Neuroleptics

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. ...

I’ve been reading another great book: Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare, by Peter C. Gotzsche [Radcliffe Publishing, 2013]. The book is an exposé of pharma’s fraudulent research and marketing. The author is a Danish physician who has been involved in clinical trials of drugs, and in drug regulatory matters. He is a professor at the University of Copenhagen. He has published more than 50 papers, including papers in the BMJ, Lancet, JAMA, Annals of Internal Medicine, and the New England Journal of Medicine. ...

There’s an interesting article on Harvard Law Petrie-Flom Center’s blog titled Daubert as a Problem for Psychiatrists. It was written by Alex Stein and is dated September 19. [Thanks to Dustin Salzedo for drawing my attention to this in a comment on an earlier post.] The article deals with the legal rules governing the admission of expert testimony. Apparently there are two different sets of rules in this area, known respectively as Frye and Daubert. ...

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. ...

BACKGROUND In the last ten years or so, the anti-psychiatry movement has been gaining adherents, and has been growing more focused and more outspoken. But we are not a unified group. I, for instance, take what I think would be considered a fairly extreme position. I believe that there are no mental illnesses; that the clusters of thoughts, feelings, and actions labeled as mental illnesses are better conceptualized as habits that have been acquired in accordance with the normal principles of behavior acquisition or as understandable responses to extreme life stressors. I further believe that conceptualizing these problems as illnesses has been disastrous for the individuals involved, and for society in general. In particular, I believe that psychiatry’s promotion of the idea that all problematic thinking, feeling, and behaving is caused by brain illnesses and can only be treated with drugs is causing extraordinary levels of physical damage to their clients. It is also severely stigmatizing and disempowering. As a culture, we are losing the notion that people can improve their lives through effort and application, and through mutual assistance and support. ...

I’ve mentioned the CATIE study before. CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) was a NIMH-funded double blinded, randomized controlled trial comparing the effectiveness and side effects of newer-generation neuroleptics versus an older neuroleptic. CATIE-AD was a part of CATIE. The AD stands for Alzheimer’s disease. CATIE-AD was published in the New England Journal of Medicine in October 2006. The results of the study were as follows: "There were no significant differences among treatments with regard to the time to the discontinuation of treatment for any reason" ...

There’s an editorial by Henry Nasrallah, MD, in last month’s edition of Current Psychiatry. Dr. Nasrallah is the journal’s editor-in-chief. The title of the article is Haloperidol clearly is neurotoxic. Should it be banned? Haloperidol is marketed under the brand name Haldol, but its patent has long expired, and a generic version is available and inexpensive. Here’s a quote from Dr. Nasrallah’s article: "If clinicians who use these decades old drugs were to keep up with medical research and advances in knowledge, we would realize what a travesty it is to use a brain-unfriendly drug such as haloperidol when we have many safer alternatives. A massive volume of knowledge has emerged over the past 15 years about the neurotoxicity of older neuroleptics, especially haloperidol—knowledge that was completely unknown before. Second-generation antipsychotics have been shown to be much safer for the brain than their older-generation counterparts (although they are not more efficacious)." ...

Sandra Steingard, MD, is a practicing psychiatrist who from time to time posts articles on Robert Whitaker’s Mad in America website. Dr. Steingard apparently prescribes psychotropic drugs in her practice, but she is by no means a pill-for-every-problem practitioner, and her articles are always interesting and thought-provoking. Dr. Steingard posted A Paradox Revealed – Again on Mad in America on July 7, 2013. In this article she mentions the recent study by Lex Wunderink et al, which found that people being treated for first episode psychosis were doing a great deal better functionally after seven years if their neuroleptic drugs had been discontinued or reduced relatively early in the process, as compared to individuals who were retained on the drugs for two years. ...

BACKGROUND The CAFE Study, conducted by Jeffrey Lieberman, MD, et al between 2002 and 2005, has been the subject of much comment. Carl Elliott, in particular, has written extensively on the matter, including his article The Deadly Corruption of Clinical Trials in Mother Jones. In order to address the issues involved in the CAFE study, we must first take a brief look at the CATIE study. This was also conducted by Dr. Lieberman et al (not the same et al as CAFE, but with some overlap). CATIE was conducted between 2001 and 2004. ...

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. ...