Kind of scary you have to leave your old self behind to walk the path of mindfulness.
What a thoughtful, thorough, and humane article. Bob Whitaker writes with a sensitivity for the perils of antipsychotics though he’s probably never been on them.
As someone who has experienced the full force and brunt of the American system, my first emotion is jealousy: why not me? Why did I have to endure this absurd treatment regimen? Seroquel, abilify, zyprexa, lithium, haldol….. I’ve been on all of these. How dangerous!! Thanks Bob well done.
Thx for clarification bob
Brilliant as usual bob. Thx for clarifying for me. I just wish you would have addressed the statistics in the article directly, rather than brushing them aside as “talking points.” They cite statistics. Can you refute them? Thx
I was locked up at the infamous Westwood lodge, now closed down. The doctors there destroyed my life. Worst place ever.
Great letter!
I hate antipsychotics. Been on them for seven years. Poison. Now they give them to babies
Same happened to me
What is this comment all about? I’m confused. What does Laura Delano have to do with this?
Agreed. The turning point is when Laura picked up anatomy. Maybe people will open their eyes now
Right on Rachel777
Go Laura!!!!!!!
Wellbutrin isn’t that safe.
Polypharmacy sucks. Psychiatry sucks.
Gee I wonder if any psychiatrist will bother to read this. Flies in the face of everything they hold sacred: their self-esteem, their livelihood, etc.
Psychiatry sucks
Doesn’t surprise me they murdered someone there. Those doctors are criminals.
I was at westwood lodge. Despicable care despicable doctors. We called dr spiro the one one minute man because he saw us for less than a minute a time.
Agreed Steve. Compelling article.
Sounds about right Steve. But cbt has a decent track record. Even for psychosis.
Why don’t you like cbt? Thanks
Do you believe in cbt?
I am in therapy. I want to trust and believe in it.
Robert thanks for replying. Clearly you believe in the power of therapy. How do you respond to szazs criticism?
Robert how do you feel about brief therapy? I.e. Milton Erickson?
Instead of psychotherapy my doc gave me a drug which took away my ability to sleep and induced a traumatic manic, psychotic episode. Hard to recover from a fall like that. Now I’ve been on antipsychotics for six years because of his mistake. Psychiatry is a disaster.
Zyprexa is awful
You are a brave soul. More power to you.
I like your style Robert
No placebo? Big shortcoming of this study
A lot of your story parallels mine. I feel robbed, just like you. A good therapist can’t hurt in terms of healing and getting some of your worth back. You are a survivor, like a lot of us. The damage these so-called doctors can cause is astounding.
I was once put on 20mg haldol plus lithium at same time. Ouch. Substantial psychotoxic effects.
JL you are one resilient dude!
The nefarious bob Whitaker expanding his reach!
What about Wunderink? Does lieberman approach the Wunderink study?
What about the kids? They hand the stuff out like candy to five year olds? What happens to them?
I was once in your shoes. They gave me 20mg of haldol and lithium. Good luck with that combo.
You are in my prayers. I have faith you will heal regardless of what the corrupt system does to you.
Great article Dr Moncrieff! Balanced and fair
Zyprexa causes suicidality
Thanks sandy. Put me in the camp of one of the ones destroyed by antipsychotics and psychiatry in general.
Tough call: take a vitamin, or an antipsychotic that causes disability.
This is awful. I am so sorry. His severe paranoia may have been from starting then stopping haldol.
Big pharma plus psychiatry’s own guild interests corrupt science. This could be straight out of Whitaker’s new book
Sandra thanks for this wonderful piece about a man I never knew. As a survivor, I am indebted to him for his efforts.
Big pharma making a boatload of money, as are psychiatrists. Polypharmacy rarely works.
Maybe placebo isn’t as effective for Alzheimer’s as it is with depression.
The last thing we need is for trump to take a psych med. will just make him worse.
A very balanced essay. I appreciate your perspective.
I was the one that quoted psychiatric times. What will psychiatrists do with the new integrated and functional approach? You don’t need a prescription to attend a yoga studio. You don’t need a prescription to go to Whole Foods and get zinc and magnesium. Their heyday is coming to an end. Whitaker et al have exposed them
Thanks for your contribution Craig. I am a psychiatric survivor. I also read Psychiatric Times. I have noticed that in the last few months there has been a noticeable shift there. Yoga, deep breathing, and other non-drug options are getting almost equal airtime to traditional psychiatric approaches. In fact, one such article discussed magnesium and zinc as being great for mental health. Two others discuss Omega-3. I am supplementing with these now.
Six years ago, I began my odyssey through psychiatry. The results are nothing short of catastrophic.
I applaud your efforts leading the charge to more integrative, non-pharmaceutical care.
Welcome to MIA.
Dig deeper into the egregious corruption. Don’t get me wrong. I admire your probing of the tough calls and ambiguity. But some of this stuff isn’t a tough call at all. Your anger and passion aren’t clouding your judgement imho. You are pushing the conversation forward, bravely. If I had known about you and Bob six years ago my life would be about 10x better. Hope this makes sense. Thanks
Sandy I deeply appreciate this essay of yours. I agree this is complex stuff. But some of it isn’t complicated at all….. like study 329: not complicated! Psychiatrists blatantly lied and put public health at risk. I know that’s an example of an antidepressant and so not as relevant but the point is some of this stuff is actually straightforward. Lies vary rarely lead to good medicine, especially when the lies are created on behalf of special interests. Again, thanks for your essay. Full disclosure: I am a SURVIVOR whose life was derailed by psychiatry.
Wonderfully written piece.
I believed in the drugs…. until they destroyed my life.
David, in your intro you say you value ssri. What value do these drugs have for you?
More damage to the patient
Stimulants are dangerous. They can cause mood disorders and psychosis. Hence, the use of antipsychotics to cover up the viscious effects of the amphetamine. More work for the docs/more money for big pharma.
Antipsychotics mess with metabolism. Could that lead to depression?
When Prozac came out people said it saved their lives. The placebo effect is really strong.
Looking forward to your book and hearing more from you here on Mia. As a survivor and a user I am furious that I was duped into consuming these drugs.
Looking forward to the video section. A lot of us have stories to tell
Risky drugs and little proof of efficacy. No wonder psychiatry is in crisis.
What a disgrace.
This is a very important study. Psychiatry convinced the public that their solutions were superior. In short, they lied in order to elevate their own status. Studies like this show that there is (thank God) help for those who suffer from this terrible affliction. And that solution is cbt not pills. Pills make it worse! Liars.
A brilliant piece of work. Full of humanity and hope. I wish you well as you continue your journey toward health.
I agree that psychiatrists need more than a fifteen minute session to get a feel for their patients. But where is the money in that?
Loved this article. Great post. I was perfectly happy while delusional and didn’t want meds but was forced to.
Not surprising. Prozac and Zoloft are a lie. The atypicals are a lie. Paxil is a lie. And on and on. Corruption.
Great article mr hickey. A comprehensive indictment.
I was once forced to take haldol and lithium even though I begged not to take it. Forced drugging.
I am glad to see there is slow progress being made against the behometh that is psychiatry. Keep us posted Bob.
Matt I agree that when going through a psychotic experience there are other people to see first before a psychiatrist. Cbt is a safer first line treatment for psychosis.
Long term antipsychotic use is in the spotlight now. Hopefully science can revolve and move forward on this critical issue.
Thanks for sharing this. So much insight. Life is really hard sometimes. Who am I really? This is a tough questions that for some people (like me) is a tough, paralyzingly one that can cause enormous depression and angst. If a psychiatrist gets involved and there is a bad reaction to meds then all bets are off.
You are so brave for turning your pain into helping others. You have so much insight into the causes of angst and intense depression. So sorry for your loss.
Jeez a healthy spice or a potentially deadly drug that kills sex drive. Tough call
Another damaging article for antipsychotics. I forward this stuff to my shrink friends. I never get a response. Or they say “it’s complicated”.
I can totally relate to something you said Caleb: the delusions are there but your so sedated….. I get that.
I agree w Rossa can you clarify the med piece for us? Thanks
Amazing story. Did haldol help with the delusions? You were pretty bad with your paranoia. Would you have recovered without the meds? Or do you think it was just an episode or a phase that you would have organically grown out of?
Really good podcast. Thanks for sharing Justin. Mania psychosis insomnia and sexual side effects seem too big a tradeoff for a tiny improvement in depression. Plus no mention of the concept of active placebo. In sum I’ll take a pass on antidepressants. Lying psychiatrists won’t give up on this fight however.
Denial and cognitive dissonance.
Well done peter. I am one person only but an antidepressant stole my life causing mania insomnia and psychosis. Keep up the good work!
An antidepressant ruined my life. It caused insomnia and psychosis and led to five years of antipsychotics. I cannot come off the antipsychotics.
Is it possible that there has been a zyprexa coverup vis a vis suicide just like the Paxil coverup?
You are really brave and resilient. I noticed both hospitalizations were preceded by insomnia. That’s what got me too. Fifty days of bad sleep on Wellbutrin led to psychosis and then polypharmacy.
Zyprexa sometimes causes suicidal thinking. Awesome drug.
How long has big pharma known this I wonder.
That’s a horrible story. I became psychotic on Wellbutrin and as a result have been on antipsychotics for five years.
Lying greedy criminals they are
Open dialogue sounds like a promising development. Too late for me though. I was put on antipsychotics after becoming psychotic on Wellbutrin. That was five years ago. And once ur on antipsychotics it’s hard to stop. Five years of dopamine blockage. Huge surprise I am disabled and dysfunctional now.
As lex Wunderink has said, dopamine is important. Curiosity, drive, goal setting may all have their origin in healthy dopamine functioning. Dopamine blockers (antipsychotics) are dangerous!
So any approach that encourages minimal use of these harmful drugs is very promising indeed.
As someone who has been grievously harmed by an antidepressant, I find this article both disheartening and infuriating at the same time.
Plain and simple this is a COVERUP! Yes Steve, so shocking that the industry would put profits over safety. Grrrrrrrrrr
Are antidepressants better than placebo for moderate depression?
Sounds like when you were at you worst you were suffering terribly. From a psychiatrists point of view they would say why not take a small dose of an antipsychotic? Answer: once you start it’s hard to stop.
Pies has added yet another clarification regarding withdrawals on the psych times website.
Agree with Liz. Generalizing that all kids cry it out in France over generalizes. Anyway it’s much nicer to soothe your kid to sleep imho.
But ya big pharma is ridiculous and has captured psychiatry
Pies and Pierre’s response to Whitaker:
Some Methodological Issues: A Supplementary Statement from Drs. Pierre and Pies:
Our commentary cited six studies of “quality of life” (QOL) and antipsychotics (AP) that involved a placebo control (Hamilton et al, Nasrallah et al, Beasley et al, Leucht et al, Witte et al, and Isitt et al). All these studies found an advantage for AP use vs. placebo, with respect to improving QOL. Like all studies, the ones cited have limitations and methodological shortcomings, and we carefully qualified our conclusions as “provisional”, pending more long-term placebo-controlled studies.
Some critics argue that APs make patients with schizophrenia worse (or even cause “brain damage”), but then simultaneously invoke the speculative notion of “withdrawal” to explain away the results of the studies we have cited, arguing that these studies did not use “true” placebo groups. But if APs actually make patients with schizophrenia worse, then discontinuing the AP ought to make patients better. Conveniently invoking “withdrawal” to explain why, in fact, patients with schizophrenia who are taken off APs do not usually get better is contradictory. (To critics who respond, “Oh, we concede that antipsychotic medications may be helpful in the short term, but they make things worse in the long term,” we would reply that there are no convincing randomized controlled data, either on the basis of relapse frequency or quality of life, that demonstrate that antipsychotics worsen outcome in the long term. As the Sohler et al study concluded; i.e., “Our study did not support the hypothesis that long-term treatment with antipsychotic medication causes harm.” [Am J Orthopsychiatry. December 14, 2015]
Critics also confuse two uses of the term “withdrawal.” One use means, “stopping or discontinuing a drug.” The other refers to withdrawal syndromes, such as the kind experienced when a patient is suddenly taken off a barbiturate or opiate, and experiences shivering, diarrhea, hallucinations, seizures, or even death. There is no such documented “withdrawal” syndrome associated with discontinuation of antipsychotic medications—even sudden discontinuation–except for generally mild and transient cholinergic rebound symptoms, such as hypersalivation, cramps, or diarrhea. These are usually seen within a few days of stopping the AP; are usually mild and self-limited; and rarely need clinical intervention (In rare instances, they are easily managed with anticholinergic medication). These short-term symptoms are quite distinct from a relapse of the illness, which typically occurs 1 or more months after stopping the medication. Thus, the notion that the placebo groups in the studies we cited did worse because they were “in withdrawal” and not “being treated for withdrawal” is completely unsupported by any empirical data.
A “true placebo group” is a group that is given a placebo—period. There is no other definition in the medical literature. It would require an individualized, patient-level analysis in order to demonstrate that any particular patient taking the placebo was “in withdrawal.” We are not aware of any such data. The notion of a “supersensitivity psychosis”, as invoked by some critics, remains only a speculative and theoretical possibility—not, to our knowledge, one confirmed by any biological study (PET, fMRI, etc) of the brains of actual patients.
Finally, while all studies, including the ones we cited, have methodological limitations and potential biases (e.g., pharmaceutical company sponsorship), we have yet to see critics cite a single controlled study, using standard measures of QOL, showing that quality of life improves for patients with schizophrenia when they are no longer taking their antipsychotic medication.
Joseph M. Pierre MD
Ronald W. Pies MD
Pies just offered a response to Whitakers rebuttal. It is on the psychiatric times website underneath their article.
You may have literally saved your child’s life. Look up the TADS study that Whitaker and Healy have reported on.
Kind of scary you have to leave your old self behind to walk the path of mindfulness.
What a thoughtful, thorough, and humane article. Bob Whitaker writes with a sensitivity for the perils of antipsychotics though he’s probably never been on them.
As someone who has experienced the full force and brunt of the American system, my first emotion is jealousy: why not me? Why did I have to endure this absurd treatment regimen? Seroquel, abilify, zyprexa, lithium, haldol….. I’ve been on all of these. How dangerous!! Thanks Bob well done.
Thx for clarification bob
Brilliant as usual bob. Thx for clarifying for me. I just wish you would have addressed the statistics in the article directly, rather than brushing them aside as “talking points.” They cite statistics. Can you refute them? Thx
Bob you are brilliant but you are on the wrong side of this particular issue https://www.google.com/amp/s/www.nationalreview.com/2019/08/yes-the-u-s-has-a-mental-health-problem/amp/
I was locked up at the infamous Westwood lodge, now closed down. The doctors there destroyed my life. Worst place ever.
Great letter!
I hate antipsychotics. Been on them for seven years. Poison. Now they give them to babies
Same happened to me
What is this comment all about? I’m confused. What does Laura Delano have to do with this?
Agreed. The turning point is when Laura picked up anatomy. Maybe people will open their eyes now
Right on Rachel777
Go Laura!!!!!!!
Wellbutrin isn’t that safe.
Polypharmacy sucks. Psychiatry sucks.
Gee I wonder if any psychiatrist will bother to read this. Flies in the face of everything they hold sacred: their self-esteem, their livelihood, etc.
Psychiatry sucks
Doesn’t surprise me they murdered someone there. Those doctors are criminals.
I was at westwood lodge. Despicable care despicable doctors. We called dr spiro the one one minute man because he saw us for less than a minute a time.
Agreed Steve. Compelling article.
Sounds about right Steve. But cbt has a decent track record. Even for psychosis.
Why don’t you like cbt? Thanks
Do you believe in cbt?
I am in therapy. I want to trust and believe in it.
Robert thanks for replying. Clearly you believe in the power of therapy. How do you respond to szazs criticism?
Robert how do you feel about brief therapy? I.e. Milton Erickson?
Instead of psychotherapy my doc gave me a drug which took away my ability to sleep and induced a traumatic manic, psychotic episode. Hard to recover from a fall like that. Now I’ve been on antipsychotics for six years because of his mistake. Psychiatry is a disaster.
Zyprexa is awful
You are a brave soul. More power to you.
I like your style Robert
No placebo? Big shortcoming of this study
A lot of your story parallels mine. I feel robbed, just like you. A good therapist can’t hurt in terms of healing and getting some of your worth back. You are a survivor, like a lot of us. The damage these so-called doctors can cause is astounding.
I was once put on 20mg haldol plus lithium at same time. Ouch. Substantial psychotoxic effects.
JL you are one resilient dude!
The nefarious bob Whitaker expanding his reach!
What about Wunderink? Does lieberman approach the Wunderink study?
What about the kids? They hand the stuff out like candy to five year olds? What happens to them?
I was once in your shoes. They gave me 20mg of haldol and lithium. Good luck with that combo.
You are in my prayers. I have faith you will heal regardless of what the corrupt system does to you.
Great article Dr Moncrieff! Balanced and fair
Zyprexa causes suicidality
Thanks sandy. Put me in the camp of one of the ones destroyed by antipsychotics and psychiatry in general.
Tough call: take a vitamin, or an antipsychotic that causes disability.
This is awful. I am so sorry. His severe paranoia may have been from starting then stopping haldol.
It’s more than one percent
Keep fighting the good fight peter!
http://bjp.rcpsych.org/content/139/3/255
what about this one?
Big pharma plus psychiatry’s own guild interests corrupt science. This could be straight out of Whitaker’s new book
Sandra thanks for this wonderful piece about a man I never knew. As a survivor, I am indebted to him for his efforts.
Big pharma making a boatload of money, as are psychiatrists. Polypharmacy rarely works.
Maybe placebo isn’t as effective for Alzheimer’s as it is with depression.
The last thing we need is for trump to take a psych med. will just make him worse.
A very balanced essay. I appreciate your perspective.
I was the one that quoted psychiatric times. What will psychiatrists do with the new integrated and functional approach? You don’t need a prescription to attend a yoga studio. You don’t need a prescription to go to Whole Foods and get zinc and magnesium. Their heyday is coming to an end. Whitaker et al have exposed them
Thanks for your contribution Craig. I am a psychiatric survivor. I also read Psychiatric Times. I have noticed that in the last few months there has been a noticeable shift there. Yoga, deep breathing, and other non-drug options are getting almost equal airtime to traditional psychiatric approaches. In fact, one such article discussed magnesium and zinc as being great for mental health. Two others discuss Omega-3. I am supplementing with these now.
Six years ago, I began my odyssey through psychiatry. The results are nothing short of catastrophic.
I applaud your efforts leading the charge to more integrative, non-pharmaceutical care.
Welcome to MIA.
Dig deeper into the egregious corruption. Don’t get me wrong. I admire your probing of the tough calls and ambiguity. But some of this stuff isn’t a tough call at all. Your anger and passion aren’t clouding your judgement imho. You are pushing the conversation forward, bravely. If I had known about you and Bob six years ago my life would be about 10x better. Hope this makes sense. Thanks
Sandy I deeply appreciate this essay of yours. I agree this is complex stuff. But some of it isn’t complicated at all….. like study 329: not complicated! Psychiatrists blatantly lied and put public health at risk. I know that’s an example of an antidepressant and so not as relevant but the point is some of this stuff is actually straightforward. Lies vary rarely lead to good medicine, especially when the lies are created on behalf of special interests. Again, thanks for your essay. Full disclosure: I am a SURVIVOR whose life was derailed by psychiatry.
Wonderfully written piece.
I believed in the drugs…. until they destroyed my life.
David, in your intro you say you value ssri. What value do these drugs have for you?
More damage to the patient
Stimulants are dangerous. They can cause mood disorders and psychosis. Hence, the use of antipsychotics to cover up the viscious effects of the amphetamine. More work for the docs/more money for big pharma.
Antipsychotics mess with metabolism. Could that lead to depression?
When Prozac came out people said it saved their lives. The placebo effect is really strong.
Looking forward to your book and hearing more from you here on Mia. As a survivor and a user I am furious that I was duped into consuming these drugs.
Looking forward to the video section. A lot of us have stories to tell
Risky drugs and little proof of efficacy. No wonder psychiatry is in crisis.
What a disgrace.
This is a very important study. Psychiatry convinced the public that their solutions were superior. In short, they lied in order to elevate their own status. Studies like this show that there is (thank God) help for those who suffer from this terrible affliction. And that solution is cbt not pills. Pills make it worse! Liars.
A brilliant piece of work. Full of humanity and hope. I wish you well as you continue your journey toward health.
I agree that psychiatrists need more than a fifteen minute session to get a feel for their patients. But where is the money in that?
Loved this article. Great post. I was perfectly happy while delusional and didn’t want meds but was forced to.
Not surprising. Prozac and Zoloft are a lie. The atypicals are a lie. Paxil is a lie. And on and on. Corruption.
Great article mr hickey. A comprehensive indictment.
I was once forced to take haldol and lithium even though I begged not to take it. Forced drugging.
I am glad to see there is slow progress being made against the behometh that is psychiatry. Keep us posted Bob.
Matt I agree that when going through a psychotic experience there are other people to see first before a psychiatrist. Cbt is a safer first line treatment for psychosis.
Long term antipsychotic use is in the spotlight now. Hopefully science can revolve and move forward on this critical issue.
Thanks for sharing this. So much insight. Life is really hard sometimes. Who am I really? This is a tough questions that for some people (like me) is a tough, paralyzingly one that can cause enormous depression and angst. If a psychiatrist gets involved and there is a bad reaction to meds then all bets are off.
You are so brave for turning your pain into helping others. You have so much insight into the causes of angst and intense depression. So sorry for your loss.
Jeez a healthy spice or a potentially deadly drug that kills sex drive. Tough call
Another damaging article for antipsychotics. I forward this stuff to my shrink friends. I never get a response. Or they say “it’s complicated”.
I can totally relate to something you said Caleb: the delusions are there but your so sedated….. I get that.
I agree w Rossa can you clarify the med piece for us? Thanks
Amazing story. Did haldol help with the delusions? You were pretty bad with your paranoia. Would you have recovered without the meds? Or do you think it was just an episode or a phase that you would have organically grown out of?
Really good podcast. Thanks for sharing Justin. Mania psychosis insomnia and sexual side effects seem too big a tradeoff for a tiny improvement in depression. Plus no mention of the concept of active placebo. In sum I’ll take a pass on antidepressants. Lying psychiatrists won’t give up on this fight however.
Denial and cognitive dissonance.
Well done peter. I am one person only but an antidepressant stole my life causing mania insomnia and psychosis. Keep up the good work!
An antidepressant ruined my life. It caused insomnia and psychosis and led to five years of antipsychotics. I cannot come off the antipsychotics.
Is it possible that there has been a zyprexa coverup vis a vis suicide just like the Paxil coverup?
You are really brave and resilient. I noticed both hospitalizations were preceded by insomnia. That’s what got me too. Fifty days of bad sleep on Wellbutrin led to psychosis and then polypharmacy.
Zyprexa sometimes causes suicidal thinking. Awesome drug.
How long has big pharma known this I wonder.
That’s a horrible story. I became psychotic on Wellbutrin and as a result have been on antipsychotics for five years.
Lying greedy criminals they are
Open dialogue sounds like a promising development. Too late for me though. I was put on antipsychotics after becoming psychotic on Wellbutrin. That was five years ago. And once ur on antipsychotics it’s hard to stop. Five years of dopamine blockage. Huge surprise I am disabled and dysfunctional now.
As lex Wunderink has said, dopamine is important. Curiosity, drive, goal setting may all have their origin in healthy dopamine functioning. Dopamine blockers (antipsychotics) are dangerous!
So any approach that encourages minimal use of these harmful drugs is very promising indeed.
As someone who has been grievously harmed by an antidepressant, I find this article both disheartening and infuriating at the same time.
Plain and simple this is a COVERUP! Yes Steve, so shocking that the industry would put profits over safety. Grrrrrrrrrr
Pies claims there is no such thing as an epidemic of mental health, blatantly talking s**t to you and Whitaker:
http://www.psychiatrictimes.com/blogs/couch-crisis/astonishing-non-epidemic-mental-illness?cid=home
Are antidepressants better than placebo for moderate depression?
Sounds like when you were at you worst you were suffering terribly. From a psychiatrists point of view they would say why not take a small dose of an antipsychotic? Answer: once you start it’s hard to stop.
Pies has added yet another clarification regarding withdrawals on the psych times website.
Agree with Liz. Generalizing that all kids cry it out in France over generalizes. Anyway it’s much nicer to soothe your kid to sleep imho.
But ya big pharma is ridiculous and has captured psychiatry
Pies and Pierre’s response to Whitaker:
Some Methodological Issues: A Supplementary Statement from Drs. Pierre and Pies:
Our commentary cited six studies of “quality of life” (QOL) and antipsychotics (AP) that involved a placebo control (Hamilton et al, Nasrallah et al, Beasley et al, Leucht et al, Witte et al, and Isitt et al). All these studies found an advantage for AP use vs. placebo, with respect to improving QOL. Like all studies, the ones cited have limitations and methodological shortcomings, and we carefully qualified our conclusions as “provisional”, pending more long-term placebo-controlled studies.
Some critics argue that APs make patients with schizophrenia worse (or even cause “brain damage”), but then simultaneously invoke the speculative notion of “withdrawal” to explain away the results of the studies we have cited, arguing that these studies did not use “true” placebo groups. But if APs actually make patients with schizophrenia worse, then discontinuing the AP ought to make patients better. Conveniently invoking “withdrawal” to explain why, in fact, patients with schizophrenia who are taken off APs do not usually get better is contradictory. (To critics who respond, “Oh, we concede that antipsychotic medications may be helpful in the short term, but they make things worse in the long term,” we would reply that there are no convincing randomized controlled data, either on the basis of relapse frequency or quality of life, that demonstrate that antipsychotics worsen outcome in the long term. As the Sohler et al study concluded; i.e., “Our study did not support the hypothesis that long-term treatment with antipsychotic medication causes harm.” [Am J Orthopsychiatry. December 14, 2015]
Critics also confuse two uses of the term “withdrawal.” One use means, “stopping or discontinuing a drug.” The other refers to withdrawal syndromes, such as the kind experienced when a patient is suddenly taken off a barbiturate or opiate, and experiences shivering, diarrhea, hallucinations, seizures, or even death. There is no such documented “withdrawal” syndrome associated with discontinuation of antipsychotic medications—even sudden discontinuation–except for generally mild and transient cholinergic rebound symptoms, such as hypersalivation, cramps, or diarrhea. These are usually seen within a few days of stopping the AP; are usually mild and self-limited; and rarely need clinical intervention (In rare instances, they are easily managed with anticholinergic medication). These short-term symptoms are quite distinct from a relapse of the illness, which typically occurs 1 or more months after stopping the medication. Thus, the notion that the placebo groups in the studies we cited did worse because they were “in withdrawal” and not “being treated for withdrawal” is completely unsupported by any empirical data.
A “true placebo group” is a group that is given a placebo—period. There is no other definition in the medical literature. It would require an individualized, patient-level analysis in order to demonstrate that any particular patient taking the placebo was “in withdrawal.” We are not aware of any such data. The notion of a “supersensitivity psychosis”, as invoked by some critics, remains only a speculative and theoretical possibility—not, to our knowledge, one confirmed by any biological study (PET, fMRI, etc) of the brains of actual patients.
Finally, while all studies, including the ones we cited, have methodological limitations and potential biases (e.g., pharmaceutical company sponsorship), we have yet to see critics cite a single controlled study, using standard measures of QOL, showing that quality of life improves for patients with schizophrenia when they are no longer taking their antipsychotic medication.
Joseph M. Pierre MD
Ronald W. Pies MD
Pies just offered a response to Whitakers rebuttal. It is on the psychiatric times website underneath their article.
You may have literally saved your child’s life. Look up the TADS study that Whitaker and Healy have reported on.