Time to end this grand experiment with psychiatric drugs and the mentally ill brain

Two articles by Robert Whitaker today. The first is from the Register Guard. Here is an excerpt:

It’s time to end this grand experiment with psychiatric drugs

For more than 20 years, our country has been conducting an extraordinary medical experiment. Ever since Prozac arrived on the market in 1987, our societal use of psychiatric medications has gone up and up, and while the drugs generally have been shown to curb a target symptom better than placebo over the short term, their long-term effects have not been regularly assessed. Thus, 23 years into this psychopharmacology era, it might be wise for us to ask: How is this medical experiment turning out?

As a society, we naturally would expect that the widespread use of these medications would have lessened the societal burden of mental illness. Unfortunately, that has not been the case. From 1987 to 2007, the number of adults receiving government disability payments due to mental illness more than tripled, rising from 1.25 million to 4 million.

The disability numbers for children are even more alarming. In 1987, there were 16,200 children under 18 years of age who received a government payment because they were disabled by a mental illness. By 2007, there were 561,569 such children on the disability rolls. In the short span of 20 years, during which time the prescribing of psychiatric medications to children became common, the number of disabled mentally ill children rose 35-fold.

These numbers do not tell of a paradigm of care that is working well for us as a society. But we also need to look at a second question: How is this paradigm of care working for individuals? Does the scientific literature tell of medications that alter the long-term course of mental disorders for the better? Or for the worse?

This is a controversial topic, but suffice to say that the scientific literature contains one surprise after another. For instance, we all “know” that people diagnosed with schizophrenia need to be on antipsychotic medications all their lives. Yet, the National Institutes of Mental Health have been funding a long-term study of schizophrenia outcomes by University of Illinois researcher Martin Harrow, and in 2007 he reported that at the end of 15 years, 40 percent of schizophrenia patients off medication were “recovered,” versus 5 percent of those on medication. More than 50 percent of those off medications were working, including several in “high-level” professional jobs. read the rest here

The second is from Robert Whitaker’s blog on Psychology Today. It looks at the evidence that suggests neuroleptics cause brain loss and/or shrinkage:

Charlie Rose and the Mentally Ill Brain

On a recent PBS television show hosted by Charlie Rose on the “mentally ill brain,” Columbia University’s Jeffrey Lieberman presented a series of brain scans of a person with schizophrenia, which showed enlarged ventricles and thus, as Lieberman told the audience, “loss of brain gray matter.” (See minute 29:30 of video.) The idea being presented by Lieberman was that schizophrenia is a neurodegenerative disease, characterized by brain tissue loss.

In the discussion, Lieberman also implied that antipsychotic medications, in some way, protect against this neurodegenerative process. The drugs “stabilize the illness,” he said. But when people “stop taking the medicines, they get sick again, and when this happens, they have repeated insults to the brain . . . and this leads to a progression, and the progression, like somebody who has multiple little strokes, can lead to some decline in which people are not able to recover to the same level. And if you actually take brain scans over time, you can see the subtle, perceptible loss of brain grey matter.”

To the public, this is a new paradigm for understanding why antipsychotics are an essential treatment for schizophrenia. Schizophrenia is a neurodegenerative illness, characterized by brain tissue loss, and antipsychotics are “neuroprotective” agents that thwart that pathological process in some way.

Given that this idea is taking hold, it seems worthwhile to check the literature to see if it is well grounded in science. read the rest here

I once posted an interview with Dr. Nancy C. Andreasen by the NYT and she too reveals that brains on neuroleptics lose 1% of their mass per year. She is a traditional psychiatrist who still thinks people should take these drugs. She simply can’t deny what she’s seen in her studies.

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