At times, I think that I must seem like a dog with a bone, and that I just can’t let this one particular subject—the long-term effects of psychiatric drugs—go. I wrote about this in Anatomy of an Epidemic, and since then I have given many talks and written many blogs on the topic, and more recently, I engaged in a back-and-forth of sorts with Ronald Pies and Allen Frances about this.
But I know that my reason for this obsessiveness is always the same: I want the science to become known. Then perhaps society can have a discussion about what to make of that science.
With this thought in mind, after the last go-round with Pies and Frances, I decided to lay out, in as succinct a manner as I could, the “case against antipsychotics.” I figured the paper could become part of the drug-info resources on our site, with readers able to download it and find there, in one package, a presentation of the science relevant to this question. Perhaps some readers will be motivated to urge prescribers of these drugs to read it as well.
The “Case Against Antipsychotics” is organized in a simple fashion. It has four parts:
- A review of the research cited by psychiatry as evidence for long-term use of antipsychotics.
- A critique of that research, in terms of whether it provides evidence that antipsychotics improve long-term outcomes.
- A presentation of a history of science, stretching across six decades, that tells of how antipsychotics, on the whole, worsen long-term outcomes.
- A review of the criticisms of that argument, by E. Fuller Torrey, Pies, Frances and others, and my responses to those criticisms.
Although this may be a review of the scientific literature that I have written about many times, I like to think I learn something new every time I take a swing at it, and that turned out to be true in this case too.
This past December, Nancy Sohler, from the City College of New York, and researchers from Columbia University, wrote that they had put the argument made in Anatomy of an Epidemic to the test: Is there evidence that antipsychotics do more harm than good? They conducted a methodological review of the medical literature to answer that question, and in their published article, they concluded that the literature was “inadequate to test the hypothesis.” They had identified 18 research articles that provided longer-term findings related to antipsychotic use, but they concluded that design flaws and inadequate reporting of data in the 18 studies made it impossible to draw a conclusion one way or the other about the long-term effects of these drugs. New research was needed to “establish a sufficient evidence base to understand its benefit/risk balance for patients with schizophrenia,” they wrote.
Now, from my perspective, this conclusion was both somewhat validating and somewhat of a rejection of the case made in Anatomy of an Epidemic. It was validating in the sense that these researchers agreed that there wasn’t evidence showing that antipsychotics improved long-term outcomes, but they also decided that there was a lack of evidence supporting a conclusion that the drugs worsened long-term outcomes.
Sohler and colleagues published their paper last December, but I didn’t find the time back then to review their work in depth. However, while writing this paper, I reviewed the 18 studies, which proved to be very informative. Their review provides a new addition to the “narrative of science” that makes the case against antipsychotics. I write about why that is so in the paper.
It’s important to note that “The Case Against Antipsychotics” doesn’t challenge psychiatry’s “medical model” conception of schizophrenia as a “disease.” Psychiatry’s research on antipsychotics for the past 60 years has been shaped by that understanding of schizophrenia and other psychotic disorders, and thus the primary focus of its “effectiveness” studies has been on whether a treatment reduces the “symptoms” of the disease, e.g., psychosis. In this paper, I am simply reporting on what psychiatry’s own research has to say about the long-term effects of antipsychotics on this “illness,” which is what I did in Anatomy of an Epidemic.
In short, it’s a review of psychiatry’s own “evidence base” for antipsychotics.