Tuesday 16 April 2013

What do 'antipsychotics' do to people?


An interesting quote from Robert Whitaker's Anatomy of an Epidemic: magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America.

This is a quotation from a 1952 article by Delay and Deniker describing the psychic syndrome caused by their newly discovered drug chlorpromazine (Thorazine/ Largactil) the first of the class of agents now called antipsychotics, but then called major tranquillizers (in the USA) or neuroleptics (by Delay and Deniker) .


Seated or lying down, the patient is motionless on his bed, often pale and with lowered eyelids.

He remains silent most of the time. If questioned he responds after a delay, slowly, in an indifferent monotone, expressing himself with few words and quickly becoming mute.

Without exception, the response is generally valid and pertinent, showing that the subject is capable of attention and reflection. But he rarely takes the initiative of asking a question; he does not express his preoccupations, desires or preference.

He is usually conscious of the amelioration brought on by the treatment, but he does not express

The apparent indifference of the delay of the response to external stimuli, the emotional and affective neutrality, the decrease in both initiative and preoccupation without alteration in conscious awareness or in intellectual faculties constitute the psychic syndrome due to the treatment.



And this is exactly what antipsychotics do - more or less, in a dose dependant fashion and with varying degrees of potency. It is not a 'side effect' it is their core clinical effect.

Wouldn't imagine that people would be queueing up to take that stuff would you? Yet chlorpromazine became one of the biggest selling drugs to that date, and one of the most influential drugs of all time.


Of course, people never have been keen on taking antipsychotics voluntarily, except when they were in extreme distress - but this does not matter, because these drugs have mostly been given by various coercive means, and once established on treatment they produce dependence, so it is often very difficult/ impossible to stop taking them without provoking a psychotic breakdown.


Anyhoo - over the last couple of decades antipsychotic class of drugs has been thriving, in newly patented versions, and is current being force-fed to children diagnosed as ADHD or 'bipolar disorder', and in general pushed to hard and in such quantities that antipsychotics became (as Whitaker documents) the top revenue-producing class of drugs of 2008.

Clearly, my article of 2006 had no effect:




Samson J. said...

What's your feeling on using them occasionally for agitation?

dearieme said...

I found this interesting.

Bruce Charlton said...

@SJ - In principle, antipsychotics could safely (reasonably safely) be used for short term treatment of agitation, if people were aware of what the drugs did and of their hazards.

In practice, it would be safer to regard them as a second line treatment to be used only after sedation (eg with promethazine and or lorazapam) had failed to control behaviour; and for severe psychotic agitation emergency ECT is probably safer and less harmful than big antipsychotic doses.

You see, antipsychotics are known *for sure* to be neurotoxic agents (as evidenced by tardive dyskenisia); and that is NOT a good thing!

For this reasons I would NEVER use antipsychotics in children (instead of using them in tens of thousands of children or young teens and increasingly, as at present; under new ideas of 'progress' in psychiatry with the notion of 'preventing' long term psychoses which very probably are not going to happen anyway).

Nate said...

Thanks for this post. I'm a physician, and Anatomy of an Epidemic was quite an eye-opener for me. I think it is the most important medical book I've read. It really highlights the very real possibility of doing harm.

Are there any other good medical books you have come across in your days as editor of medical hypothesis or since then?

Bruce Charlton said...

@Nate - Pharmageddon by David Healy is a must-read.

John said...

Sounds like they become Bhuddists :) Except that Bhuddism describes non-attachment as accompanied by a quiet joy and happiness.

For someone who is tormented, cessation of torment might be the closest to happiness he can get. Neutral affect should not be underrated. Euphoria is great, but not everyone can have it, and even those who have it regularly know that it brings a crash, and that wisdom means not the constant search for euphoria.

Anonymous said...

...with the notion of 'preventing' long term psychoses which very probably are not going to happen anyway

Er, well, wouldn't have happened if they hadn't pumped the youngsters full of psychotropic drugs. But when the kiddos grow up with lifelong mental problems that will be spun as validation of the early diagnosis, not as what it is in truth: an effect of putting children on psychotropics.

Bruce Charlton said...

@z. Indeed. We are living though one of the worst ever episodes of medically sanctioned abuse of children - hidden in plain sight - zealously and self-righteously being implemented and defended with aggression on the basis of calculatedly-faked research.