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Story of antipsychotics is one of myth and misrepresentation

Antipsychotic drugs are usually considered to be one of the 20th century’s major medical breakthroughs. They are often believed to be so effective that they brought about the closure of the old mental…

Bipolar isn’t psychotic. Jacobnmartinez

Antipsychotic drugs are usually considered to be one of the 20th century’s major medical breakthroughs. They are often believed to be so effective that they brought about the closure of the old mental asylums and enabled the mentally ill to return to the community.

But newer antipsychotics, such as Zyprexa and Seroquel, are no longer just used to treat severe mental disturbance but have broken into the mainstream to become some of the most profitable drugs in history.

They now rival statins (used to lower cholesterol) and antidepressants in terms of the revenue they bring in. And in England, their use has increased by two thirds over the last few years. The most lucrative market is for treating the newly fashionable diagnosis of bipolar disorder.

But far from normalising these drugs, we should be worried about their increasing use. While antipsychotics can be useful for those who are severely psychotic, these dangerous drugs should be considered with a heavy dose of caution.

Bizarre practices

The first drug considered to be an antipsychotic was chlorpromazine, also known as Largactil or Thorazine, which was introduced into psychiatry in the early 1950s.

Even from these early days, almost nothing about the story of antipsychotics is as told.

Henri Laborit in 1991 Erling Mandelmann

Henri Laborit, the French surgeon proclaimed as a hero for introducing it to psychiatrist colleagues, was using it in a highly dangerous procedure he devised called “artificial hibernation” or “sedation without narcosis”. But the procedure killed off most of the dogs it was demonstrated on during Laborit’s tour of the US.

Psychiatrists who used chlorpromazine and other antipsychotics in the early days regarded them as special sorts of sedatives and documented the reduced responsiveness and reactions which were part of the artificial state they produced. They suggested the drugs worked by inducing an inhibition of the nervous system and that they reduced psychotic preoccupations by slowing thought processes and flattening emotions.

People (both with mental illness and volunteers) who’ve taken antipsychotics also report a state of physical, mental and emotional suppression. Those suffering from mental disorders describe how the drugs can help to diminish disturbing thoughts and experiences, but at the cost of stifling important aspects of their personality such as initiative, motivation, creativity and sexual drive.

As Richard Bentall, an expert on psychosis and a volunteer into a study of Droperidol, described it:

For the first hour I didn’t feel too bad. I thought maybe this is okay. I can get away with this. I felt a bit light-headed … [After being asked to fill in a form] I couldn’t have filled it in to save my life. It would have been easier to climb Mt Everest … It was accompanied by a feeling that I couldn’t do anything, which is really distressing. I felt profoundly depressed. They tried to persuade me to do these cognitive tests on the computer and I just started crying.

Antipsychotics gained a reputation as “chemical straight-jackets” and they are still used for the control of disturbed and aggressive behaviour in mental health units - and as animal tranquilisers in veterinary medicine.

Antipsychotics: the chemical version of a straight-jacket? Mark NL

Side effects

There’s been much debate more recently about the value of antipsychotic treatment but there’s reasonable evidence that they can reduce the symptoms of an acute psychotic episode in the short-term. It’s more difficult to judge their longer term benefits.

On the one hand, the drugs may suppress mental processes in people locked into a persistent psychotic state just enough to enable them to regain a foothold in reality. But for some, the benefits may not outweigh the considerable mental and physical impairments the drugs can produce: neurological damage, diabetes, heart disease, impotence and brain shrinkage.

Serious effects have been obscured because the frank descriptions provided by early clinicians were replaced by a vision of the drugs as a cleverly targeted, sophisticated and essentially benign treatment. And despite no convincing evidence to support the theory, the view emerged that they work by reversing an underlying “chemical imbalance” or other such abnormality rather than by inducing an abnormal or altered state.

This idea has enormous appeal for psychiatrists, politicians, consumers and the pharmaceutical industry. The belief that they reverse a chemical imbalance has been particularly useful in distracting attention from the serious harm they can do.

It has also enabled antipsychotics to be marketed to a wider segment of the population and fostered a movement that antipsychotics should be started as early as possible, without waiting for a definite diagnosis. Even more worrying, there has been a trend to prescribe them as a preventative measure in young people who are not psychotic but might be “at risk”.

The bipolar market

The popularity of antipsychotics has occurred partly through the transformation of the concept of bipolar disorder over recent years. Once considered rare, episodic and seriously disabling, bipolar disorder has expanded - under pharmaceutical industry influence - into the vague notion of “mood swings” that can apply to almost anyone.

Although drugs such as antipsychotics have only been properly tested in people with classical bipolar (previously known as manic depression) and have never been shown to be useful for everyday variations in mood, people who might previously have been characterised as “depressed” may now be encouraged to view themselves as bipolar. In this way antipsychotics can corner some of the vast antidepressant drug market.

The way antipsychotics have been misrepresented, their benefits inflated, their dangers minimised, illustrates how what is presented as neutral and objective “science” may in fact conceal a whole array of political and commercial interests. The psychiatric profession wanted to present a new image to society and politicians wished to replace costly mental institutions with cheaper community care.

All of this has helped transform antipsychotic drugs from dreaded chemical straight-jackets to modern-day soothers, lining the coffers of the pharmaceutical industry along the way. It’s time we woke up.

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14 Comments sorted by

  1. John Doyle

    architect

    All I can say is Bloody Hell!!!
    Here we go again. Yet another lapse by governments, outsourcing science and allowing us all to reap the consequences. Where are the fearless researchers who call a spade a spade? Not in the pharmaceutical industry where jobs depend on toeing the company line. The government should wake up to the false economies in cutting science spending, false because medical costs to the commonwealth are snowballing beyond control.
    We read in the USA that the FDA regulates drugs, but it's also become compromised, statins are a good example, by skewed "science" from vested interests.
    We see the whole of western economies distorted by all these biases, in our foods and in our health. Remove them and see the costs to Government come down. Make the vested interests pay, not the rest of us.
    Fat chance though! Governments are so compromised and distorted now that good governance is just a dream.

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  2. Sue Ieraci

    Public hospital clinician

    The author's point about inappropriate use of the newer anti-psychotics is well made.

    The article, however, appears to skip over of the real benefits of anti-psychotic medication - which can be life-saving in severe, disabling psychotic illness.

    For people with schizophrenia, long-term anti-psychotic treatment can mean the difference between a stable, productive life and a chaotic life of homelessness and distress. And the newer anti-psychotics, despite having some adverse effects, don't leave older schizophrenic patients with disabling movement disorders like the older phenothiazines did.

    The problem is not the advent of newer, safer drugs - it is their inappropriate prescription. It is the duty of the prescribing practitioner to obtain a firm diagnosis and use medication appropriately - like in any other medical condition.

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    1. Mia Masters

      person

      In reply to Sue Ieraci

      I would like to see some solid evidence on people on anti-psychtic drugs skipping back to a "stable, productive life". Those on the short term course and also on the long term. Please provide the link to a study that is free of bias.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Mia Masters

      Ms Masters,

      Having some insight into severe psychotic illness from both professional and social contact, I would never say that anyone with severe disease ''skipped back'' to a stable and productive life - it can take years to find the right balance of medication.

      Short-term courses are sometimes effective for - say - drug-induced psychosis but for many people, severe psychotic illness is life-long.

      The use of antipsychotic medication - or any class of medication, can't be based on a single study. Clinical practice requires the accumulation of evidence of reasonable safety and efficacy. Effective drugs, having an action, can also produce reactions and side-effects. Individuals may need to try various, or combinations, to find an effective and tolerable treatment.

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    3. Allan Gardiner

      Dr

      In reply to Sue Ieraci

      Quite apart from the right balance of medication, the correct type to give them is always a good place from which to be`guinea-pigging...err..begin.

      The right balance, too, is extemely important...lest they be tipped right over the edge...of reality, thereby draining them completely of any vestige vested in them beforehand.

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  3. Daniel Haszard

    logged in via Facebook

    Thanks for posting this vital information.The Eli Lilly company made an astounding $70 BILLION on Zyprexa that they PUSHED on the elderly and underage children (*Viva Zyprexa* Lilly sales rep slogan) with wanton disregard for the side effects

    *FIVE at FIVE*
    The Zyprexa antipsychotic drug,whose side effects can include weight gain and diabetes, was sold to Veterans,children in foster care, elderly in nursing homes.
    *Five at Five* was the Zyprexa sales rep slogan, meaning *5mg dispensed at 5pm would keep patients quiet*.
    -- Daniel Haszard Bangor Maine FMI http://www.zyprexa-victims.com

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  4. Harry Mavity

    logged in via Facebook

    My experience:

    Aged thirty (nearly) now, I am still in a struggle with 'Mental Health Services' because of a suicide attempt aged 17. I blame what happened aged 17 on a teenage problems mainly, but hundreds of factors contributed to me making that choice. The treatment I received has been extremely harmful. Antipsychotics are harmful and have no benefits. On Antipsychotics I was unable to concentrate enough to read a book, unable to take public transport or sit in University lectures without…

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    1. scotty cooper

      DSP

      In reply to Harry Mavity

      Wow Harry I have Ptsd to, and like you been in and out since age 25 I am now 45 i want this to stop! Docs medicate me and well this cycle goes on and on and on..years pass by! Your not a mad man!!! Ptsd Anxiety can be a real pain! I feel your frustration..Scott

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  5. scotty cooper

    DSP

    Chemical Handcuffs I call them, Oh how i Yearn for a med free life one day, I dont know how to live though of meds. I find myself all over the place half the time taking them anyhow Never stable so why bother????........All I know is Anti D'epressents dont do a thing, Anti Psych's make me feel Robotic.... So I mostly Take Valium or try to just numb anyway i can!!! What else can one do??? I want to be like i was at age 20...... Carefree Lost so many years to Mental Health!!!

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  6. Hannah Rivers

    Architect

    I appreciate the point this article is attempting to get across about the risk factors of anti-psychotics, but for me labelling bipolar as 'fashionable' reduces it to no more than a gossip column. Bipolar is consistently stigmatised, and for those who suffer, it can be absolutely life destroying and alienating. Anti-psychotics are of course marketed to a wider audience than ever before, and a close eye should always be kept on big pharma, but lets not kid ourselves that any sort of mental illness is fashionable.

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  7. Mia Masters

    person

    Sadly, if patients raise concerns about the drugs, they are labelled non-compliant and threatened with discontinuation of medical care (a kinda blackmail, if you ask me).
    Patients are told off (or kicked out) for questioning the expertise and authority of the doctors for prescribing this stuff, even though they also admit that it is mostly just a grand experiment.
    It is shameful what is happening, and I think medical, professionals have a slightly different view on quality of life, and the side-effects…

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  8. Steve Phillips

    Nurse Practitioner

    I agree with much of what the author has said. We cannot however allow abuses of a drug to colour our perception and concern over conditions like bipolar and schizophrenia. Nor should the Govt 'react' and do more damage by withdrawing useful but overprescribed drugs from the market.
    I have seen the inapropriate use of the new atypical 'anti-psychotics' first hand and have serious doubts that enough training and control is exercised over their prescription by GPs.
    This can be rectified and raising the issue with professional organisations like the RACGP is a good fist step.
    Perhaps they could also address the ADHD 'industry' as well where insufficient attemts at diagnosis and a subscriber form of medication regulation and supply is prevalent.

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  9. Nicki Glasser

    business owner

    I suggest folks read two very good books that address some of these topics. "Mad in America" looks at the history in the US (and probably everywhere) that brought us to the drug-cures-all mentality. Second, Anatomy of an Epidemic, addresses (a partial dissection in my opinion of) the destructive force of this approach. They are both by Robert Whitaker, an award winning journalist.

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  10. Allan Gardiner

    Dr

    Be sure to have a very informative read of the "Rosenhan experiment" and then make up your own mind as to how many people the world over have then -- since that very epoch -- become addicted to certain drugs through their having been forced to take them quite unnecessarily in the first place. People exactly like David Rosehan and his clever pseudo-patients. Even the completely non-existent psuedo-patients to boot. Come in Spinner!

    Some folk may try to say that things are a lot different now than…

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