I see many patients who want to stay on medications because they have been told for so long how necessary they are for them. But what evidence do we have that shows this? Meanwhile many patients get harmful side effects – like movement disorders, dulled cognition, obesity, diabetes, high blood pressure, high cholesterol, sexual side effects, muscle spasms, slowed movements, restlessness, etc., and I wonder; What if I am giving these meds not only for no recovery benefit, but am adding to the problems?
I love pushing the envelope on psychiatric treatment. What is best for my patients? More importantly, what do they want? They certainly have a right to be the driver of whether or not they take these medications. I am grateful that many of my patients trust me enough to have trials off of antipsychotic medications. APA recommendations, after all, are to taper and try patients off antipsychotic medications, if they have not had symptoms in one year. All of the above has changed the way I talk to patients about their treatment and recovery.
I helped organize an upcoming conference at Hutchings Psychiatric Center in Syracuse, NY on Pharmacological Treatment for Psychosis: Emerging Perspectives. I am excited about this conference because of my increasing ambivalence, based on the data, about prescribing antipsychotic medications, and a lack of a serious conversation about the pros and cons of these medications. On Oct. 2nd, 2014, clinicians and researchers will have a chance to have this conversation, including a discussion of the latest research on antipsychotic medication and long term outcomes.
Speakers will include Courtenay Harding, PhD, who found through her work that many patients with schizophrenia stopped taking antipsychotic medication over 3 decades and still had significant recovery. Martin Harrow, PhD, studied patients for 20 years and found that long-term recovery was higher in those that did not take antipsychotic medication. These results − combined with similar ones by Dr. Lex Wunderink (who is not speaking at the conference) from the Netherlands, have really shaken my view of antipsychotics.
It was pointed out to me that many of the patients who dropped out of Dr. Wunderink’s study were the sickest types of patients, similar to those I work with in Syracuse, New York. So some are skeptical about what his results mean to those of us who work with that group. I hope the sickest patients can be studied soon, randomized to be on and off meds.
I hope the conference will ignite an intense discussion about antipsychotic medication use that will continue for some time in the field. A randomized controlled trial on the most chronic and lowest functioning patients, on and off medications should be designed and executed in a safe way. These are answers that we need to know.
* * * * *
Admission to the conference is free, and we are inviting mental health clinicians, not just prescribers. The hope is to make it an academic discussion. You can register by contacting [email protected]. Patients, families and others are welcome as well.