Taking “Anti-Psychotics”
When You Are Not Psychotic


The Wunderink study has been discussed here in other blogs (herehere, and here). In brief, using a randomized control design, Wunderink found that in adults diagnosed with a psychotic disorder continuous use of neuroleptics was associated with worse functional outcomes than intermittent use.  Higher doses were associated with worse outcomes than lower ones.

These days neuroleptic drugs are widely promoted to treat depression and they are often used “off-label” to treat behavioral problems in children.   They are among the most widely prescribed drugs; given the theory that “schizophrenia” affects 1% of the population, it is clear that many individuals – adults and children – who do not have this diagnosis are prescribed these drugs.

Is the Wunderink study relevant to those who do not experience psychosis?

As Joanna Moncrief has argued, there are many reasons to think in a drug-centered rather than a disease-centered way. For instance, it is not controversial to state that the benzodiazepines (Valium and others) affect everyone in similar ways; they will induce a soporific effect on anyone, not just those who have difficulty with sleep.

Although it may be less obvious, we should expect that neuroleptics have similar effects on people regardless of the diagnosis.  When we learn that individuals diagnosed with Schizophrenia who take these drugs over several years are less likely to be working, we need to be worried about everyone who takes these drugs over an extended period.

I am not sure child psychiatrists or adult psychiatrists who prescribe these drugs for depression will read the literature on schizophrenia.  In a recent report, it was noted that there was a three-fold increase in the incidence of diabetes in children who are prescribed these drugs.  It is straightforward and obvious why child psychiatrists should be concerned about that report.  But Wunderink’s study raises even more concern.

If psychiatrists choose to prescribe neuroleptics to children, depressed adults, and others, I do not think they can ignore the increasing data on  impaired functional outcomes associated with long term use of these drugs.

First do no harm.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. Working in workers comp I deal with many folks with chronic back pain who have been put on these drugs (zyprexa and even more often Seroquel) simply as an industrial-strength sleeping pill. The results can be a devastating pile-up of side effects that are the LAST thing you need if you’re coping with a serious back injury: serious, debilitating weight gain and diabetes, drowsiness. I’m sure the long-term effects on your mental abilities are not good either … of course so many doctors are giving these drugs out in tandem with the Vicoden, Ambien, Xanax and lord knows what all else that fixing the blame can be a delicate task …

    I also wonder if these drugs — especially Risperdal — are doing their nasty bit to contribute to the breast cancer epidemic in this country. They do boost prolactin and can cause men and boys to develop female-type breasts. I read last year that women with serious mental illness have three times the breast cancer risk as the average American woman — and breast cancer is NOT strongly linked to smoking so that’s not a likely explanation.

    • My friend, a guy, was overprescribed Risperdal and developed prostate trouble. This contributed to his losing his job.

      I missed periods due to Risperdal. I had bone loss and broke my leg. Then Seroquel caused rapid weight gain and, I assume, a dangerous and risky spike in estrogen. I’d say the only advantage of all that eventually was that my bones healed. I didn’t care for being twice the weight I should have been, nor the discrimination. Not only that, afterward my treatment team denied that I ever had prolactin problems and denied that I had had osteoporosis from it, but it really did happen. This is coverup!

      I don’t understand why doctors don’t own up to their errors. I never understood their reluctance to admit Seroquel caused weight gain. At 200 pounds I could no longer walk and was in a wheelchair for three months. And my therapist was telling me to Accept Myself! Hah! And get bigger and bigger? I couldn’t walk nor even stand up, and I was supposed to accept this as inevitable and never ever blame the drugs nor those that gave them to me….

      I’m so happy that I told them to go screw in the end. I’d tell that to anyone. Take charge of your health. Just stop believing what doesn’t even make sense to you.

      They are not gods. They are not gods. They are not gods. Please stop worshiping doctors. You don’t need their permission to live your life. Don’t let them run your life. Go be happy, be free, be yourself and live.

  2. ” I read last year that women with serious mental illness have three times the breast cancer risk as the average American woman”

    I wonder – of the serious mentally ill women, how many are within the poverty levels? How many have histories of childhood sexual abuse, neglect and all other abuses? How many are within the middle class (lower middle class? upper middle class?) and how many take yearly family vacations? How many shop for their clothes and shoes at WalMart and how many shop at American Eagle and the mall? How many are upper class (oh, silly me – they’re NEVER included in the statistics, lol).

  3. I wanted to comment that, tapering off of Seroquel has illuminated for me, at least in a subjective way, what that “something” Sandy refers to looks like from the perspective of someone experiencing a psychosis (let’s please just call it that for purposes of this post), and then what it looks like for someone who, years later but still on Seroquel but no longer experiencing a psychosis. There has been much said about neuroleptics being little more than tranquilizers that induce people to no longer care about the concerns they have while in the throes of a psychosis. Subjectively, that seems right as a mechanism of action from my experience. While hospitalized, my experience was I suspect no different than many of the other folks on this site. Which is that, the more I communicated my distress and defended my reasons for it, the higher the psychiatrist increased the dosage. Eventually, yes, I was so sedated that I forgot what I was so concerned about and then, by the time sufficient wits had returned to me, I became newly more concerned with immediately practical things such as, most significantly, earning my clothes back and then getting out of the hospital so that I might mitigate damage to my personal relationships and employment situation. Notably, as I suspect is also the experience of many here (perhaps not the people you’ve worked with, Sandy), so long as the offending beliefs were no longer being emphasized by me, no effort was made by the psychiatrist to revisit what exactly the beliefs were about and where they came from. Instead, the (highly questionable in my view, if true) standard of care appears to be to avoid any discussion or further thought of the beliefs, so as to avoid a return to them and the purportedly accompanying high risk of succumbing to them as a result. Fast forward to 8 years later, and, while tapering off I notice something which, subjectively to me was chilling. I’d forgotten a dose and then took one mid-day, to keep up because I am being extremely deliberate and vigilant with the taper, which I very strongly recommend to anyone out there interested, because so far it has been successful even for someone with 4 prior episodes. But I took this mid-day dose only after having been used to the greater clarity I had acquired from having begun the taper. So as a result, what appeared to happen — without my having at all anticipated it — was that, while I was engaging in conversation I encountered greater difficulty than had been the case following the recent cognitive gains, in keeping track of my thoughts. It was as if a thought would flee from me just as I was articulating it. I wonder if this effect has been examined more closely, beyond fuzzy descriptions of tranqulization and reductions of symptoms. This concerns both the un-psychiatrically-diagnosed as well as, also seemingly relevant to Sandy’s post, the diagnosed who are no longer suffering from acute psychosis. As I described elsewhere on this site, Seroquel certainly seems to makes you no longer care about your immediate concerns, and may make you in fact forget any train of thought you happen to be communicating at a given moment. Especially if what you’re trying to communicate is something you care about — the more passionately you feel about something, the more important the point you’re trying to make, the very thing that you’re trying to convey: those thoughts and feelings are snuffed out and silenced by the effects of the drug. The drug stands between the self and the outside world. The intended and actual effect of neuroleptics reminds me of something Nietzche wrote:

    “Consider the cattle, grazing as they pass you by. They do not know what is meant by yesterday or today, they leap about, eat, rest, digest, leap about again, and so from morn till night and from day to day, fettered to the moment and its pleasure or displeasure, and thus neither melancholy nor bored. […] A human being may well ask an animal: ‘Why do you not speak to me of your happiness but only stand and gaze at me?’ The animal would like to answer, and say, ‘The reason is I always forget what I was going to say’ – but then he forgot this answer too, and stayed silent.”

    “Untimely Meditations,” by Friedrich Nietzsche

    • I can attest to everything that you mentioned about your experience with Seroquel. I was a “patient” in the state hospital where I live and over and over again I witnessed psychiatrists upping the doses of the toxic drugs for anyone who complained about the bad effects they were experiencing on the damned things. “Patients” were never listened to, just given higher doses of the drug they complained about! How much sense does this make?

      As a staff person at this same hospital I witness people who come in very much able to express themselves turn into people who can’t hold one thought in their head. It saddens me to sit with them and listen to them try to express their ideas and not be albe too….they just stop and drift away somewhere and then get frustrted because they can’t say awhat they want to say. I meet these people when they come through Admissions and then I watch them deteriorate into people who can barely state their name. And this is considered the “best practice of care.” I also know that the doctors never, absolutely never, discuss the “offending beliefs” and just keep poking people full of the toxic drugs. So, the end result of this is that people keep coming back again and again through the revolving door in Admissions because no one ever helps them deal with the issues that cause the “offending beliefs” in the first place. And then everyone stands around and wring their hands and lament the fact that the “revolving door” exists! It’s disgusting and sickening and I get to see it all on a daily basis!

      Thanks for sharing your experience and I’m glad that you’re getting off the toxic drugs.

      • I saw many patients sitting in a drugged daze as their family and friends tried to ask the staff what is happening only to be told the doctors knew best. It was particular sad when the family wasn’t English speaking or very elderly so their concerns were easily dismissed.

  4. Respectfully, it is for you, mjk. I can only speak for myself. And as myself I recognize that, notwithstanding the experiences and grievances we may all have in common, we cannot speak for each other. There are some whose voices are not heard that some of us may feel, with strong basis I believe, we should take it upon ourselves to amplify. There are surely others who lack the ability or information to make sound judgments on their own behalf, who may need the assistance of others. But there are also others whose decisions regarding their use of psychiatric drugs (including decisions to take them, in whatever circumstances) are fully informed: informed by science, by opinion (both mainstream and other opinion), by peers, and, most of all, by their own subjective personal experience. I don’t purport to speak for them, or, for that matter, for anyone else who chooses not to adopt my opinions. Nor could I, because I agree with many of you here that each person is entitled to his or her own decisions about what they do with their bodies, in the end. I would focus my energies as an advocate, if I were one, on making sure that all of those at risk are fully informed in all relevant respects.

    • So, you think I’m speaking for others?

      You may ask me to clarify but please, don’t presume to know my meaning or intention.

      “some of them appreciate the effects of the drugs”

      Let’s remember that we’re primarily dealing with psychology. Psychiatry is the *response* to the psychopathology.

      I made my point clear:

      “But I wonder if there’s any psychological screening to determine whether it’s the successful effects of a drug or if there’s a desperate attempt to win approval and be loved.”

      I was using critical thought. To expand on that critical thought, the basis of it is precisely this:

      Are claims of drug efficacy automatically and passively accepted, without question? We ALL know that many people LIE in locked-ward settings in attempt to get out.

      What’s to say the same manipulations aren’t present in clinical settings, including outpatient hospitalizations?

      I hope somebody sees the point I’m getting at. I feel like I’m making it very clear.

      • To anyone,

        Oh yeah, and I have to defend myself just a little bit:

        I wrote, “Or, maybe for those people – it *is* the drug talking and they truly feel better because of the drug.”

        So I *wasn’t* denying or undermining people’s claims of drug efficacy. I acknowledged the possibility (and for some, their reality?) of drug efficacy.

        ~ mjk

  5. There are reasons why people may “feel better on the drug” which don’t have to do with simply kidding themselves or desperately seeking the approval of doctors and others who have power over them. We now have a black market in Seroquel in this country, both on the streets and in our prisons. My guesses as to the reasons: first, people are dosed with this stuff both in prison and in the US armed forces as a remedy for agitation and anger, nightmares, insomnia and PTSD. Once you’re on it, it appears to be wicked hard to stop, with “rebound” distress that may be worse than the distress you felt before the Seroquel. I do not know if it can actually cause “rebound” hallucinations or paranoia — maybe Sandra does?

    Another reason is that people are living in hellish environments and dealing with hellish things (especially in prison and the army which are both producing people with the constellation of suffering we call PTSD). When you’re going through hell, a pill that lets you sleep 12 hours a day starts to seem awfully attractive.

    Finally, I’ve never experienced classical “paranoia” but have watched it from the outside (both in people on coke or PCP and those said to have schizophrenia). It looks like a terrifying experience. I would not judge anyone who took Seroquel or Zyprexa in a crisis of this kind. I just think they need to know that these drugs are like chemotherapy, terribly damaging in the long run, and just as you wouldn’t take toxic chemo drugs a day longer than necessary, you should never let anyone sell you Zyprexa or Seroquel as a long-term solution.

    • Hi Johanna,

      “Once you’re on it, it appears to be wicked hard to stop, with “rebound” distress that may be worse than the distress you felt before the Seroquel. I do not know if it can actually cause “rebound” hallucinations or paranoia ”

      At least if Seroquel is taken in “antipsychotic” doses, say maybe 600 mg – 800 mg, withdrawing from that can cause at least in principle “supersensitivity psychosis” like other neuroleptics (see Seeman, etc). I’ve also observed some people trying to quit Seroquel and I’ve quit it myself too, and I think another thing is that at lower doses, even 25 mg or less, it has a very strong sedating effect, largely from its antihistamine action (similar to Benadryl). Because their bodies have got accustomed to these effects, people may have trouble sleeping without Seroquel, etc. Maybe some people find use for its sedating effects. Anyway, yes, I guess most people don’t find it very pleasurable or addictive in the sense of benzos or opiates, but maybe some people want to use it for its sedating effects.

  6. When my son ended up in psychiatric care he was paranoid and totally out of touch with reality. He was coaxed into taking haloperidol and within 15 minutes he was back to being his real self. Two days later he wanted the psychiatrist to help him off the medication but he refused and my son was forcibly drugged with Risperidone. So my son had to pretend that he was getting better to get out of hospital. Nobody took seriously the side effects he was having either. Getting discharged was the only way of getting off the meds, behind doctors backs of course. He developed all the symptoms of Parkinson’s, hyperprolactinimia, couldn’t stop eating, was permanently dizzy etc. and not one doctor took him seriously, they were saying that he was doing. fine. Nobody inquired where his paranoia came from or discussed it with him. They weren’t interested.

  7. I had been on Zyprexa and Seroquel some years ago. I developed Seroquel Diabetes and Seroquel Acute Pancreattis (lengthy hospital stay). These drugs make me incoherent, scared, akathsia, tardive dyskinesia..horrible side effects the psychiatrist dismissed as worsening mental illness.

    The drugs were given to me because my psychiatrist deemed me crazy and changed drugs and doses every visit. To everyone but him saw a drugged obese woman who rambled and couldn’t sit still. These drugs took away my will, my life and make a non ill person sick. I tapered off all my psyche drugs and fought a determined battle with the withdrawals that I won.

    I was told by other physicians I’d never been mentally ill and the damage from long term atypical prescribing?? Physically I’ll never be well but my mental clarity is beautiful and the return of drug free calmness is describable.

    It will always boggle my mind I was prescribed atypicals and how they caused me great harm. In no way did they help me.

  8. I was chemically raped for twenty five years when I reported to doctors about my
    distress stemming from being sexually assaulted and battered for the first 16 years of my life. The coma-like sleep from the drugs was a relief, but like suicide, psych drugs are a permanent “solution” to a temporary problem. My brain was not broken before, but it, and every body system, is sure broken now, by the people who said they were helping me.

    I appreciate what you do Sandy, but this is a holocaust and your voice is a whisper in the roaring flames.

  9. I was looking for documentation on the effect of antipsychotics on dopamine firing. I was given multiple antipsychotic drugs over many years and I was never psychotic. The first was Thorazine. I kept telling them I had an eating disorder and when I said “the drug isn’t working” I meant “It isn’t helping my eating disorder” but since they didn’t recognize that I had ED, refusing to acknowledge that ED was anything that mattered, they had no clue what I was talking about nor how much I was suffering. They only raised the drugs, thinking I was complaining about something vague and psychosomatic. I ended up on three antipsychotic drugs that did not help my eating disorder. They were raised to the highest doses, including Seroquel 900 and other antipsychotics. None of these drugs helped me. I needed to be listened to, not drugged. The side effects were horrific, including bone density loss from Risperdal. When my weight shot up 110 pounds my bones mysteriously healed, I believe because my estrogen must have hit the roof from rapid weight gain from the Seroquel. Then they had the nerve to tell me I never had bone loss since somehow they ” misplaced” the old records. They couldn’t deny that I had broken my leg, though.

    I lost all that weight and then some. I kept wondering about what taking all those antipsychotics would do to me long-term. I have heard your dopamine can get badly screwed up because your brain is signaled to overproduce it. So maybe that is why I couldn’t sleep all the sudden. Five years of that insomnia, it was bad bad bad. Also, i get hiccups all the time, which is embarrassing and sometimes I choke from the hiccups. I heard that could be dopamine. I just don’t tell anyone about my former life anymore.

    34 years slavery to psych…..Lost years. No one should have their life stolen from them like that.

  10. My boyfriend was force-drugged with Clozaril and he’s dead now.

    One day, maybe around 1992 or so he said to me, “Jules, maybe I am not mentally ill because I know when I was diagnosed they didn’t take alcohol withdrawal into account. But I learned in AA that what I went through was alcohol withdrawal.”

    I know at that time, both of us were very scared to defy our doctors or deny that we had illnesses. It would have angered our families. So we stayed on the drugs. We were stuck being designated patients, but lucky to have each other for many years. I believe it wasn’t just smoking that killed him.

    I also see that my siblings expected me to stay a patient forever. Aw, shucks. Did I disappoint them that I didn’t stay stuck in that godawful role? Uh oh, here comes trouble……

    • Hi Julie,

      I identify with your boyfriend. One of the reasons people are so happy to join the AA is because they are immediately surrounded by people who understand them and have their best interests at heart.

      The experts on alcohol and alcohol withdrawal are the AA – not the medical profession.

      Any heavy drinker can see things and hear things and experience panic, anxiety, strange ideas – when they stop drinking.

      A regular and controlled drinker (anyone) can experience lots of ‘symptoms’ six months further down the line.

      Alcohol dependency can have no physical symptoms. A controlled and dependent drinker can pass all the health checks – but still appear mad when they stop. And there’s no special rule for what normal drinking is.

      • So what does AA say about nondrinkers? That was a difficulty I had. I had ED for sure, but no interest in booze whatsoever. I have tried it but just do not like it. I have no interest in a chemically-induced high, certainly not in drinking booze. And yet the stereotype ED is a person who is also alcoholic. But I’m not. And I’m not an obsessed perfectionist, either. So since I didn’t fit that stereotype I guess I got bypassed by the ED crawlers, too. And I never liked benzos, had no interest nor any interest in getting high off of painkillers. I found it easy to quit cigarettes. But damn, I was tempted to starve myself all over again for a very long time. It continued to lure me, like a drug I couldn’t say no to.

  11. My boyfriend usually told people that alcoholism was different from drug addiction and he was very hesitant to comment when he felt that this was an area where he had no experience. He felt that the mentality was different. I know he felt helpless and frustrated when younger members asked him to help with certain drug addictions and he felt he should hand them to someone else. He said he would rather be honest than go out on a limb. He said the same about ED with me although he was far more helpful to me than he realized. He told me he didn’t want to make incorrect assumptions and I respected that.

    • Julie,

      I used to attend (a lunchtime meeting) in a big city and people from all walks of life used to come, some dressed in expensive suits with briefcases. During this meeting people would acknowledge all kinds of lunacy (beyond anything I’ve heard in a mental hospital).

      After the meeting all the professional (attendees) would get up and go back to their banks and law offices as if nothing happened.

      (In these settings – I’m deliberately vague)

  12. Fiaschra, in my various attempts at asking MH “professionals” for “help” I would confess to my various crazy things I would do with food or around food or various “tricks” I would do to not eat. This included eating out of garbage containers, or eating rat-infested food or eating things that by all means were not food. When I read about a famous guy a long time ago who apparently ate rats and cats alive, I was not surprised. They said he would eat anything and seemed to not be able to control his urges. Apparently finally they decided he had brain damage, but never figured it out. I was very scared of stomach rupture, since these things can happen and often after you die it’s mistaken for a heart attack. I was so afraid of dying like that and no one ever finding out what I really suffered from. I knew so many suffered in silence and our voices went unheard, that we showed up in emergency rooms and were told our complaints were trivial. I was even told it was “impossible” to eat what I had eaten, and one doctor told me he’d send his kid to an ER if he ate what I ate. Hey doc, where do you think I am? No one heard, no one cared, no one listened. Following their advice only made me worse, and being weight-monitored was like a strait-jacket for me. Getting away from therapy was the only way I could survive, and following my own instincts ended up the right thing for me. The biggest crime they do to young people is to tell them their bodies are lying to them. Geez. That turns them into permanent dependent patients.