Researchers Test Harms and Benefits of Long Term Antipsychotic Use

Justin Karter
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Researchers from the City College of New York and Columbia University published a study this month testing the hypothesis that people diagnosed with schizophrenia treated long-term with antipsychotic drugs have worse outcomes than patients with no exposure to these drugs. They concluded that there is not a sufficient evidence base for the standard practice of long-term use of antipsychotic medications.

“In this systematic review of the published literature, we addressed a hypothesis recently proposed by Robert Whitaker: People with schizophrenia exposed to long-term treatment with antipsychotic medications have worse outcomes than they would have had if they were not exposed to these medications,” the researchers wrote. “We found the published data to be inadequate to test this hypothesis. By extension, these data were also inadequate to conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average.”

“How is it that 60 years of research fails to produce evidence affirming the widespread clinical practice of maintenance antipsychotic treatment, or, alternatively fails to yield data that can refute claims of dire harms associated with this treatment approach?”

Researchers question whether there is sufficient scientific evidence to support the long-term use of antipsychotics
Researchers question whether there is sufficient scientific evidence to support the long-term use of antipsychotics

The current standard treatment guidelines published by the American Psychiatric Association (APA) for people diagnosed with schizophrenia recommend the use of antipsychotic drugs in both the short-term, acute phase, and over the long-term and recovery phases. However, several recent reviews of the evidence have questioned whether there is quality scientific evidence to support the recommendation that antipsychotics be used over the long-term.

Most notably, researchers like Harrow and Jobe, McGorry, Alvarez-Jimenez and Killackey have drawn attention to the fact that these drugs can hinder recovery over the long-term. Antipsychotic drugs are known to cause serious severe neurologic side-effects that can get worse, or become irreversible, over time. In addition, some patients appear to improve significantly without any pharmacologic intervention and some now question whether this natural recovery is inhibited in patients who are heavily medicated.

The researchers became concerned about the current standard of care and the heavy reliance on antipsychotic drugs after encountering Robert Whitaker’s review of studies that suggested that the drugs may bring about a hypersensitivity to dopamine and produce an iatrogenic effect, inducing schizophrenia symptoms over time. They then set out to conduct a systematic review of the available literature to test the hypothesis that continued use of antipsychotic drugs is less beneficial than no medication at all for people diagnosed with schizophrenia.

Only eighteen studies were found to adequately address this hypothesis. Of these, ten studies had some outcomes that would support the hypothesis that patients taking no medication would fare better than those with extended antipsychotic use. Three of these studies had results that supported the hypothesis, and seven studies had some outcomes that suggested that those treated with antipsychotics fared worse and others that did not. Eight of the eighteen studies were not consistent with the hypothesis, however. The review was confounded by the design flaws apparent in all of the examined studies and the fact the studies were so divergent that the results could not be compared to one another.

“The results of the studies reviewed here are widely heterogeneous and the designs do not allow us to draw firm conclusions about Whitaker’s hypothesis,” they wrote. “Although it was not the purpose of our review, we note that our data also failed to determine whether long-term antipsychotic medication treatment results in greater benefits than harm on average when assigned or prescribed to patients with schizophrenia.”

The researchers also note that the review supports previous findings that long-term antipsychotic use is “not needed for some patients with schizophrenia who improve without such treatment” (their emphasis). The dearth of research in this arena is attributed to how quickly the clinical community adopted the belief in the long-term use of antipsychotics and that, given this widespread belief, it was and continues to be considered unethical to withhold this standard treatment from patients for the sake of study.

“Our systematic review found that the evidence base is insufficient to adequately address questions about the potential harm and benefits of long-term antipsychotic medication use for people with schizophrenia given current scientific knowledge. Despite decades of research in this area, it seems new data may be needed to fully address these questions. To do this, researchers will have to find solutions for the numerous challenges to conducting rigorous and ethical longitudinal research in this area.”

To fully meet the standards of medical informed consent, the researchers suggest that clinicians and practitioners must “accurately communicate to patients the uncertainty of evidence regarding the long-term use of antipsychotics in treatment of psychosis.”

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Sohler, N., Adams, B. G., Barnes, D. M., Cohen, G. H., Prins, S. J., & Schwartz, S. (2015, December 14). Weighing the Evidence for Harm From Long-Term Treatment With Antipsychotic Medications: A Systematic Review. American Journal of Orthopsychiatry. Advance online publication. http://dx.doi.org/10.1037/ort0000106 (Abstract)

28 COMMENTS

    • Not trying to be flip, as RW considers this to be a fairly groundbreaking study which concludes there is no sufficient evidence to make a determination one way or the other about the value of such chemicals. Still when one studies “schizophrenics” it is as scientific as studying witches.

    • My psychiatrists put me on antipsychotics because of a dream query regarding my feeling “moved by the Holy Spirit,” which is rather the opposite of demons, but also among the “unseen.” So the psychiatrists are definitely majorly tranquilizing people for belief in God now. Leaving me believing it’s highly likely they also believe antipsychotics “cure” people who feel they’re dealing with demons. Belief in anything other than our money only worshiping, material world requires antipsychotics to today’s doctors, it seems.

  1. “To fully meet the standards of medical informed consent, the researchers suggest that clinicians and practitioners must “accurately communicate to patients the uncertainty of evidence regarding the long-term use of antipsychotics in treatment of psychosis.” ”

    …Yes thank you very much…and therefore HOW can it be either ETHICAL or LEGAL to have forced treatment with antipsychotic medication for any person.

    Informed CONSENT that is all we need…once that happens so, so many other problems associated with `psychiatry’ or ‘antipsychiatry’ will just evaporate…………………………….

    *

    • “To fully meet the standards of medical informed consent, the researchers suggest that clinicians and practitioners must ‘accurately communicate to patients the uncertainty of evidence regarding the long-term use of antipsychotics in treatment of psychosis.'”

      I agree, Sa, it is not ethical, nor should it be legal “to have forced treatment with antipsychotic medication for any person.” And the UN also agrees with this. And history has shown us only unethical and illegitimate governments have ever given psychiatrists unchecked power in the past, which the medical and financial evidence is now pointing out seems to be a problem with our present US government today, as well. How embarrassing, I used to believe my country was a decent one.

      And such appropriate and honest “medical informed consent” would be 100% the opposite of what the psychiatric practitioners have been doing for the past several decades. Currently most of them claim to believe that their DSM “mental illnesses” are caused by “chemical imbalances” in their patient’s brains, which require lifelong medications, a theory which was largely disproven decades ago.

      • My case I even dont know. Is it psychosis or not ? I was severely paranoid, before antipsychotics. Medications it seemed helped with that, but then depression crushed. I tried to wean off, but my paranoia is coming back. I dont know. It seems in general that process or disease is not in the brain, but somewhere else.

        • time33,

          If you’re weaning off of antipsychotics you should research drug withdrawal induced super sensitivity manic psychosis. Because one of the common withdrawal effects of the antipsychotics is a manic psychosis, which can be scary or confusing, especially if you are not forewarned about it, which next to none of the psychiatrists do. And, absolutely, if you land in a hospital due to such, it will be misdiagnosed as a “return of symptoms,” not a withdrawal induced problem.

          But I am one of the people here who experienced this common withdrawal manic psychosis, and did recover, so of course you could get through it as well. I would definitely forewarn your family about this potential withdrawal problem, however, and set up a support system.

          On the other hand, I have communicated with people who say the antipsychotics do help them, so you may be one who is actually helped by them.

          Best of luck in your recovery.

          • Hi time33,

            I describe ‘paranoia’ as anxiety – what do you do for paranoia? Are you able to neutralise it?

            I found I could overreact and get locked into ‘high anxiety’; but if I could get a distance my thinking normalised.

            I’d take the withdrawal nice and easy and level off at each phase because the main thing is to remain outside of the system.

            It’s a difficult process anyway. Good Luck!

          • “On the other hand, I have communicated with people who say the antipsychotics do help them, so you may be one who is actually helped by them.”

            Hi Someone Else,

            I wonder about this. I find the mainstream system — essentially playing Russian roulette with dangerous neurotoxic drugs — beyond abhorrent, especially when drugs are given coercively. And yet, there are people, possibly a very small minority, whose functioning depends on these drugs (e.g., Ellen Saks). When Bob Whitaker’s Epidemic came out, there was a long back-and-forth running commentary in Amazon’s review section. One young woman, who did not give the book high rating, said Whitaker should have acknowledged stories such as hers — she was a successful, very well-functioning professional with fantastic parents (she said) and a serious thought disorder that she kept totally in check by antipsychotics which she took knowingly and voluntarily. At the time, I thought she was deluded about what drugs do, etc. and ready to pile on her, along with the rest of Bob Whitaker’s fans. Now I am less sure. I remain convinced that the drugging paradigm is manufacturing mental illness in unprecedented rates and believe that drugs should be the very last resort, and never given to children. But real serious mental illness, which is thankfully rare, pre-existed drugging and for some people, these drugs might be the magic bullet, as much as I do not like saying this. I am convinced that much more remains to be learned than we already know — the field is still in the Dark Ages — and we all should keep that in mind.

  2. I tried to stop taking my medication before and I ended up in hospital again and again. But it worked when I came off it slowly.
    I wouldn’t have survived though without basic psychotherapy.

    I think it’s not just about coming off the “antipsychotics”, suitable nondrug support needs to be provided as well.

    There’s s very real “antipsychotic” withdrawal syndrome and this is why so many people are unsucessful.

  3. Why are these studies not free to the public in full form? This particular one was only $11.95, but many are $30 or 40 just to read one article. Which is ridiculous.

    Many of these authors are funded partially by taxpayer money through the NIMH. It is outrageous that they are trying to profit more off the taxpayer by charging money for research that is publicly funded. This also prevents lower-income people, who need accurate information on “treatments” like antipsychotics, from getting the full picture. We should complain.

  4. I do have access to most articles via my university affiliation, but oddly, this one isn’t accessible. I also looked on ResearchGate (facebook for researchers), and couldn’t find it there either. Doesn’t hurt to ask the authors directly (You write better than most academics in this area anyway and could probably impress them enough to get the article 🙂 ).

    FYI- if you want access to full articles, anything NIH funded becomes available to the public for free via PubMed Central within a year after the article has been published.
    http://www.ncbi.nlm.nih.gov/pmc/
    ResearchGate is another good resource (its free), many articles get uploaded there and you can request access to full texts there as well.

    • Thank you. But I don’t want to impress psychiatry authors. I wish they would be fired and the research money redirected toward psychological and social programs that actually help people. At least in this case the researchers have reported a finding that calls antipsychotics into further doubt. But still, this information should be free to the public.

      • Not everyone who writes these articles is out to advance psychiatry in its current dysfunctional state. After all, these authors were inspired by Whitaker to do this paper. I don’t really understand why you want the researchers who write articles that call standard psychiatric practice into question to be fired…

        The lead author’s education is public health, the same area I am currently a grad student in. My hopes are to advance ACE based research that helps develop primary prevention strategies/ stops intergeneration transfer. I know there many others with similar goals in this field

        • I was not being clear enough. There are a few researchers doing what I’d regard as worthwhile investigation. Maybe these ones qualify. I was referring to the large majority of research on short-term treatments for so-called schizophrenia, based on a predominantly biological/genetic model, that make no measureable difference to real people’s lives and serve as false justification for drugs. These are the charlatans that we’d be better off without.

  5. Zyprexa withdrawal basically GAVE me schizophrenia or scitzo afffective they labeled it when I went to the hospital during the hellish withdrawals from that evil shit.

    10 years ago they pushed it for everything , its “great” for anxiety and insomnia, here is a free sample bottle courtesy of the soulless psychos at Eli Lilly.

    Anyway if taking for insomnia leads to withdrawals that resemble schizophrenia and a hospital stay how could it not make all the schizo diagnosis worse and chronic ?

    All they wanted to do if feed me more to treat the symptoms they created.

    • Yes, it’s actually called drug withdrawal induced super sensitivity manic psychosis. But since that’s not in the DSM, thus is not a billable illness, the doctors misdiagnose it as any of the “serious mental illnesses.” I ran into that type malpractice, too.

      And my moronic doctors thought the “cure” was to force medicate me with 10 different drug cocktails, consisting of 8 to 9 different drugs a day, for ten days straight. And every single one of those drug cocktails contained drug interaction warnings that the drugs that were forced upon me can cause “psychosis,” via anticholinergic toxidrome, another drug induced illness that needs to be added to the DSM.

      The doctors “know enough to be dangerous,” now I do too.

  6. I am supposed to be consuming an antipsychotic, for the fear of mental illness returning, I don’t.

    Most people advocate a slow withdrawal, I advocate a quick one.

    Rational behaviour comes from rational thinking.

    Do I have brain damage from previous medications/drugs? It doesn’t matter. All that matters is today. What am I doing today? You prove yourself sane or insane by your actions.

    “My friends, love is better than anger. Hope is better than fear.
    Optimism is better than despair.
    So let us be loving, hopeful and optimistic. And we’ll change the world.” Jack Layton