March 20, 2006

Schizophrenia - Are Drugs Always Needed?

A new scientific paper will be coming out at the end of the month that asks whether antipsychotic medications are always needed in treatment of schizophrenia.

As reported in today's New York Times, some research suggests that medications are not necesarily needed all the time.

While the research seems solid, the concern that we would have is that with schizophrenia its common that the person who has schizophrenia frequently isn't the best judge as to whether medications are the best solution or not - given that by definition, if a person has schizophrenia he or she has a thought disorder.

Our opinion on this is that its interesting research, and we hope much more on this topic will be studied and reported on - but its far too early to make any decisions based on this one review article. Given the common difficulties of getting people who have schizophrenia to understand that they have a brain disorder - we hope people use this article as a point of consideration and for discussion with their psychiatrists, and nothing more.

As it suggests in the article, studies indicate that somewhere between 10 percent and 40 percent of people with symptoms of psychosis may be able to manage without medication. But there is no test to identify these people, and "psychiatrists say that withholding drugs after a full-blown psychotic episode is highly risky. Psychotic episodes tend to become worse over time when untreated, they say, and the effect of the experience on the brain is still unknown."

Following is an excerpt of the NY Times Article:

"The only responsible way to manage schizophrenia, most psychiatrists have long insisted, is to treat its symptoms when they first surface with antipsychotic drugs, which help dissolve hallucinations and quiet imaginary voices.

Delaying treatment, some researchers say, may damage the brain.

But a report appearing next month in one of the field's premier journals suggests that when some people first develop psychosis they can function without medication — or with far less than is typically prescribed — as well as they can with the drugs. And the long-term advantage of treating first psychotic episodes with antipsychotics, the report found, was not clear.

The analysis, based on a review of six studies carried out from 1959 to 2003, exposes deep divisions in the field that are rarely discussed in public. ...

The studies demonstrate that the drugs are the most effective way to stabilize people suffering a psychosis. Millions of people rely on them, and the new report is not likely to alter the way psychiatrists practice anytime soon.

But some doctors suspect that the wholesale push to early drug treatment has gone overboard and may be harming patients who could manage with significantly less medication, perhaps because they have mild forms of the disorder. ...

"My personal view is that the pendulum has swung too far, and there's this knee-jerk reaction out there that says that any period off medication, even for research, is on the face of it unethical," said Dr. William Carpenter, director of the University of Maryland's Psychiatric Research Center and the editor of the journal Schizophrenia Bulletin, which will publish the article on April 1, along with several invited commentaries.

Dr. Carpenter said that while antipsychotics are central to treatment in most cases the field's aggressive use of the drugs leaves "little maneuvering room" to try different options, like drug-free periods under close observation after a person's first episode of psychosis. "It's a very controversial issue, and I thought it was important to get it out there," he said.

Other experts warned that the new report's conclusions were dangerous, and represented only one interpretation of the evidence.

"I am usually a pretty moderate person," said Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University Medical Center and director of the New York State Psychiatric Institute. "But on this I am 110 percent emphatic: If the diagnosis is clear, not treating with medication is a huge mistake that risks the person's best chance at recovery. It's just flat-out nuts."

We encourage you to read the full news story here: (free registration required to read the story) Revisiting Schizophrenia: Are Drugs Always Needed? , New York Times


I don't like recomendations of this type. When I remeber what my family had been through until my brother accepted the medications, I'm really scared of this kind of argument. People tend to not take their medications anyway, why scare them more?

Posted by: maria at March 21, 2006 12:23 AM

This research echoes the wisdom from Torrey's fine book that recommends coming off drugs after a first psychosis and wait to see if another episode takes place.

Posted by: Chris Kirby at March 21, 2006 08:19 AM

Take a closer look at the article. It is by John Bola, he is a coauthor with Mosher in a number of articles who happens to be quite antipsychiatry.

Aslo John Bola is not a psychologist or a psychiatrist. He is in social work.

It is like taking studies from drug comanies with a grain of salt... here we should take the study here with a big grain of salt also given John Bola's track record.

Posted by: Daniel Wu at March 23, 2006 02:08 PM

Daniel Wu: "Take a closer look at the article. It is by John Bola, he is a coauthor with Mosher in a number of articles who happens to be quite antipsychiatry."

I'm always surprised when people accuse psychiatrists of being anti-psychiatry."For over a decade Loren R Mosher, MD, held a central position in American psychiatric research. He was the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health, 1969-1980. He founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief."

Apparently, anti-psychiatry has come to be associated with anti-pharmaceutical. Here's some more stats to contend with...

"...85% of our clients (all diagnosed as severely schizophrenic) at the Diabasis center not only improved, with no medications, but most went on growing after leaving us."

- John Weir Perry

"Ongoing research shows that over 80% of those treated with the approach return to work and over 75% show no residual signs of psychosis. Official government statistics comparing 22 health districts in Finland found that Dr. Seikulla's district was the only one not to have any new chronic hospital patients in a two year period."

- Jaakko Seikkula

Among those who went through the OPT program, incidence of schizophrenia declined substantially, with 85% of the patients returning to active employment and 80% without any psychotic symptoms after five years. All this took place in a research project wherein only about one third of clients received neuroleptic medication.

- Jaakko Seikkula

At 2 years post-admission, Soteria treated subjects were working at significantly higher occupational levels, were significantly more often living independently or with peers, and had fewer readmissions; 571/16 had never received a single dose of neuroleptic medication during the entire 2-year study period.

- Loren Mosher

Incidentally, I went through a schizophrenic break four years ago. Because I did not know that what I was experiencing was a "schizophrenic" break, I did not go to the hospital. Because I did not go to the hospital, I did not receive any form of psychiatric medications or formal therapy.

I have been working for three years, my relationships are all stable. I have still not had any form of psychiatric medication nor formal therapy.

Posted by: spiritual_recovery at May 19, 2006 12:38 AM

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