Psychiatry Has its Head in the Sand: Royal College of Psychiatrists Rejects Discussion of Crucial Research on Antipsychotics

Joanna Moncrieff, MD
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Two pieces of research have been published over the last two years that should prompt a major reorientation of the treatment of schizophrenia and psychosis, and a fundamental reappraisal of the use of antipsychotic drugs in general.  Put together, these studies suggest that the standard approach to treating serious mental health problems may cause more harm than good. Long-term treatment with antipsychotic drugs has adverse effects on the brain, and may impair rather than improve chances of recovery for some. Many people ask me how the psychiatric profession has responded to this data. Surely, they think, it must have stimulated a major debate within the profession, and some critical reflection about why it took so long to recognise these worrying effects? Sadly, this does not appear to be happening.

I have described both of these studies in detail in previous blogs. Briefly, in 2012 the research group led by Nancy Andreasen, the former editor of the American Journal of Psychiatry, published results of a brain scanning study of people diagnosed with schizophrenia or psychosis. The study found that people’s brains shrank over time in proportion to the amount of antipsychotic drugs they had been exposed to. The report concluded that  ‘antipsychotics have a subtle but measurable influence on brain tissue loss over time‘(1, p 128).  The study confirmed that the brain shrinkage observed in animals(2) also occurs in humans.

We don’t know whether these observed effects of antipsychotic treatment are temporary or permanent, and we don’t know whether they have any functional implications. In other words we don’t know whether the brain shrinkage is associated with intellectual decline or other brain-based abnormalities. The evidence is conflicting, with some studies suggesting there is no impact on mental ability(3), but worryingly, other studies, including Andreasen’s study, indicate that there may be an association between reduced brain volume and some cognitive or mental deterioration(4;5). It is obviously a worrying possibility.

The second game changing publication was the paper reporting the seven year follow up results of the Dutch antipsychotic discontinuation study(6). This study, conducted with people who had recovered from a first episode of psychosis, found that people randomised to a flexible and gradual antipsychotic discontinuation strategy were twice as likely to show a full social recovery than those who were allocated to continuous (maintenance) antipsychotic treatment. Moreover, relapses, which had been higher in the discontinuation group at 18 month follow up, had equalised.

As I have said elsewhere, I am not against the use of these drugs altogether, but these studies suggest that antipsychotics are bad for the brain and can reduce people’s social functioning when used continuously over long periods. When I present these findings to audiences of non-psychiatrists, they are shocked that the drugs can continue to be so freely used in the face of this evidence. ‘How can this be ethically justified?’ someone commented at a recent meeting I attended.

When people ask me how psychiatrists have responded, I have, up to now, tried to give my profession the benefit of the doubt.  Some leading psychiatrists have been publicly critical of the overhyping of antipsychotics(7) and there are undoubtedly many others who are concerned about these research findings and trying to avoid antipsychotic drug treatment if possible, and use low doses for short periods where not. I have expressed the hope that as this research becomes more widely known, others will follow suit.

My illusions were recently shattered, however, by the Royal College of Psychiatrists’ conference planning committee.  Recently I proposed a symposium for the 2014 annual conference entitled ‘Re-Evaluating Antipsychotics – Time to Change Practice?’ I invited Lex Wunderink, the first author of the Dutch study, to discuss his study, along with a leading British psychiatrist involved in brain scanning studies of people with schizophrenia. I was confident the symposium would be accepted, because obviously, I thought, the conference committee would recognise the importance of this research, and want to ensure it was widely publicised to, and debated by, members of the profession.

To my astonishment it was rejected. I wrote to the conference organiser to ask why, pointing out that patients, carers and the general public are wondering what the profession is doing about these research findings. They would be most surprised to know that the profession did not consider the results sufficiently interesting to merit discussion at the principal meeting of UK psychiatrists. She replied that there were too many competing suggestions. So I asked if any of the symposia selected covered these same areas of research.  I did not get a reply.

Surely, these findings are so momentous they deserve a whole conference in themselves? Every department of psychiatry around the country should be considering the implications of these studies, and be thinking about how psychiatric practice should change as a result. Yet the representative body of UK psychiatrists feels the evidence is not worthy of an hour and a half’s discussion at its annual conference.

Although I would like to believe it is was an aberration, I fear that the conference committee’s view is a barometer of the profession’s general attitude. It seems not to be interested in discussing the serious harm its drugs can do to both physical and mental health, and in taking the steps necessary to minimise this harm. The profession appears to believe that if it keeps quiet about these inconvenient findings, and discusses them as little as possible, the fuss will blow over and nothing need change.

It is disgraceful that the profession is not taking these findings more seriously, but sadly not unprecedented.  In the 1970s, the profession was accused of being ‘completely unconcerned’ about emerging evidence on the association between antipsychotic use and the syndrome of brain damage called ‘tardive dyskinesia’(8).

At best psychiatry appears indifferent and complacent. At worst it is subconsciously attempting to hush up inconvenient data, so that, along with its partner, the pharmaceutical industry, it can continue ‘business as usual.’ Either way, it appears that the critics are right: the profession has its head firmly in the sand.

 

References:

(1)    Ho BC, Andreasen NC, Ziebell S, Pierson R, Magnotta V. Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia. Arch Gen Psychiatry 2011 Feb;68(2):128-37.

(2) Dorph-Petersen KA, Pierri JN, Perel JM, Sun Z, Sampson AR, Lewis DA. The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys. Neuropsychopharmacology 2005 Sep;30(9):1649-61.

(3) DeLisi LE, Hoff AL, Schwartz JE, Shields GW, Halthore SN, Gupta SM, et al. Brain morphology in first-episode schizophrenic-like psychotic patients: a quantitative magnetic resonance imaging study. Biol Psychiatry 1991 Jan 15;29(2):159-75.

(4) Gur RE, Turetsky BI, Bilker WB, Gur RC. Reduced gray matter volume in schizophrenia. Arch Gen Psychiatry 1999 Oct;56(10):905-11.

(5) Gur RE, Turetsky BI, Bilker WB, Gur RC. Reduced gray matter volume in schizophrenia. Arch Gen Psychiatry 1999 Oct;56(10):905-11.

(6) Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-term Follow-up of a 2-Year Randomized Clinical Trial. JAMA Psychiatry 2013 Jul 3.

(7) Tyrer P. From the Editor’s desk. British Journal of Psychiatry 2012;201:168.

(8) Crane GE. Clinical psychopharmacology in its 20th year. Late, unanticipated effects of neuroleptics may limit their use in psychiatry. Science 1973 Jul 13;181(4095):124-8.

40 COMMENTS

  1. “We don’t know whether these observed effects of antipsychotic treatment are temporary or permanent, and we don’t know whether they have any functional implications. In other words we don’t know whether the brain shrinkage is associated with intellectual decline or other brain-based abnormalities.”

    I am absolutely floored by this… just sitting here… staring at the screen…

    The profession that argues that brain abnormalities so small and indistinct that they cannot be observed using modern imagining technologies are the cause of serious mental “diseases” like schizophrenia and bipolar disorder, go on to say that brain shrinkage, which surely effects all aspects of brain function, may have no noticeable or significant effect on peoples mental functions?

    What does the neuroscience community have to say about this? Surely they don’t think that brain shrinkage could have little or no consequences. That would be like saying that Huntington’s disease may have no real consequences. Should scientists revisit the research literature to determine if Huntington’s disease should even be called a disease anymore, since it seems that brain damage/shrinkage itself may have no detrimental effect on peoples mental health?

  2. These are the same people that think the treatment of psychosis should include waking people up who became psychotic from lack of sleep in the first place for a early morning blood pressure check as cover for disregarding a hospital patients right to undisturbed rest.

    These are the same people that will tell a severely depressed person they can’t have morning coffee in the hospital to get there day started.

    These are the same people who will treat a person suffering from paranoia by making them live in a locked ward with those ugly security cameras pointed at them 24/7 .

  3. “The profession appears to believe that if it keeps quiet about these inconvenient findings and, discusses them as little as possible,the fuss will blow over and nothing need chnage.”

    I think this sums everything up perfectly. Their egos and pocketbooks and large homes in gated communities and large SUV’s and their reputations are too hard to turn loose of, even though what they’re doing in the name of “medicine” is actually harming and even killing thousands of people. Disgusting.

  4. Hi Joanna!

    You don´t cut the branch on which you are sitting.
    I fear, it´s as simple as that.

    Most psychiatrists seem to feel utterly helpless without what they conceive to be their only tools.

    And deeply afraid of losing their “raison d`etre”.
    And their reputation. And money. And their jobs.

    Understandable reasons to have their heads in the sand…

  5. “Money is the root of all evil,” bipolar doc.

    And thank you, Dr. Moncrieff, for at least putting the information on the web and writing books about it.

    It’s sad that the psychiatric profession has chosen to behave as a bunch of unethical, unrepentant hypocrites. But hey, those are the people Dante claimed belong in the lowest depths of hell in his epic Inferno. At least we now know who belongs in hell, if there is a God.

  6. I think it is time for those in ANY position in psychiatry and (the “mental” system), who can and will, to go on some sort of strike.

    I think if people at the “Royal College” reject discussion, it must be because they’re in possession of something unknown to others.

  7. I think what’s “unknown to others ” is that the psychiatric profession has bought out the medical profession, religions, and governments with their ability to defame, discredit, torture, and legally kill anyone. Thier ability to “create” bipolar / schizophrenia in others with their drugs is convenient to unethical people in positions of power. And history shows this is for what the antipsychotics have traditionally been used. It’s all about maintaining power unethically, and greed. Can anyone think of any other reasons?

  8. Even a child wouldn’t believe in a Chemical Imbalance in the Brain, but you’d wonder how far it can be taken:

    Top universities give out Phd s in scientific research into how medicines heal the brain. These Top Universities are funded by Drug Companies that are trying to make a science out of the use of tranquillizers. 10% Brain Loss is easy to identify – the Phd’s are worthless.

    The reason Psychiatric ill health is played down by other medicines is because the Drugs money has infected Research and all of medicine.

    While I stayed with the ‘services’ I was disabled and expensive to the taxpayer.
    But moving away from tranquillizers to non drug recovery got me back to work and onto the same playing field as anyone else. A psychologist told me 30 years ago that everyone could recover without drugs.

    The taxpayer pays for the Sickness, the Drugs, and the Universities without even knowing it.

  9. There are many scientists and businessmen that reject findings of all studies that strongly suggest that climate change is being excessively driven by the actions of mankind. These “head in the sand” psychiatrists who do not question the risk profile and efficacy of their approach need to be put on the spot. In business, the risks are carried by the parties that are stupid enough or unfortunate to be lumped with them – it is time that the excessive risk taking for little reward and the pain associated with these outcomes be shared back up the tree.

  10. I’m not surprised by the rejection of the symposium. One can’t expect a profession to commit suicide easily. With clients, therapists know that you can’t expect a client to change behavior without an alternative solution to a problem. I think the same principle goes for professions as well. I am encouraged by the story on the fast-spiking, GABA interneurons and deficient signaling through NMDA receptors as the primary culprit in schizophrenia and probably Bipolar I as well. I was happy to see the NMDA story appear on the front-page attachment of Psychiatric Times (12/13). The treatment for retardation of NMDA receptors include omega-3s (fish oil), N-acetylcysteine, and other chemicals to manipulate the availability of d-serine. All of these interventions are far less damaging. Let’s hope the NIMH funds this stuff and psychiatrists become exponents.

  11. Jill,

    Given the fact that bipolar I to 1,000,000 is just another garbage can stigma pretty much replacing the similarly bogus, life destroying schizophrenia used to defame, discredit and destroy anyone inconvenient to those in power, I find your attempt to attach hard science causes and cures to such junk science unbelievable as usual. Ironically, both rapists and rape victims, murderers and abuse victims and on and on have been “fit” into the despicable bipolar fraud fad stigma, so claiming minute causes and cures for this debacle is quite bizarre in my opinion.

    Dr. Thomas Insel has even declared the bogus DSM with its junk science bipolar and schizophrenia totally INVALID since it lacks any scientific, biological or medical evidence whatever. Rather, the bipolar horror show was invented/voted in to push the latest poison drugs on patent per Dr. David Healy in his great book, MANIA, and many other enlightening books and articles. One psychiatrist admitted that even character disorders like psychopathy and narcissism were to be fit into the bipolar fad fraud since such Axis II stigmas wouldn’t be covered by insurance otherwise.

    I continue to find what amount to eugenics theories that have been repeatedly debunked very offensive since it aids and abets the corrupt biopsychiatry/Big Pharma/corrupt government hacks empire.

    Again, how can you claim genetic, chemical or other causes for a fraudulent, voted in stigma that includes millions of very unique people with opposite life, health, genetic, stress and other situations and retroactively pretend they all suffered from the exact same “illness” that can also be retroactively claimed to have been caused by these very unique, specific chemical reactions you cite with no tests or evidence whatsoever? Sorry, but I find such claims very ignorant, bizarre, misleading and downright fraudulent as usual. But, you have made no secret of blaming genes for everything including so called alcoholism (also totally debunked in many sources like Pseudoscience in Biological Psychiatry) while tons of recent articles including those by Dr. Jay Joseph on this web site have debunked such fraud as an underhanded way of blaming the victims of the power elite’s abuse, exploitation, injustice and predation on the less powerful and wealthy or 99%. Many of these articles have been posted on MIA and I urge you to read them despite your die hard eugenics views.

    I hope anyone can see the absurdity of such claims of very specific, targeted causes and cures of bogus stigmas like bipolar and schizophrenia when the status of these so called “diseases” is like that of being accused of being a witch in another nasty era with torture and even drowning the so called cure then too. Such nasty debacles in each era is all about power or the lack thereof.

    It is already known that fish oil and other nutrition can help the brain, but that hasn’t had any influence on the billions made from poison neuroleptics whatsoever on those falsely accused of being bipolar to line the pockets of the psychopathic elite.

  12. Sadly, a lot of people have a fear to what they are NOT ready to understand, so they stay stuck with the beliefs and opinions of others despite the damage being caused.

    EXCERPT FROM MY MANUSCRIPT, “An Angel’s Testimony”

    What is an atom in relationship to a Schizophrenic?
    An atom is a fundamental piece of matter. (Matter is anything that can be touched physically like us, a table, an animal, etc.) Everything in the universe (except energy) is made of matter, and, so, everything in the universe is made of atoms.

    An atom itself is made up of three tiny kinds of particles called subatomic particles: protons, neutrons, and electrons. What constitutes protons, one part of an atom? Protons are made of quarks, but physicists say that they are made of 99% “empty space.” Now replace the two words ‘empty space’ for another two word definition: “not real”. ‘Not real’ is to schizophrenics as ‘empty space’ is to physicists.

    So when we say schizophrenics believe in things that are not real, essentially they are more conscious or connected to the empty space of the surrounding reality they perceive. Therefore, if I could link the connection between what science have observed regarding the relationship between energy and matter and what schizophrenics perceive as to real to not real, then it may stand to reason that schizophrenics are more gifted than we give them credit.

    Is it possible that this was intentionally designed this way so we wouldn’t get lost into thinking that the material version of life is all that there is? I’ll leave you to ponder on that question.

    • Life is multidimensional and so is the Mind.

      Like the atmosphere has layers (exosphere, thermosphere, mesosphere, troposphere, ionosphere, stratosphere), the Mind also has layers (realms, dimensions, planes).

      We can and we do “travel” in the Mental Body (mental space). We can and we do connect with others via the Mind.

      Meet Omcasey, Consciousness Exploration

      http://www.youtube.com/user/omcasey1/about

      Omcasey is no “schizophrenic” but she does explore her mental space and mental activity. How is that any different from what “schizophrenic” people do? It seems to me that Omcasey has greater Mental Height (elevation) and expansion, while some others are trapped, by mental “ceilings”, at lower levels.

      Of course, it is all so complex and I don’t think the Mind will ever be simplified.

      • Brilliant post. I think this is what the mental health field is missing, the awareness of our multi-dimensionality. I think that’s one of the major factors in all these disagreements about reality, in general.

        Neither are we linear beings, nor are our lives linear. These are illusions fabricated by highly limited and narrow perceptions, from minds that have yet to be awakened. Demanding that we all accept linearity and duality is asking everyone to stay asleep to what life and the mind are all about. That’s not only extremely undesirable, it’s also impossible.

        Expanding awareness–that is, personal growth and evolution–does require explorations of these dimensions. When that experience is labeled as an illness and something to be suppressed and avoided, we are damning–and damning up–growth and evolution.

        Whereas if we allow and celebrate these expansive experiences, then we are encouraging our awakening to a better (in my evaluation), more truthful and robust reality–honoring life experience in all it’s diversity.

        Thanks for your sharp and precise clarity, mjk. It’s a gift.

        • It’s just a wave I’m currently riding (biorhythm). My intellect and awareness have been simultaneously peak (100%). I looked ahead to my upcoming birthday where I will *potentially* be fully incapacitated in every way except intuition, which will be at maximum. That ought to be fun (not).

          http://www.biorhythmonline.com/

          “These are illusions fabricated by highly limited and narrow perceptions, from minds that have yet to be awakened. Demanding that we all accept linearity and duality is asking everyone to stay asleep to what life and the mind are all about.”

          The box syndrome!

          I blame TV (electromagnetic box). The other electromagnetic boxes are microwaves and computers. I sometimes think of Earth as having been boxed in, literally, atmospherically, as a result of harnessing electricity (poling & wiring of the planet) and creating these electromagnetic boxes. I formed this idea many years ago after studying my birth chart, which is painfully busy, and has in it a very distinct square (box) configuration.

          This “box syndrome”, as I call it, I think it was prophesied. People have been so fixated on triangles but I’m mostly fixated on boxes (and interestingly, I studied the birth charts of my kids, and some others, all born in the 90’s, where the charts were extremely neat and full of triangles). Sacred geometry is becoming a popular interest.

          “Expanding awareness–that is, personal growth and evolution–does require explorations of these dimensions.”

          I have a mental “expansion” method. It’s really simple and anyone can do it.

          It requires stillness in an environment where one feels comfortable and familiar. No distractions or interruptions.

          I start with my most immediate location and work my way out, in every increment, from nearest to furthest:

          I’m in my living room.
          I live on ___________ Ave.
          I live in ___________ (name of neighborhood, if it applies)
          I live in (city or town)
          I live in (county)
          I live in (state)
          I live in (region)
          I live in (country)
          I live in (continent)
          I live in (hemisphere)
          I live on Earth
          I live in the Milky Way galaxy

          Now my mind has reached the Universe.

          Anybody can do this and I wouldn’t doubt, in this world today, that everyone is already at least global thinkers. I can’t and don’t claim “intellectual property” because I think this “method” is plain nature and not the least bit unique. Still, if one mediates and goes through this process they will literally travel – mentally.

          My mind goes so far that I have a full understanding of Eternity (which is the life cycle of the Universe) and Nothingness (from which the Universe does indeed “explode” into existence).

          One of my favorite sayings,

          Nothing is real
          Nothing exists
          Nothing is something
          and it exists

          When I took the abuse (and negative charge) out of it, I found that I truly am a MENTAL person. Sigh…

          Thanks, Alex. Here’s to looking forward to Humanity’s future of waking up and Understanding. I’ve got great hopes for 2020 (“perfect vision”, Justice and Balance).

          ~ mjk

          • “Here’s to looking forward to Humanity’s future of waking up and Understanding. I’ve got great hopes for 2020 (“perfect vision”, Justice and Balance).”

            Cheers to that! The eternal awareness you write about is what keeps hope alive. I, too, envision the scales coming into perfect balance.

  13. Brain disease theory makes everything so simple for everyone down the line form shrinks to uni students on hire.
    And there is the money or just the regular guaranteed salary and career …ah the good life. They are all on holiday right now at the tie their charges are most alienated – they make sure the non-humans or unhumans? (called so because they are not allowed to have the basic laws of human psychology applied to them )are finished with Xmas two or three weeks early so nothing will interfere with their “Dolce Vita”.
    ..
    I once told a brief synopsis of my narrative to a uni undergrad concluding with “so you can see from my example Schizophrenia is not incurable” and as I was pouring myslef a cuppa I heard her protest “But it is incurable!”.
    ..
    I didn’t contend because I was in the enemy’s stronghold .. tut-tut…head full of straw and all that – sometimes is the best way to survive and gather information.
    .

    So how does a 2nd year uni student have the life experience to know what is possible and what is not or without undergoing a process of confrontative critical self-inspection even understand basic human psychology?
    But they know.
    This is because of authoritative indoctrination – it really works well.
    ..
    And on this topic notice how adamant the Government literature etc is in Canada – “There is NO cure”. …in cancer societies they say they are searching for a cure but no search here – they absolutely “know” – they simply don’t want to find it. Talk about cure to any of those in this pillar of ignorance – the brick wall of the mental unhealthiness industry – the word cure is not even understandable in their minds..

  14. Hi
    If I think about the Recession first thing in the morning I can get upset. If I think about the Recession when I feel okay – it doesn’t bother me.

    I attended a Stress Management lecture given by an Indian woman years ago. She said to deal with stress we need to sit with the feelings and avoid the thinking. She said that when something happens to us and we get upset this is not because of the present event but because it reminds us of a previous hurt and we invest these past feelings in the present event. Then She said ‘So you see, we are all really Schizophrenics’.

    I’ve tried this for ‘Schizophrenia’ and it worked.

  15. Thank You Dr. Moncrieff.

    I’m afraid it goes somewhat deeper than attempting to continue with “business as usual”.

    No country I know of – and especially not the United States – allows anyone to knowingly sell homicide, which the FDA does ascribe to the use of many Psychiatric drugs: not just the antipsychotics.

    Once that criminal aspect of these drugs is openly discussed, the whole game collapses and everyone involved in it faces long prison sentences at the very least.

  16. Hello

    I would like to know what other papers WERE accepted at the conference. If the overall tenor of the conference is to let the science speak for itself, maybe there were just too many papers submitted. However, I’d imagine that many of the papers being presented are drug-friendly, and support the interests of the exhibitors and supporters of the conference / profession/ society.

    Daniel Heller N.D.
    Marin County, California