Major Tranquilizers

On February 1, Allen Frances, MD, published an interesting article on the Huffington Post blog. The article is called Do Antipsychotics Help or Harm Psychotic Symptoms?, and is a response to Robert Whitaker’s post of January 27: “Me, Allen Frances, and Climbing Out of a Pigeonhole. This post, in turn, was a response to Dr. Frances’s Psychiatric Medicines Are Not All Good or All Bad, which was published in the Huffington Post on January 15. Readers may remember that I published a critique of this latter article on February 9. ...

On July 17, I wrote a post on the use of neuroleptic drugs as chemical restraints in nursing homes. The article generated some comments, one of which touched on some very fundamental issues which, in my view, warrant further discussion. The comment was from drsusanmolchan and read as follows: "All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use. ...

There’s an interesting February 11, 2014, article on Peter Breggin’s website: $1.5 Million Award in Child Tardive Dyskinesia Malpractice. Thanks to Mad in America for the link. Here’s the opening paragraph: "On February 11, 2014 a Chicago jury awarded $1.5 million to an autistic child who developed a severe case of tardive dyskinesia and tardive akathisia while being treated by psychiatrists with Risperdal and then Zyprexa between 2002 and 2007. The drug-induced disorder was diagnosed when he was fifteen years old and by then had become disabling and irreversible." ...

In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog. What’s remarkable about this blog is that it is highly critical of psychiatry. Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline. The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes. ...

In December 2012, Mark Olfson, MD, et al, published an article in the Archives of General Psychiatry. The title is National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with Antipsychotics. The authors collected data from the National Ambulatory Medical Care Surveys for the period 1993-2009, and looked for trends in antipsychotic prescribing for children, adolescents, and adults in outpatient visits. Here are the results: Age Increase in no. of antipsychotic prescriptions per 100 population (1993-2009) 0-13 0.24-1.83 (almost 8-fold) 14-20 0.78-3.76 (almost 5-fold) 21+ 3.25-6.18 (almost 2-fold)   The authors provide a breakdown of the diagnoses assigned to the children and adolescents during the antipsychotic visits. ...

ANOTHER VIDEO FROM DR. LIEBERMAN On October 28, Jeffrey Lieberman, MD, President of the APA, made another video. This one is titled An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs, and was made for Medscape. You can see the transcript at the same site. Medscape is a web resource for medical practitioners. The video is Dr. Lieberman’s commentary on an article that appeared in JAMA Psychiatry online on August 28: Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials, by Arif Khan, MD, et al. ...

In my view, one of the most destructive developments in psychiatry in recent years is the prescribing of neuroleptic drugs to children. Much of this prescribing is off-label, meaning that the prescribed use is not approved by the FDA. Off-label drug prescribing is legal, however. Once the FDA has approved a drug for one purpose, a physician may prescribe it for another purpose. But under Medicaid rules, the physician is not permitted to bill Medicaid for writing this prescription unless the use of the drug in the specific circumstances is endorsed by any of the three pharmaceutical compendia approved by Congress for this purpose. A physician who deliberately submits a bill to Medicaid and, thereby, effectively causes Medicaid to pay for, a prescription that is both off-label and unapproved by any of the compendia is open to a charge of Medicaid fraud. Medicaid, incidentally, is the US government’s health insurance system for poor people. Eligibility is based on income. ...

I guess everybody knows by now that Robert Whitaker spoke at the NAMI conference in San Antonio last Saturday (June 29). You can view an outline of his speech, The Case for Selective Use of Antipsychotics here. He spoke about the fact that for people who have been assigned a “diagnosis” of “schizophrenia,” long-term outcomes are better among those who took relatively little of neuroleptic drugs, and worse among those who took relatively more. ...

I recently wrote a post called: Do Major Tranquilizers Make Things Worse? The post was based on a study by Drs. Harrow and Jobe in which they speculated that the high relapse rate of “schizophrenics” who stop taking their drugs may have more to do with drug withdrawal than the supposed drug efficacy. Monica, at BeyondMeds, pointed out that these drugs should not be called tranquilizers because some of their effects (e.g. akathisia, tardive dyskinesia, etc.) are anything but tranquil. And this, of course, is a good point. ...

BACKGROUND On March 19 of this year an article by Martin Harrow and Thomas Jobe was published in the Schizophrenia Bulletin: Does Long-Term Treatment of Schizophrenia with Antipsychotic Medications Facilitate Recovery? You can see it here. The term “antipsychotics” embraces drugs such as Haldol, Risperdal, Thorazine, etc… I prefer the term major tranquilizers, because it is more accurate. Drs. Harrow and Job have conducted a long-term (15-20 year) study of people diagnosed with the condition known as schizophrenia. They found that individuals who had been given “anti-psychotics” continuously for these long periods showed “…considerable psychopathology and few sustained periods of recovery.” ...