieve their personal goals (for example, living independently, going back to college or finding a job). Medication management is therefore about a process of shared decision-making in which two experts (clinician and patient) share information and agree jointly the best treatment plan to enable patients to achieve their personal goals. Long-acting injections (LAIs) are one of the choices that patients and clinicians should consider to enable effective management of symptoms and promote recovery. Ultimately the choice about whether to stick to this plan is the patient’s. However, this does not mean that clinicians are passive; for example, if an appointment for an LAI is missed then it is important to follow up and explore with (but not blame) the patient the reasons why this was the case. Although the evidence base remains equivocal, many authors argue that unless we work with patients to make shared collaborative choices, clinical outcomes for patients will not improve.2,10,11”
Then in the later part of the article there are all the delicate details of giving an injection.
Also, the current idea is that schizoprenics (or bipolars, psychotics, etc) should take neuroleptics indefinitely. For instance, many of those people in Harrow’s study who quit neuroleptics probably did it without a consent from psychiatrists. Some of them were possibly also the people who would have been offered more injections just because they were not compliant if this adherence/injection system was more widespread. Or with injections they wouldn’t have been able to exit the system? I don’t know, just some ideas. But it resonates with what I experienced. I had to do it in secret.
Another great coincidence! Today, I found this typical article about psychopathic bosses among my Comcast news articles being all too common and destroying many people and their careers with their pathological lying, abuse, bullying and charming those in power to get away with it:
Why isn’t biopsychiatry doing anything about this massive nightmare assault on humanity? I think it’s because those at the top of the food chain of biopsychiatry are psychopaths themselves and they do tend to recognize each other.
Thank you for your thoughtful post, Sandra.
Dr. Nasrallah’s editorial and your blog seem oddly prescient given the recent NY Times article on involuntary outpatient treatment which enables the government to mandate ongoing medication with these “neurotoxic” medications.
Oddly prescient because the NY Times didn’t mention Dr. Nasrallah’s editorial at all.
I don’t think Nasrallah’s editorial is considered very important at all (where does Sandra find all these silly persons? Is the case really that they’re the best of the breed?).
However, I think there are many different axis to prescriptions of neuroleptics, for instance. One axis is the pharma axis. Another is the social/behaviour control axis. Etc. And all of these mesh in ‘interesting’ ways…
Oh, I forgot the biological axis. It’s important too.
As I noted above, Dr. Nasrallah is the editor of Current Psychiatry. This is a trade journal so it’s academic standards are not high. I wrote about it because it is distributed for free and a lot of psychiatrists as least glance at it. I think these sorts of articles have some impact but it is hard for me to know how much.
Thanks for your many helpful comments. I do want to try to get a better handle on this.
Yes, it wasn’t an attack against you. I like your posts and way of seeing the world a lot. I just recalled that other post, the topic of which was neuroleptics/adherence or whatever. I just wondered if this really is the best that the current bio-psychiatry has to offer, then it’s pretty much crackpottery.
And yes, I understand that it’s a trade journal or whatever. In part, my interest is not at all what new information the paper claims (nothing), in this case I’m interested in this whole complex promotional system they are trying to perform.
I read Dr. Nasrallah’s opinion on haloperidol and his indirect support for the use of the so-called second generation neuroleptics (SGNs) that he acknowledges are no more efficacious than the first generation neuroletics (FGN.) Though it must be emphasized that this distinction between “first” and “second” generations is rather week as the grandmother of the SGN, clozapine, was “generated” by the great-grandmother of all of them, chlorpromazine, already in 1970.
First of all, let’s be clear on the fact that Dr. Nasrallah operates with BigPharma on the dark side of Psychiatry. Among many examples, Dr. Nasrallah, based on flimsy evidence, a great ignorance of receptor occupancy rates and eyes firmly planted on the prize that follows the promotion of brand names, sang the praises of the concomitant use of 2 antidepressants (SSRIs and SNRIs) for poorly responding depressions.
Second, his opinions about haloperidol are totally biased and partial.
The real biggest problem with haloperidol arise when you examine the doses at which it is used and its half-life (t.5).
Haloperidol is always dosed at extraordinary large doses, ≥ 20 mg/day. For example, in the first head-to-head comparisons between SGNs and first generation neuroleptics (FGNs) haloperidol was invariably administered at 40 mg/day while the SGN was given at the lowest dose possible, generating large side-effects for haloperidol and lower ones for the SGN. The large haloperidol dosages have been in use forever and, like with every neuroleptic used at large dosage, being either FGN or SGN, the long term effects are unpredictable but mostly bad. When you run lab experiments with haloperidol on isolated neurons you get a lot of effects that run from vacuolizations to activation of caspases and what not. Always calculate the concentrations employed in these experiments (always read the Methods section of the papers) and you will almost invariably find that they are enormous thus obtaining effects that are actually impossible to translate to clinical practice with any significance. Haloperidol, like many, or most, neuroleptics, activate NMDA receptors, and give signals of Ca release in Fura-2-like experiments, but what is important is to determine if the cellular Ca-buffering systems are functioning adequately or the drug overrides them. For example, ketamine is neurotoxic, promoting neuronal vacuolization (Olmney’s lesions) and apoptosis and mimics psychotic symptoms in humans (and monkeys.) Everybody knows that, but it has not stopped psychiatrist to study its potential as an antidepressant and even a psychiatrist applying for a patent under his name for the use of Special K as an antidepressant. And not a peep about this from the good doctor, Nasrallah. Moreover, said doctor lists “depletion of gluthatione” as problem with the administration of haloperidol. But, without going any further, a drug that does reduce gluthatione activity, and in a significant way, with the potential for causing liver failure, is valproate. Where is the chochem of Dr. Nasrallah denouncing the dangers of using of Depakote® and Depakote® ER when we need it? The symbol ® is meant to be tongue-in-cheek, as Dr. Nasrallah would never, ever, give any grief to Abbot or any cause for Abbot to be angry at him.
As to the t.5 of haloperidol, it is several days or weeks. If you recalculate the t.5 of haloperidol in the brain from the published washout curves you will see that it stays in the brain for a long, long time. Therefore, haloperidol might be simply given every third day or even once a week.
So, when you add large accumulating doses, you may expect large, accumulating side effects.
If you examine the old Wolkin’s haloperidol D2 occupancy curves you realize that the system saturates at the equivalent oral dose of 2.5-5.0 mg; so, why give more than 5 mg every third day, for example, or use decanoate at doses greater than 50 mg once a month? Because a drug as effective as haloperidol and that costs so little but comes without the benefits of a pen and sandwich and with no speaker’s fee is not in the realm of Dr. Nasrallah’s sphere of interest. Use haloperidol judiciously, an advise that you can extend this to every generic neuroleptic and to one of the best mood stabilizers: Lithium, that also comes without pens, pizzas or speaker’s fees.
If you read the science-free articles by Dr. Nasrallah, only one advise: Caveat emptor. He is the friend of Pharma, not yours.
So much left to analize and to say in Psychopharmacology!
Thanks for this message, mah3md. It sounds like you have longer experience with him than I have. I know NMDA antagonist drugs can directly cause the “dissociative” part of some types of psychosis, but they don’t usually directly cause anxiety, etc. They’re actually very pleasant to many people. I’m thinking that maybe in some forms of paranoid psychosis prolonged stress, lack of sleep, etc, causes on the brain level something similar to NMDA antagonism or some related glutamate stuff. Stress, prolonged negative thoughts, etc, combined with NMDA antagonism type dissociation => a type of paranoid psychosis. But what causes what?
By the way, in a sense there’s perhaps something good about SGAs compared to haloperidol. It’s much harder to cause very severe D2 antagonism and all the related crappy stuff on patients with SGAs, so in a sense they have training wheels for doctor. But then again, not every FGA is haloperidol either, drugs such as perphenazine and chlorpromazine also have different receptor profiles, etc, compared to haloperidol. So, I don’t know if it’s neutral to find all the bad things haloperidol can cause and then generalise it to mean all FGAs. Though I must admit that CATIE did a similar thing with perphenazine. Maybe instead of comparing FGAs with SGAs or brand names with each other, they should be studying things such as what are the adverse or beneficial effects of D2 antagonism with different receptor populations, time of use, etc.
Perhaps these days when a doctor thinks he’s not getting the response he was looking for, he adds another neuroleptic to the soup. Or sometimes even third one. One person with schizophrenia diagnosis told that he was on large doses of two neuroleptics (Abilify and maybe Seroquel), and when he told the head psychiatrist of a clinic that he wanted to drop the other neuroleptic, the psychiatrist almost jumped over table and told that every schizophrenic takes at least two neuroleptics.
“receptor occupancy rates”…. sheesh…. I guess in one way it’s ‘nice’ to know what the ‘doctors’ have been reading all about and closely studying the art of ‘occupying receptors’ they can’t even prove are diseased, with toxic chemicals, against the will of innocent human beings they label ‘patients’ by force and without consent, for the crime of becoming overwhelmed with life. I mean if I was going to be slammed to the floor by thugs, and whom like an invading army, ‘occupied’ and invaded my receptors, at least its nice to know they actually believe they have it down to a fine art, the art of getting people who dare have mental crises and dare believe bizarre thoughts, to shut up, stop saying things people don’t like, stop doing things people don’t want them to do, I mean, you almost have to respect their sincerity, they seriously believe the art of tranquilizing human beings as if they are zoo animals, is worth turning into a science with all these journals and studies and whatnot. Now if only we could have the human right to say no to their quackery, we can dream.
Still waiting all these years later for my attackers to demonstrate disease in my D2 receptors. The world’s been waiting decades for that proof, and centuries for actually any demonstrable, replicable somatic evidence of actual disease.
“Haloperidol, like many, or most, neuroleptics, activate NMDA receptors, and give signals of Ca release in Fura-2-like experiments, but what is important is to determine if the cellular Ca-buffering systems are functioning adequately or the drug overrides them.”
Sounds like a lovely thing to do someone against their will, allow MDs who perform zero investigative diagnostic biological tests, who demonstrate no actual disease, who have zero insight into any demonstrable biological aberration in the person labeled ‘patient’, to mess around with the cellular function of any man, woman, child, elderly person, in society, by force, without consent. Psychiatry is a profession that dreamed up parts of the human body and human being to rape, that had never been raped before. Sentenced to live for the rest of my life knowing society thinks its OK to violate my brain, ‘occupy’ my receptors, and force me to live in constant terror of attack at the hands of people who believe, like religious fanatics, that they are ‘treating disease’ when they are drugging people to shut them up. Thanks society! you’ve clearly got our back.
Thanks for this post, Anonymous. I personally would not take neuroleptics even if I was hallucinating pink elephants or whatever. If I was threatened by forcible injection of these drugs, maybe I’d travel to Goa or wherever. But I’m still interested in the way these drugs work in the brain or nervous system. In that sense, this new poster gave valuable information. There was not much that I disagree with.
I agree its interesting information. I like to read about how Sarin gas works on the body in wikipedia sometimes too. I’m interested in everything. I’m an interested person. These drugs took away my ability to use my intellect for years, so I make up for lost time by broadly reading on many topics. I think someone would call the airport and label you a ‘danger to self or others’ if you tried to get on a plane to Goa or anywhere. I strategize and war game escape from forced psychiatry regularly. Any option is on the table, if it ever goes down again. We need an underground railroad to be able to escape psychiatry’s violence against us. Safe deposit box, go-bags, envelopes marked do not open until crisis left with family members, cash reserves, secret trailer park hideouts, it’s all in place. If they refuse to give us our human rights, we have to do what we can to marginally alleviate the terror they force us to live in. Clearly I’d rather die than ever be ‘receptor occupied’ again, and nobody here would doubt my sincerity.
Lithium is a horrible toxic drug with many life threatening “side effects.” It makes people into drugged zombies with loss of all their humanity, liveliness, will to live and anything else that once made them human. It also destroys their minds, intelligence, creativity, passion, livelihoods and all else that makes life worth living just as the horrific neuroleptic drugs. I think every psychiatrist should be forced to try these poison drugs in the doses they dole out to see how they are able to function in such a chemical straight jacket.
I despise such fraudulent claims that poison lithium is a good “mood stabilizer,” given that this bogus term was invented by Big Pharma to push Depakote and other toxic drugs on patent for biopsychiatry’s fake “diseases.” See Dr. David Healy’s book, Mania: A Short History of Bipolar Disorder, exposing the great “mood stabilizer” fraud along with the fraud of the bipolar epidemic created to push the latest lethal neuroleptics and epilepsy drugs like Depakote on patent.
Check out Dr. Joanna Montcrieff’s The Myth of the Chemical Cure about the fact that doses of lithium deemed necessary to supposedly help the target of fraudulent biopsychiatry is about the same as the toxic dose that destroys human organs and kills them.
So, I have to question the validity of the information provided by mah3md as is necessary for all of biopsychiatry’s deadly main stream paradigm.
Yes, Lithium Carbonate can cause horrific conditions like CJ Disease, also known as Turn Your Brain Into a Sponge Disease.
Psychiatrist Grace Jackson is a really wonderful person and her book Drug Induced Dementia is excellent.
Vitamin C is known to help reduce the toxic side effects of Lithium but seldom do psychiatrists are even aware of this.
Lithium Orotate, said to pass through the liver brain barrier easier and is less toxic, is now sold in health food stores.
Take care, Maria Mangicaro
DISCLAIMER: This comment is not intended to replace medical information and does not give out medical advice. Withdrawing from psychiatric medications can be dangerous; consult your treating physician regarding all such treatment decisions.
Lithium cannot “cause horrific conditions like CJ (Jakob-Creutzfeldt) disease.” There is one (1) report suggesting CJ-like illness in Li toxicity (plasma level >2 mM), in a 70-some year old patient and then only based on EEG patterns. No brain pathology was reported.
There is no evidence that Vitamin C reduces any toxic side-effects of Li. I hope that psychiatrists are not recommending Vitamin C to “reduce” Li toxicity. In the not so distant past, psychiatrist used to prescribe Vitamin E to reduce neuroleptic-related tardive dyskenesias, with no evidence whatsoever. Thank god, they have stopped the practice, as it can cause severe bleeding in some patients and nary an evidence that is efficacious.
There is no evidence that Li orotate is more efficacious than all other Li formulation or that is less toxic. Li orotate manufacturing is not regulated and the advocacy of unregulated medications is irresponsible, to say the least. It is sold as a “dietary supplements” not only in health food stores but also can be purchased on line in Amazon and the like. Li plasma levels have to be followed closely and other laboratories have to be performed. To tout the use of Li orotate with no medical support is the closest thing I have heard to malpractice, though in this case is glorified (with no evidence) by non-professionals.
Li is metabolized in the body as Na is, and follows the same routes of absorption and elimination. It tends to accumulate in cells because it “leaks” into the cells through Na channels, following activity gradients, but is not “pumped” out back through the Na/K ATPase because the intracellular Na site of the ATPase excludes Li in favor of Na. There is no particular participation of the liver in Li metabolism. What on earth is then the “liver-brain barrier?” Where is it located? How does it work? Sounds like Galenic medicine, not even Vesalius talked like that.
Please, is anybody there with any scientific background that can spot these dangerous off-the-cuff nonsense?
And, by the way, what all these “comments” by Ms Mangicaro about Li use has to do with the topic of haloperidol toxicity, the original theme of the posting?
Lithium is naturally ocurring – obviously, as a mineral: in the earth and some foods, ie, tomatoes. There is lithium on our bodies, including trace amounts in our brains,
It’s very toxic in large amounts, particularly 1,200 mg a day as prescribed by psychiatrists!
I happen to take lithium by water in trace amounts (Crazy Water brand from Mineral Wells, Texas):
I also take the “dangerous” type you mentioned – in 5 mg size, both lithiun orotate and aspartate forms.
There are a few articles about how orotate crosses the blood brain barrier more easily than carbonate. Look up Hans Nieper if you’re interested.
So, in short, I take lithium in small amounts. I listen to my body, and I’m careful.
And I could just give a rat’s backside what a psychiatrist or other conventional doctor might have to say about it. For the most part, I don’t trust the vast majority of doctors:
I decided long ago to be my own doctor. Sue me.
And if you take a couple of deep breaths, I bet you could learn a few things from my good friend, Maria.
Most of us are smart enough to know that all psychiatric drugs are dangerous with neuroleptics the most lethal drugs of all to create permanent “patients” out of people having temporary crises made permanent by biopsychiatry if the victims are unable to escape in time. Of course, lithium is equally deadly to those manipulated into taking this poison for bogus disorders like bipolar. Robert Whitaker exposes this debacle in his great works Mad In America and Anatomy of an Epidemic.
Like lithium, neuroleptics of all kinds make people feel like drugged zombies robbed of their humanity, libido, creativity, incentive, abilities and other horrors along with causing huge weight gain leading to diabetes, heart problems, eye problems, tardive dyskinesia, early death by about 25 years on average and many other complications if on these poisons long enough. Of course, biopsychiatry’s horrific stigmas or “spoiled identities” are lethal in themselves.
That’s why Dr. Peter Breggin, the conscience of psychiatry, has been a life saver for many who had life crises and made the fatal error of seeing a psychiatrist only to learn about Dr. Breggin’s very wise warning that “the most dangerous thing one could do is visit a psychiatrist” once the profession sold out to Big Pharma with the creation of DSM III in the 1980’s. Many of us credit Dr. Breggin as a hero who helped literally save the lives of our loved ones by writing such books as Toxic Psychiatry, Your Drug May Be Your Problem, 2nd ed., Reclaiming Our Children, Talking back to Prozac, Talking Back to Ritalin and many others.
Thus, whether one is prescribed first or second generation neuroleptics, the lethal effects are pretty much the same for bogus, voted in “disorders” invented to perpetrate the “collective fantasy of science behind the DSM,” per Dr. Allen Francis, editor of the junk science DSM IV. Dr. Francis also admitted in a Wired article Gary Greenberg that defining mental disorders is bullshit and there is no definition of mental disorders since you can’t define who’s normal or not. Gary Greenberg includes many other enlightening conversations with the powerful Dr. Francis in his great book, The Book of Woe, about how the junk science DSM has been the undoing of biopsychiatry or at least should be its undoing. The fact that Dr. Robert Spitzer, creator of the original junk science DSM III admitted that if any environmental stressors, toxic relationships or nasty social contexts were considered, the whole house of cards would fall apart shows that the DSM was invented to obfuscate and hide the causes of the extreme emotional distress to blame the victims and create permanent customers for the biopsychiaty/Big Pharma cartel. Dr. Spitzer has supposedly said he regrets the fact that context was not considered in the DSM, but that does not change the fact that many lives were destroyed as a result of this massive fraud including those of children and toddlers no less.
So, we have had to find our own life saving information in spite of biopsychiatry, thank you very much.
‘How does it work? Sounds like Galenic medicine, not even Vesalius talked like that.
Please, is anybody there with any scientific background that can spot these dangerous off-the-cuff nonsense?
And, by the way, what all these “comments” by Ms Mangicaro about Li use has to do with the topic of haloperidol toxicity, the original theme of the posting?
Thank you for giving us the most concise distillation of MD psychiatrist hubris we’ve been treated to here for quite a while.
The irony of someone that floods never-proven-diseased brains with Lithium calling someone else out for not being scientific enough is evidently lost on you. A biological psychiatrist invoking Galenic medicine to mock others! Don’t make me laugh.
Iodine is a good way to protect the thyroid if taking trace amounts of lithium by water or orotate form. Of course, most doctors know nothing about this.
Respectfully, I appreciate your honest and open critique.
Advocating for the health, safety and welfare of others is something that I take very seriously and I believe transparency in advocacy is a must. I would like to address the claims that you are making against me.
Considering some individuals suffering from symptoms of severe “mental illness” and “psychosis” engage in harmful behavior to themselves and others, and treatment of symptoms can involve limiting a patient’s personal freedoms and treatment options, strict scrutiny should be used in assessing the problems within our current paradigm of care, professional standards and proposed solutions.
I would like to note that Robert Whitaker correctly points out that psychosis can have “flu-like” characteristics of coming and going on its own.
While I do not claim to have a scientific background, I have taken courses in Human Anatomy and Physiology, Abnormal Psychology and have some training in complimentary therapies. I’ve also found resources at the medical library open to the public extremely helpful to gain insights into one’s own health problems. Not all information can be found online, therefore those involved in online-mental health advocacy must keep an open mind to the criticism of others.
Developing a shared perspective is critical to formulate an effective, economical, best-practice advocacy agenda that can be supported with a unified platform.
Concerns over the use of Lithium were introduced by a prior comment.
As a person who has taken Lithium, I have an experiential background and concern for others who may be taking it. As you can clearly see, I was cautious to add a “Disclaimer” on my statement as I am a peer and not a medical professional and I know my place.
The duty of care required of professionals is one of reasonableness.
Patients considered “mentally ill” are often deprived of the right to make reasonable decisions for themselves.
I believe that individuals labeled “mentally ill” should not be deprived treatment options. If Lithium is a treatment option, they should be provided with informed choice on the types of Lithium available. The patient is the ultimate consumer and should have the right to information and choice, regardless of their scientific background.
In 1996 I experienced an acute manic/psychotic episode. After being treated unsuccessfully with several different medications (including haloperidol) and suffering side effects that included severe-Parkinsonslike syndrome and tardive dyskinesia, symptoms were temporarily alleviated by treatment with Lithium Carbonate. It was a temporary solution, not a permanent fix.
A psychopharmacologist with a stellar reputation prescribed ascorbic acid because there is evidence to support it will help prevent toxic side effects and improve the patient’s quality of life. I was also advised to take Omega 3 supplements, which is reported by NAMI.
After spending two years cycling in and out of manic/psychotic episodes, I made the decision to incorporate complimentary therapies into my recovery strategy.
The use of Functional Lab testing revealed past exposure to Lead and other chemical toxins were impacting my health. I had been employed for 15 years in the prepress department of a printing company and exposed to numerous chemical toxins. I began a series of EDTA intravenous chelation treatments and noticed remarkable improvements in my mental health. Within 6 months I was able to taper off of all psychiatric medications.
On my own I explored the connection to chemical exposure and symptoms of psychosis/mania. Eventually I gained supportive depositions in a worker’s comp case to Substance Induced Psychosis/Mania and the dx of toxic encephalopathy. I have assisted 4 other individuals originally dx’d bp/sz and actually suffering from toxic encephalopathy establish worker’s comp cases.
During the past decade, environmental allergies, the routine use of over-the-counter cold and pain medicine, a bout of ocular shingles and bacterial infection from an abscessed tooth have exacerbated symptoms of psychosis but in each situation quickly came under control once the underlying problem was treated.
Prior to an acute manic episode, the only noticeable symptoms I had were yellowing of my eyes and memory impairment.
Just from a general science background, we understand the liver is the most important blood purification organ in the body and is the body’s principal chemical plant. By comparison, if a plant was built to perform all of the chemical functions of one person’s liver, it would have to cover 500 acres, so we understand it is a pretty intricate organ.
“The blood-brain barrier (BBB) is a dynamic interface that separates the brain from the circulatory system and protects the central nervous system from potentially harmful chemicals while regulating transport of essential molecules and maintaining a stable environment. The blood-brain barrier (BBB) is formed by highly specialized endothelial cells that line brain capillaries and transduce signals from the vascular system and from the brain. The structure and function of the BBB is dependent upon the complex interplay between the different cell types (such as the endothelial cells, astrocytes, and pericytes), and the extracellular matrix of the brain and blood flow in the capillaries”
“elevated blood lead levels (BLLs) impair the blood-brain barrier function…The blood-brain barrier has a very important function in maintaining the fluid environment of the nervous system. While other organs in the body transport molecules by the simple method of diffusion, the blood-brain barrier is very persnickety in that it selects only certain and essential water-soluble molecules (essential amino acids, glucose, calcium, sodium, and potassium) to be transported by carriers in the plasma membrane. This intricacy in the transportation of molecules through the blood-brain barrier explains the barrier’s susceptibility to trauma due to dangerous toxicants”
“The ability of lead to pass through the blood-brain barrier is due in large part to its ability to substitute for calcium ions. Within the brain, lead-induced damage in the prefrontal cerebral cortex, hippocampus, and cerebellum can lead to a variety of neurological disorders, such as brain damage, mental retardation, behavioral problems, nerve damage, and possibly Alzheimer’s disease, Parkinson’s disease, and schizophrenia.”
“Cerebral allergy is an allergy to a substance, which targets vulnerable brain tissue and alters brain function. Masked cerebral allergy can cause symptoms of mental illness (Walker, 1996; Rippere, 1984; Sheinken et al., 1979). Symptoms range from minimal reactions to severe psychotic states, which may include irrational behavior, disruptions in attention, lack of focus and comprehension, mood changes, lack of organizational skills, abrupt shifting of activities, delusions, hallucinations, and paranoia (Sheinken et al., 1979; McManamy et al., 1936).”
While doctors and many mental health advocates may not be concerned about “Drug-induced Creutzfeldt-Jakob like syndrome”, the patients who have taken the drugs or are being prescribed the drugs, might have a different opinion if they were aware of it.
“A patient with progressive neurological deterioration characterized by cognitive impairment, myoclonus, Parkinson’s syndrome, an abnormal electroencephalogram and fasciculations was considered for brain biopsy for suspected Creutzfeldt-Jakob disease. Complete clinical recovery followed discontinuation of lithium and nortriptyline. Awareness of this unusual drug-induced Creutzfeldt-Jakob like syndrome can avoid costly, invasive and unnecessary investigative procedures.”
Those with scientific backgrounds may have an advantage when it comes to understanding the language of the research but it is those with experiential background who have an understanding and compassion for the suffering and consequences of failed research.
While a tremendous amount of effort seems to focus on what treatment works best for symptoms of “psychosis”, there is a failure to recognize the importance of best practice assessment standards as outlined by the BMJ.
There is a great harm being done to mental health patients because of the failure of medical professionals to test for and treat underlying causes of psychotic/manic symptoms.
There is less reliance on medications when the underlying condition is treated. This is based on common sense, as well as scientific research.
I assume you’re a doctor.
If so, would it be possible to write your next comment in latin. None of us will understand it, and you will fee much smarter than the rest of us.
A win-win of sorts.
Only use latin when writing prescriptions?
That’s okay, never mind.
You’re actually going to go on about “Ca release in Fura-2-like experiments”, “vacuolizations to activation of caspases and what not,” Have abbreviations for SGN and FGN; and completely skip the fact that with either form (or subform) of these “medications” you are causing the brain to start producing more dopamine; and consequently a person can’t without difficulty get off of these “medications.” *The amount of loss of life; the increase in disability, relapses and loss of recovery. And the habituation, and addiction to turning off the natural functions of the brain; and call this “mood stabilizing” or a cure for psychosis; when statistics actually point out that it’s so much a con job (this disabling of natural brain functions as if the problem has gone away), things actually get worse. Well, then you need to go on about some sub-fixation with things that avoid and distract from the main effect (the INCREASE in mental illness, the suppressing of understanding of an innate expression of being human; see prior comments at the * sign…); and you need to have comparisons with older or newer brands or brand names or “what not,” sort of like advising beer is better because it’s a cheaper form of inebriation than Champagne or expensive wines.
Well one thing certainly is right, New and Improved doesn’t necessarily mean better in the Mental Health system. Neither do older treatments like Lobotomies necessarily mean things were better before. If I might point out: Cocaine use and Meth (both older medications, and both mess around with neurotransmitters to “alleviate” distress just like modern medications and maybe cause euforia like Electro Shock which could be considered either new or old also, and you don’t need a prescription for this; just enough money to make an illegal drug deal); this also wouldn’t be a good idea, *probably* even though they are older methods (and outside the realm of getting a pen, sandwich and speaker fees for representing), I think….And this also here that although we’re not having anti-depressant wars with China, we don’t necessarily need to repeat the Opium wars in finding a way to make everyone forget their problems….
Many individuals who appear to have psychological disorders have worked in industries that involve being exposed to organic solvents and heavy metals that have the same neurotoxic effects as psych meds. Psychiatrist are treating psychosis caused by a neurotoxin with other neurotoxins.
“Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year.”
Neurotoxic effects of n-hexane on the human central nervous system: evoked potential abnormalities in n-hexane polyneuropathy.
Y C Chang
Copyright and License information ►
This article has been cited by other articles in PMC.
An outbreak of n-hexane polyneuropathy as a result of industrial exposure occurred in printing factories in Taipei area from December 1983 to February 1985. Multimodality evoked potentials study was performed on 22 of the polyneuropathy cases, five of the subclinical cases, and seven of the unaffected workers. The absolute and interpeak latencies of patterned visual evoked potential (pVEP) in both the polyneuropathy and subclinical groups were longer than in the normal controls. The pVEP interpeak amplitude was also decreased in the polyneuropathy cases. Brainstem auditory evoked potentials (BAEP), showed no difference of wave I latency between factory workers and normal controls, but prolongation of the wave I-V interpeak latencies was noted, corresponding with the severity of the polyneuropathy. In somatosensory evoked potentials (SEPs), both the absolute latencies and central conduction time (CCT) were longer in subclinical and polyneuropathy cases than in the unaffected workers and normal controls. From this evoked potentials study, chronic toxic effects of n-hexane on the central nervous system were shown.
Here are some “side effects” of lithium as a supposed “treatment:”
Obviously, it is a real gem of a drug for bogus stigmas of bipolar or nonexistent “diseases” misdiagnosed for normal life crises, trauma, stressors and losses from abuse and other dilemmas lied and denied by biopsychiatry.
As Dr. Joanna Moncrieff exposes in her great book, The Myth of the Chemical Cure, the so called therapeutic effect of toxic lithium is about the same as the toxic effect that damages organs and the body in general.
I love the work of Dr. Moncrieff.
And I’m on your side in this debate, however I think it’s important to know that she gets lithium – in her diet. We all do. And we all need to – some may need slightly more than others.
I’m not suggesting that anyone get a prescription from a shrink for 1,200 mg a day:
by Lawrence Wilson, MD
© August 2013, The Center For Development
Lithium is one of the most important elements in the human body. Its main functions include:
1. It is needed to protect the brain against damage from oxidative stress. For example, studies have shown some benefit with natural lithium supplements for people with Alzheimer’s disease, other dementias, and those taking psycho-active medications.
2. It can help produce an increase in the strength and quality of the tissues that is quite subtle, but important in some cases.
3. Lithium is also used in every cell of the body for subtle functions, some of which have to do with mental development or enhancement of the brain.
4. Some patients have reported pain relief when they took lithium orotate or lithium aspartate. I do not know the mechanism for this.
SOURCES OF LITHIUM
The best sources are foods.
1. Mustards of all kinds, particularly organic mustard.
3. Sardines, and other fish and sea products are good sources, but we only recommend sardines due to mercury contamination of all products from the sea.
4. Blue corn, but only the blue corn, not other varieties of corn to the same degree.
5. Raw or roasted pistachio nuts are also a good source of lithium, but only a few every few days. Do not overdo on this food, as it is quite yin.
6. Cooked vegetables. In fact, this is one reason I recommend that 70-80% of the diet be composed of cooked vegetables. The only cooked or raw vegetables to avoid are: 1) the nightshade family of vegetables (tomatoes, potatoes, eggplant and all peppers). A little cayenne pepper is okay, but the nightshade vegetables are irritating and contain a poison called solanin. They are also much too yin. 2) mushrooms, summer squashes, okra and cucumbers. These are also too yin. Read Yin Disease if you wish more information about yin foods and their many problems.
7. Other. Noni juice, for example, has some lithium. However, I do not advise consuming this very much, as it is very yin, as are most fruits.
8. Lithium supplements. Some people need more lithium than they can obtain in foods. Common supplements are lithium orotate or lithium aspartate.
IMO, a person should be very careful if they decide to take lithium orotate or aspartare; in small amounts, hopefully working with a holistic doctor, who may suggest taking iodine to protect the thyroid.
To clarify, I agree with you that lithium as used by psychiatry – in high amounts, is toxic. In fact, these toxic level doses can cause coma and death.
I hope you know that I appreciate your presenting the facts about the dangers of psychiatry – not only with lithium, but the other drugs, ECT, and other barbaric “treatments.”
“Seeing a psychiatrist has become one of the most dangerous things a person can do.” – Peter Breggin, M.D.
Thanks for your kind words and validation of the toxic effects of psychiatric drugs for bogus, voted in life destroying stigmas to push toxic drugs/ECT and other barbaric tortures in bed with Big Pharma/business to prey on the majority suffering normal human dilemmas, extreme stressors and other crises.
I know that you have studied the more physical and biological causes of emotional and other distress and I have not, so I’m not qualified to comment on your views that small amounts of a certain kind of lithium or other substances might be helpful. Given that lack of knowledge on my part, I would not be inclined to experiment with it given what I know about it with regard to toxic psychiatry. But, for those willing, able or qualified to do the research, it is up to them to make their own personal decisions for their best interests. The Alternative Mental Health or Safe Harbor web site deals with such alternative natural and other methods too.
You are right that I have done tons of research about such toxic psychiatry with its life destroying stigmas and deadly torture treatments to mostly cover up massive human inequality and corporate/government predation on the majority of people for greed, power and profit. Therefore, that is mainly what I feel knowledgeable about.
Further, this supposed expert criticizing us as incompetent non-experts fails to realize or admit that we have researched the many best experts and doctors on the topic who also have a conscience, so we are citing them and not something we have made up ourselves unlike mainstream psychiatry with its never ending stream of corrupt junk science, bogus studies with fraudulent positive spin, ghost written journal articles and other massive crimes against humanity for self serving interests.
The author of this blog, Dr. Steingard is one of many psychiatrists struggling with what she and others are discovering is a rather corrupted enterprise with mainstream psychiatry. Thus, she has read books by Robert Whitaker, Dr. Joanna Moncrieff, other experts at the Critical Psychiatry Network, 1boringoldman and many others to help her challenge the current paradigm of biopsychiatry that serves the interests of the select KOL’s and leaders of the APA rather than the interests of the majority of psychiatry and their clients.
Thanks for your support Duane. I didn’t see your views on your use of lithium challenging my input on toxic levels of lithium used for supposed therapeutic effects on nonexistent brain diseases by biopsychiatry. Unlike certain others, I try to avoid commenting when unfamiliar or biased about certain topics.
Nasrallah has continued the discussion on his site, Current Psychiatry.
A forum for haloperidol http://www.currentpsychiatry.com/home/article/a-forum-for-haloperidol/0f52df0a52419383f4488a33d2127170.html
“The efficacy and neurotoxicity of haloperidol are independent mechanisms. Blocking dopamine receptors controls psychotic symptoms, but neurotoxicity involves triggering apoptosis, increasing free radicals, binding to sigma receptors, increasing intracellular calcium, decreasing neurotropic factors, increasing P53, T-box, Jun kinase, etc. Neurotoxicity is separate from extrapyramidal side effects. Similarly, the neuroprotective effects of atypical antipsychotics, such as enhancement, neuroplasticity, increasing neurogenesis, and growth factors, are separate from their antipsychotic efficacy.
The assertion about the neurotoxicity of haloperidol is based on 28 published studies in neuroscience journals (which are rarely accessed or read by clinicians). Thus, the terms “premature and damaging” do not apply. I served as a messenger summarizing all these destructive properties of haloperidol1 and I certainly was prepared to parry and deflect some arrows.”
You don’t do science by counting how many published studies you’ve found that support your case, or showing how huge list you can make of different chemicals that maybe relate to haloperidol neurotoxicity.
“I served as a messenger summarizing all these destructive properties of haloperidol1 and I certainly was prepared to parry and deflect some arrows.”
I guess in reality he wasn’t really prepared for the feedback that he’d get. If you do a Google search for for instance, “nasrallah haloperidol”, this thread comes up before his writings.
If there’s one thing Nasrallah is certainly supporting for, it’s the use of “atypical” neuroleptic injections. They have a patent for many years. He suggests for a more wide use of “atypical” neuroleptic injections. He also suggests that as a psychiatrist, once you’ve started a patient on an injection, you should never stop, you should not even switch to an oral form of the same drug, because disaster will ensue. This is already known.
However, he’s also promoting the oral form of a new neuroleptic Lusaridone, which is kind of haloperidol of atypicals. It hits dopamine D2 very hard, and also serotonin 5-HT2a which perhaps entitles some people to claim the drug “atypical”. It hits those receptors very hard but doesn’t work so much on histamine receptors, etc. Apparently, the results haven’t been very good. However, Nasrallah has been very excited about this particular drug:
Nasrallah: Newer Atypical Antipsychotics Draw Praise
“It has placebo-level metabolic effects,” said Dr. Nasrallah, professor of psychiatry and neuroscience at the University of Cincinnati. “The metabolic profile is better than for Geodon [ziprasidone] or Abilify [aripiprazole], which are currently accepted as the least metabolically adverse atypical antipsychotics.”
Earlier on this thread I posted about Nasrallah’s opinion about weight gain and neuroleptics:
“Dr. Nasrallah: Yes, I analyzed data from CATIE as part of the metabolic working group and am presenting the findings at the 2007 Society of Biological Psychiatry and American Psychiatric Association meetings.[13,14] Because several investigators had found that patients who gain weight seem to respond better, a statistician and I examined the relationship between weight gain and therapeutic response. We found a strong relationship between weight gain and improvement on PANSS positive-symptom and total scores across all the medications prescribed in CATIE, whether FGA or SGA. In each case, the more the weight gain, the lower the psychosis score at the end of the study.
This finding suggests that weight gain is part and parcel of improvement, although excessive weight gain, which happens with some of the SGAs, is not necessary. We know that patients with schizophrenia already have high risk for metabolic syndrome with and without antipsychotic treatment, and they tend to be poorly treated for diabetes, hyperlipidemia, and hypertension.”
Can’t you see, that with your own pharma propaganda of drug propaganda concerning lurasidene, you contradict the incredible suggestions you made earlier concerning weight gain and typical/atypical neuroleptics?
Lurasidone is the haloperidol of atypicals (D2 Ki = 1.7 nM, 5HT2A Ki = 2.0 nM). If you think that haloperidol should be banned, then a ban on lurasidone should be considered as well. Yet Nasrallah promotes it.
Two days ago I for some reason googled for “lurasidone”, or whatever, I don’t remember what I googled. Google showed up a new article about lurasidone where the drug again “draws praise”. It was a recent one, released just a day or so ago. It got up to the most recent Google results.
By: MITCHEL L. ZOLER, Clinical Psychiatry News Digital Network: “Lurasidone’s potential for bipolar depression draws praise”
Here Mitchel L. Zoler tries to promote that luresidone is great for bipolar, never mind it works like haloperidol except it also works on 5-HTA. He’s getting funds from the makers of luresidone with a brand name Latuda.
When researching this thing, I noticed there were some sites which immediately released this article or at least a reference from Mitchel Zoler. These sites all come from the same ip address and they all look the same next to next another.
http://www.clinicalpsychiatrynews.com canonical name = clinicalpsychiatrynews.com.
Some of the sites under this scheme:
* http://www.clinicalpsychiatrynews.com This is the place where Nasrallah “Draws praise” to Larusidone
* http://www.currentpsychiatry.com This is the place where Nasrallah is the leading director or whatever. “Findings” about Larusidone were published here, or at least now a link to the next site ..
* http://www.familypracticenews.com/ At the current time, here’s the article that draws praise: http://www.familypracticenews.com/single-view/lurasidones-potential-for-bipolar-depression-draws-praise/c0456654064f771cdc0a50b6117c83b9.html
All of these sites come from the same ip address 220.127.116.11 and all of them look like some crap shit made for idiot doctors.
The site Current Psychiatry has this kind of idiotic polls for random psychiatrists. Many of them try to promote lurasidone between the lines.
“Mr. P, age 25, has a history of schizophrenia. His psychotic symptoms respond well to olanzapine, but he gains 30 pounds in the first 2 months of treatment and his blood glucose level hovers in the pre-diabetic range. How would you treat Mr. P?
21.7 % Obtain baseline metabolic data and monitor him monthly 97 votes
33.2 % Switch to a newer antipsychotic, such as lurasidone 148 votes
11 % Lower Mr. P’s olanzapine dosage 49 votes
34.1 % Recommend diet and exercise 152 votes”
Ms. Z, age 31, has a history of bipolar I disorder, which has been well controlled with risperidone, 2 mg/d, for 5 years. She recently learned that she is 6 weeks pregnant and is concerned about risperidone’s effect on her baby. How would you treat her?
0 % Maintain Ms. Z’s risperidone dose and educate her about the risks of untreated illness No votes
0 % Switch Ms. Z to quetiapine, 400 mg/d No votes
0 % Switch Ms. Z to lurasidone, 40 mg/d No votes
0 % Discontinue risperidone and schedule frequent follow-up appointments No votes
I’m afraid some IDIOT DOCTORS will soon start to prescribe lurasidone to their patients because of this kind of IDIOTIC PROMOTION.
I actually *learned* from some psychological testings and I think some of the questions were suggestions and / or designed to be informative. A lot of them annoyed me and I felt like I needed to protect myself from the actual test itself.
And when my honest, truthful answers weren’t accepted and I was harassed into giving a different answer (one that was wanted), that was the beginning of my full, conscious awareness and recognition that this entity WAS actually against me and not FOR me.
Manipulation, manipulation, manipulation (and that’s something that I personally abhor in human behavior).
I never use this long term and refuse to but when my April to December manic season comes, I have 2.5-5 mg of Haldol and 2 mg of Ativan and within a week or two, I am practically back at baseline but I also have psychotic features with my diagnosis as well. Mania is a different animal to the schizophrenic disorders but the psychosis often toward the end really make things hard to do period on a behavioral level.
I regularly take Lamictal and Dexedrine which ironically are two meds that will seem to keep me stable and calm but I also spent years on both of them and it is odd that this helps. I use Klonopin for panic attacks during thunderstorms and it is all that has worked because it startles my heart and I can’t use skills while the storm is happening and they are no good for long term either.
I think that manic depression at it’s extreme can be bad and is possibly something different with the psychotic component but one thing I love about this, is that there is focus on psychosis. I am grateful my experience with psychosis isn’t as extreme or longer lasting but I have a great amount of respect for you for doing this. Thanks.
Dr. Steingard – I mean you no disrespect with what I’m about to say but quite frankly, I was stunned when I learned that you are a Medical Doctor who had possessed so little knowledge about the
negative effects of the medication called Haldol. Particularly considering that your bio states that you participate in your “community mental heath practice.” I think it would behoove you to change your focus from studying how Big Pharma’s advertising influences clinical practice to Big Pharma’s influence on millions of people’s lives through their dedication to the Almighty Buck in lieu of ethical behavior in the mental health industry.
Ms. Steingard, I learned about the deleterious effects of Haldol around 2009-2010 – from a good friend who studied Neuroscience. The few things he told me about Haldol were extraordinary enough that it compelled me to do my own research on the drug. I wanted to learn more about this drug that was so toxic to brain tissue. Coincidentally, I encountered a patient who was taking Haldol when I was at a hospital visiting someone – and the man was clutching both sides of his head, and exclaiming, “It’s
eating my brain!!” Needless to say, the man was escorted back to his room and I’m sure no one believed that his brain was actually being eaten. But years later, I learned that Haldol indeed destroys brain tissue – and I thought back on that gentleman – and realized he was probably right.
It should be noted that the extent of my formal education was high school. I have learned more by looking for the learning and self-education than I did in the public educational system. That said, it truly escapes me that you could have gone through four years of undergraduate study plus four years of medical school to acquire your MD degree – not to mention the years of residency you surely put in – and still have no real knowledge about the perils of Haldol; to the point where you were wary about believing the well-researched information in Dr. Nasrallah’s article! You even refer to his paper that
contained the (valid) information that “Haloperidol (Haldol) is bad ..” as “new knowledge”!! Truly, what were you thinking? I realize you wrote this article in 2013, but my goodness; I learned that Haldol was “bad” years before 2013.
Haldol is a “Neuroleptic.” In your reference to Dr. Nasrallah’s article, it seemed to be news to you that the 2nd generation neuroleptics are safer than the old ones like Haldol – and then later in your article, you actually state this:
“The current evidence suggests there is no differential efficacy between the older and newer neuroleptics.” I don’t know where you’re getting your information, but everything I’ve read just today is that the newer ones are not as harmful as Haldol. (From my perspective, no neuroleptic is good.) What I’ve learned is that the only reason they still prescribe Haldol is because it’s cheaper than the new ones – which actually doesn’t make much sense since Big Pharma’s primary directive is the Almighty Buck.
But of paramount importance, are the ramifications of consuming a neuroleptic like Haldol – which I shouldn’t need to educate a medical doctor about. Since you claim to have read Dr. Nasrallah’s paper, you learned that older generation neuroleptics incuding Haldol cause grave effects on the brain, such as apoptosis, necrosis, mitochondrial damage; much more. I have read about the devastation caused by Haldol in other papers as well, and Dr. Nasrallah’s data was the same – and he referenced twenty-eight studies reporting the various destructive effects of Haloperidol on brain tissue that were published in
prominent Neuroscience journals, based on work in animal models, cell culture, and post-mortem human tissue. There’s a great book I came across that is definitely required reading for you called “Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex.” (Author: Peter R. Breggin, MD) One of the chapters is “Deactivation Syndrome Caused by Neuroleptics.” The author cites research going back into 1980’s and even as far back as 1937 – so again; it really escapes me how you admittedly possess very little knowledge that Haldol is bad. Perhaps if you hunker down and start conducting real research by reading white papers instead of asking viewers to tell you about articles they think you should read, you’ll garner reliable and credible data. I mean, really; getting your information from articles people think you should read??! What’s wrong with that picture?
A medical doctor should already be well-versed on where to obtain reliable information.
Your apparent lack of comprehensive education is very similar to many people who profess to be medical doctors today – it seems that what the universities are teaching you is not dedicated to learning cures – doctors today are only taught “treatments” not “cures.” They are not schooled on many things they used to be. My own doctor had never heard of the unprecedented Fukushima event! Keeping oneself aware of current day events that have the widespread propensity to negatively affect the health of the entire country is an imperative every medical doctor should be doing. Doctors should be educating their patients on suggested supplementation to repel potential illnesses that the presence of excessive background radiation can cause. But, my doctor was totally unaware of the Fukushima event! Doctors don’t really seem to address preventative measures these days either.
In addition to the required reading I suggested to you above, I’m giving you the link below, to a must-watch video – it will provide you with a wealth of information about the collusion between the psychiatric and pharmaceutical industries, and what they have collectively focused on since 1967. They’ve turned it into an industry that rakes in over one-third of a trillion dollars every year! Watching this video is the most important thing you will do this year – do it for your patients – do it for you:
“Making A Killing: The Untold Story of Psychotropic Drugging” here’s the link:
Dear Dr Sandra
MODECATE mentioned beliow is FLUPHENAZINE
For example, a study published in 1982 reported that when a group of patients with schizophrenia were each given 20 mg of fluphenazine, the difference between the highest and lowest blood level of the drug was 40-fold.5
Adverse Drug Reaction Warning Request Letter sent to Galway Nov. 8 1986
ADR Request ltr Pg 1
ADR Request ltr Pg 2
ADR Request Ltr Pg 3
The Irish Record Summary dated November 24 1986 was Sent To UK In Response:- but WITHOUT Requested ADR WARNING
Irish Record Summary Pg 1
Irish Record Summary Pg 2
Wellness Presentation at Galway in November 1980, according to Dr Fadel https://drive.google.com/file/d/0B0zhbh8V4MBANjBTZEtkbjBhMkU/view?usp=drivesdk
Dr Donlon Kenny False Reasurrance Letter November 1986
Near Fatal Modecate (Fluphenazine) Experience 1. https://drive.google.com/file/d/1EY4XDLt04KgmCjg_5wXU-kbVezo_DxL4/view?usp=drivesdk
Near Fatal Modecate (Fluphenazine) Experience Pg 2
Dr Allen Frances (DSM IV) 1983 https://www.researchgate.net/publication/16313058_Suicide_Associated_with_Akathisia_and_Depot_Fluphenazine_Treatment
“…Significant symptoms of akathisia occur in:
around 20% of people on an antidepressant.
at least 50% of people on an antipsychotic. On higher doses, this rises to 80% or more..”
“..Around half of people on antipsychotics develop the condition…”
“…..Neuro-psychologist Dennis Staker had drug-induced akathisia for two days. His description of his experience was this:
“..It was the worst feeling I have ever had in my entire life. I wouldn’t wish it on my worst enemy…” ”
Drug induced Akathisia is medically acknowledged to cause suicide.
“Depot Antipsychotic Revisited Research Paper 1998” From Galway Psychiatrist Dr PA Carney.