The Bitterest Pills: The Troubling Story of Antipsychotic Drugs

Joanna Moncrieff, MD
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As I see it this website is about filling the gaping hole in the official literature on mental health problems and their treatment. Since these problems were declared to be diseases, ‘just like any other’, academic papers present them as if they were simply technical glitches in the way the brain or mind works. They can be identified by ticking a few boxes, and easily treated by tweaking the corresponding defect with a drug or a few sessions of quick-fix therapy.

What it is like to experience these problems and their treatments is nowhere to be found. Yet in post after post on this site among others, we hear about the harm produced by drugs that are prescribed for mental health problems. People report the horrible way some of these drugs make them feel, the negative impact on day to day functioning, the devastating things the drugs can do to the body, and the sometimes prolonged nature of withdrawal effects.  We also hear about how the official literature inflates the benefits of drug treatments and minimises their dangers.

My latest book, The Bitterest Pills: The Troubling Story of Antipsychotic Drugs, is a contribution to this endeavour to present a more comprehensive picture of these drugs.  Along with books by the likes of Bob Whitaker, David Healy, and Peter Gotzsche’s latest book: Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare, it shows how the official picture of antipsychotics has been distorted by commercial, professional and political interests.

Peter Gotzsche concludes that the dangers of psychiatric drugs as they are currently used outweigh any benefits they might sometimes have for people who are seriously mentally disturbed. Doctors have not been able to resist big Pharma’s formidable marketing machine. “Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them” he says “ It is inescapable that their availability creates more harm than good.”  This is an incredible indictment from a leading figure in the internationally respected Cochrane Collaboration.

Sadly, far from challenging Pharma, doctors and researchers set the scene for the pharmaceutical bonanza that atypical antipsychotics have become. Professional interests drove the transformation of antipsychotics from special sorts of tranquilisers into so-called ‘magic bullets’ back in the 1960s. It was this idea that antipsychotics constituted a sophisticated and targeted treatment, rather than a chemical suppressant, that obscured their unpleasant, mind-altering effects, thus enabling the pharmaceutical industry to expand their use over recent years. I believe that antipsychotics have their uses, but many people are currently exposed to all the risks these drugs pose in situations where their benefits remain limited and uncertain.

The early history of what are now called antipsychotic drugs illustrates the need for an alternative perspective. The French surgeon, Henri Laborit, who introduced chlorpromazine to psychiatrists in Paris in the 1950s, was awarded a share of the Lasker prize and is generally regarded as a medical hero. It transpires, however, that his use of the drug was based on bizarre and outdated theories about the origins of ‘shock’ in surgical patients. He used chlorpromazine in a highly dangerous procedure he devised called ‘artificial hibernation,’ which aimed to suppress the nervous system through sedation and cooling. American surgeons were not impressed. During his tour of the US to demonstrate the new procedure, most of the dogs he was trying it on died. French psychiatrists, on the other hand, embraced artificial hibernation because it resembled some of the dangerous interventions that psychiatry was already awash with at the time – things like insulin coma therapy and ‘deep sleep therapy.’ Eventually, however, they abandoned the cooling process (which consisted of surrounding patients with ice packs) and settled for the drug on its own.

Again and again the subsequent history of antipsychotics reveals attempts to whitewash the drugs. By the late 1960s it was reported that antipsychotics could produce a form of neurological damage, called tardive dyskinesia; a condition which could be irreversible. Over the next 20 years, however, psychiatric researchers tried to exonerate the drugs by attributing the damage to the underlying disease. Influential publications claimed that it was schizophrenia that caused tardive dyskinesia, even though the link to the drugs was well established.

A similar story played out with some of the new ‘atypical antipsychotics’ in the 1990s. Although it was plain that some of these drugs severely disrupted the body’s normal ability to regulate levels of sugar and fats, and could induce substantial weight gain and diabetes, psychiatrists and drug companies suggested that schizophrenia was to blame. There was no good evidence for this hypothesis, however, and eventually large sums were paid to settle claims from people who had suffered these effects.

Despite these dangers, massive legal and illegal marketing campaigns have resulted in increasing rates of prescribing of antipsychotics to people with depression, anxiety, sleep and anger problems and to the rising number of people who are being labelled as having ‘bipolar spectrum’ disorders. Many people are probably unaware that the drugs have not been properly tested in these situations, so we have no idea whether any benefits they might produce outweigh their dangers.

Antipsychotics do help some people suffering from psychosis. There is evidence that they reduce symptoms and levels of distress in the short-term. It is more difficult to judge whether they are beneficial in the long-term, and there is no evidence that starting antipsychotics early prevents brain damage, as was being claimed up until recently. In the long-term, some people who recover from a psychotic episode appear to do better without drug treatment. Others probably need it, but it is likely that too many people are currently being treated with a one-size-fits-all ‘stay on the medication’ approach.

Thanks to the internet and the survivor and consumer movement, we are all more informed about medical treatment than we were in the past, and better able to discuss and negotiate that treatment with our doctors. But it remains difficult to see the whole picture when it comes to psychiatric drugs. Such basic information as how each of the new atypical antipsychotics modify normal mental processes like thoughts and emotions, and how this impacts on behaviour for example, is simply not available. No one has done, or at least published, the research because of a systemic reluctance to admit that these drugs are mind-altering substance. By uncovering some of the untold story of antipsychotics, I hope The Bitterest Pills will enable patients and professionals to make better informed decisions about the use of these drugs.

Of further interest:

18 COMMENTS

  1. I believe that the brief factual examples you share here are invaluable and so little known by those who most need to learn of critical perspectives on the monolith that mental health services have become. Why so many well-meaning people in the allied fields sit out the sorely needed debate or ignore the inescapable political dimension is very hard to answer, too.

    I hope that your book ends up on my shelf soon, along with those of your brave, friendly, admirable counterparts discussing psychiatry in dissent from the received view. That will be the only way to gather arguments enough to get folks to understand that most doctors really want patients to take their drugs so that they can say that they work, no matter how their tactics obscure the details that encourage consideration of alternative methods and modes of treatment that include the viewpoint of the medicated person, centrally.

    Thank you so much–

  2. Thank you for all of your work. We need to keep working to get the whole story out about treatment and recovery. I would like to see more research about the discontinuation syndrome…how medications impact people as they work to try and reduce or come off them. In my experience, many people who wish to reduce/come off their meds. try, often with their doctors’ advice, to reduce them too fast which backfires and then causes their doctors to decide that they will not be able to reduce or discontinue their meds. …I feel that this process needs much more research and practice protocols.

  3. Too bad my son and his family, who were alongside him during his rapid descent into madness, didn’t interface with a psychiatrist who cared enough to question the validity of antipsychotics. We couldn’t even get the psych hospital to acknowledge that substance abuse from cannabis (which my son tested positive for) could cause mood disorders. I didn’t have the knowledge then and the confidence to fight “the system” since I had read the research studies and questioned the hospital staff, but the p-doc and the out-pt p-doc were so intimidating. Even professionals I work with beat me down into accepting “this is when they break” crap… Only until I read RW’s Anatomy of an Epidemic (after my son’s death) did what took my son’s life make any sense (http://robertwhitaker.org/robertwhitaker.org/Bipolar%20Illness.html). If a p-doc had cared like you surely do, the substances used that cross the blood brain barrier (THC is one of the few drugs that does) was connected to my son’s psychosis. But take a young macho young man, tell him he’s now MI for life and those toxic drugs which are so debilitating (not to underestimate the depression they create) are a lifer, and friends recoil, his young wife leaves him for another man and all that self-doubt young adults have about themselves, the recipe is death- exactly what took my son from a family that mourns forever. My son eventually emerged from psychosis but the damage was done. He was too proud to live a compromised life that was drilled into him from the time he “voluntarily” entered but was taken to the locked unit and beaten by the staff for trying to flee. Pls keep spreading the truth Dr Moncrieff. Surely, your American counterparts are listening as they must know the horrific damages “the system” is inflicting?

    • Your story sounds identical to that of my boyfriend. He took his life last week after a shockingly fast trip through “bipolar episodes”. I tried to tell the Drs at the start of his mania that I thought his extreme cannabis use was a factor and they refused to believe me. When he did not clean up in a few days in the ER from what they thought was adderall effects he was labeled bipolar and told he didn’t have a change. I worked very hard for the past year and a half to help him recover and think he had a chance. Inevitably he returned to abusive cannabis use and another “episode” that he did not make it through. I am sorry for your loss. My heart is broken for our failed boys. They deserved more.

  4. I completely support your idea of a paradigm switch to a drug-centered model. However, Dr Moncrieff, this is not consistent
    with your advocacy of limited use of “anti-psychotics”–or your use of that term. Let’s call them neuroleptics.

    Let’s look at the history. In David Cohen’s brilliant essay “PsychiatrogenicS: Introducing Chlorpromazine in Psychiatry” he examines the original psychiatric accounts. Neuroleptics were first hailed “because they stupefied agitated inmates of mental hospitals as well as or better than the existing treatments”–you know what those were. Cohen notes–and this is CRUCIAL, “We are told repeatedly in these accounts that neuroleptics induced profound obvious neurological dysfunctions, that these dysfunctions were part and parcel of the drugs’ desired effects and that some psychiatrists sought to produce these dysfunctions with the drugs.” Bizarre movement disorders such as parkinsonism, dyskinesia, dystonia, akathisia were observed within a year after the drugs’ introduction. To pick a typical observation by a psychiatrist in 1959, “Agents having very few toxic effects are usually without action in the psychoses.The ability to induce a EPS is a sine qua non of therapeutic effectiveness.” In the context of the state mental hospital where patients were warehoused, therapeutic efficacy meant efficient patient control,effective ward management and reduction of patient violence–in an abusive (by staff) environment conducive to violent acting out. Causing the least harm was never a concern bto the psychiatrists promoting these drugs.

    But Joanna the main reason neuroleptics are used today in hospitals instead of less harmful sedatives is because the former are viewed as “anti-psychotics”, i.e,they bolster the medical model which in itself originally depended upon the belief in psychiatrists’ ability to treat schizophrenia, the sacred symbol of psychiatry.Another reason is the prejudice against the “addictive” “minor tranquilizers.” As if neuroleptics were not addictive.

    Peter Breggin’s model—all drugs are brain-damaging– often I think blurs the boundaries between different drugs. But a drug-centered model like yours should prioritize the reduction of harm. And for that matter undermining the medical model should also be a priority since the medical model is itself iatrogenic and fosters the long term use of iatrogenic drugs. It is revealing that many of the asylums based on a Soteria model or a Laingian model substituted occasional use of of benzodiazepines or “minor tranquilizers” (routinely used by “normal” people) for the use of neuroleptics. The only justification for the use of the latter might be to sedate a violent patient. But there is no reason why a frightened patient should not be given the option of taking a benzodiazepine (or a glass of wine, or marijuana if legal). The harmful effects are much less and they are not accompanied by painful “side effects.” In other words their therapeutic effects is not attained by making the patient so physically ill she is unable to do anything but sleep. It is in patients’ interests to phase out of existence altogether the use of neuroleptics which maintains the psychiatric caste system.

    People do not suffer FROM hallucinations or delusions. They suffer from anxiety, fear, panic. And copious evidence exists that these unwanted emotional states can be alleviated by the same substances that “normal” people, i.e., non-“psychotic” people, typically use to mitigate anxiety. Clearly these drugs cause much less harm than neuroleptics. (The fact that these drugs are often abused as compared to neuroleptics is an argument for caution, not for the use of a class of drugs whose “side effects” are so unpleasant that “non-compliant” patients have to be forced, often Court-ordered by the State, to take them.)
    Seth Farber, Ph.D., author of The Spiritual Gift of Madness…,http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1381529852&sr=1-1&keywords=farber+gift

  5. Seth, I agree with you that judicious ad hoc use of benzodiazepines, glass of wine, cannabis (especially in spray form) does have a place – I’ve seen some people find the latter helpful in actually managing perceptual differences having used it AFTER diagnosis(I’m unconvinced that cannabis causes as much ‘psychosis’ as is claimed), or for dampening EPS when they took neuroleptics.
    As with anything too much/too long can be a bad thing, but if chemicals are chosen rather than forced to help get through difficult periods then benzodiazepines seem a reasonable option. Ironically many family doctors/psychiatrists are unwilling to prescribe these on grounds of addictiveness yet happy to give copious quantities of neuroleptics.

  6. Joanna, You seem to make a good argument for doctors to avoid prescribing neuroleptics AT ALL to first break patients–except perhaps for controlling violent behavior and treating intractable cases of insomnia.(I exclude patients who are already addicted to them). Why do you stop short of saying this–or at least saying that they ought not to be used routinely even in the short term, and certainly not in the long term?? Why do you think alternative psychiatrists have prescribed Valium or Xanax rather than “anti-psychotics”? Why are so many patients “non-compliant”?

    You write: “Antipsychotics do help some people suffering from psychosis. There is evidence that they reduce symptoms and levels of distress in the short-term.” I don’t think there is any evidence that they are any better than other drugs that do not have their drawbacks:1)They produce “side-effects” that most patients I have talked to found mildly to extremely unpleasant(They were never told they could get off the drugs, so their suffering was protracted–from akathisia to emotional blunting to impotence to disturbing EPS 2)Their use (despite their adverse effects)perpetuates the MYTH that neuroleptics have specific anti-psychotic properties (a subset of the disease centered myth you have attacked)–a myth that has such hegemony in this society that I suspect EVEN YOU have been influenced by it–perhaps unconsciously. I have made here briefly (added to your
    considerations) a drug-centered argument against the use of neuroleptics–except in unusual cases.

    You claim, “It is more difficult to judge whether they are beneficial in the long-term…” I have not seen any evidence of the latter. Every comparison with no-drugs or different drugs (in the short term) is to the detriment of neuroleptics, particularly when you take into account the 25 years reduction in life expectancy. To me the strongest evidence is not RCS but the psychiatric survivors who got off the drugs and flourished

    I notice that you are bold enough to say SSRIs do not help depression. Is it not possible that you have been intimidated by the myth of schizophrenia–what Szasz called the sacred symbol of psychiatry?

    Seth Farber, Ph.D.
    http://www.sethHfarber.com

  7. I agree with Seth. There is solid ground to say that the scientific evidence for neuroleptics’ long term safety and effectiveness is questionable at the very least, and that the scientific evidence favoring Open Dialogue/Soteria/Recovery Movement-type approaches with little or no use of these drugs, is very promising.

  8. Peter, Considering how and why these drugs were selected in the 1950s (let’s remember they were hailed as by psychiatrists as “chemical lobotomies”)
    it would be quite a extraordinary coincidence if they had any distinctive properties that made them particularly suited for the “treatment” of “psychotics.”
    The assumption is made that they have such properties because of their long history of use, and because of the mythology that surrounds them and that surrounds “schizophrenia.” They are medieval treatments like insulin coma therapy, lobotomies and packing patients in ice. To refer to them as “anti-psychotics” as to perpetuate dangerous myths. I think one of Bob Whitaker contributions was to focus on the destructive effects of these drugs. Lars Martensson has also rightly I think singled this class of drugs out as unusually toxic.
    SF

  9. I don’t see the urgent need to normalize mental disorders. Quite possibly some abnormality regarding the nervous system could be discovered in the future.

    I personally spent two years dealing with voices/delusions in the context of a psychotic depressive episode without medication and wish I had taken medication much earlier because I think it played a part in losing a job.

  10. Indigomind,
    Judging from your comment, you have not read the article or the discussion above your comment.
    If you had read the above you would see the destructive effects that result from labeling people “mentally ill.” You would see that the drugs supposedly designed to rectify “mental illnesses” do not do that but typically have effects worse than the original problem.
    Losing a job is nothing compared to losing a life. I suggest you read my latest book on the Mad Pride movement.It also tells the stories–as did my first book in 1993–of people who resolved the spiritual crisis the psychiatrists label “schizophrenia” and “bipolar disorder” by getting out of the “mental health” system and off psychiatric drugs. They are evidence that the spiritual crisis model is more illuminating and more therapeutic than the disease model. At the time I interviewed them they were “weller than well” –to quote Karl Menninger–because they had incorporated the spiritual dimension into their lives, and because they were NOT normal. That is unlike normal people they were not adjusted to our insane society, they were “creatively maladjusted.”
    Seth Farber, Ph.D.,http://www.amazon.com/Spiritual-Gift-Madness-Psychiatry-Movement/dp/159477448X/ref=sr_1_1?s=books&ie=UTF8&qid=1382791488&sr=1-1&keywords=farber+gift

  11. Thank you so much Dr. Moncrieff. Your last paragraph caused me to gasp in agreement….” Thanks to the internet and the survivor and consumer movement, we are all more informed about medical treatment than we were in the past, and better able to discuss and negotiate that treatment with our doctors.”. For over 4 years I have administrated a Facebook group called Cymbalta Hurts Worse. We have over 1100 members. It amazes me how little doctors know about this psychotropic drug. The advice they give to people who want to stop Cymbalta such as alternating days or cold turkey is malpractice in my book. We have saved quite a few lives. I know this because people say this all the time. We encourage members to take articles and documents to help educate their prescribing doctors. Some doctors are receptive but many are too intelligent to believe a patient can know more about their experience or have contrary information, especially when it is learned from a group on the internet….We laugh at their “God-Complex” and celebrate when people are successfully off the poison of Cymbalta. The comradery and spirit in the group is #1 step to health. I can’t tell you how many people, when they find us, are so happy to find a group that believes them. How great and sad that is at the same time.

  12. Joanna I congratulate you on the work you do. It is not easy for a psychiatrist to see the harm they can do but I like Seth think that neuroleptics are particularly dangerous psychotropic drugs. I consumed many of them without informed consent and did not know at the time that the akathisia and many other terrible adverse effects I experienced were from these neuroleptics. I think if anyone who prescribed these drugs experienced akathisia, even for a few hours, they would refrain from using any drug which could have this effect. Unfortunately many of the people who are still prescribe these drugs do not know the adverse effects people endure because of their spellbinding effects. I think that doctors only use them because they do not know what else to do. I like Dr Lars Martennson RIP think that neuroeptics should not be prescribed for people when they can cause so much harm and suffering for many.

  13. Mary
    It took me 15 minutes to discover Lars Martensson died in 2009. There is very little written on him, perhaps less in English. I could not even find a single obituary. (Nothing on Wikipedia.) He wasone of the most eloquent writers on neuroleptic drugs, a pioneer—too little known here, and too little is known about him. I have no idea how old he was. I can infer over 70. That’s all.
    Seth

  14. I don’t like where the second half of the article went. Nothing justifies torture. The effects are as hard to take as the worst flu that could hit you. And I went through that for 6 months at a time. 6 months of contorting in my bed trying to contort and change position to escape the feeling at no relief. These patients deserve a comfortable jail cell and although they would argue that, they would not understand the pain and torture their doctors are saying is worth their condition.