November 24, 2006

Ongoing Dispute over Schizophrenia Medication Effectiveness

The BBC news service has a story today on the ongoing disputes over the relative effectiveness of newer (so-called "atypical antipsychotic") medications, and older "typical antipsychotic" medications.

The story notes:

"Older schizophrenia drugs may be as effective as the new generation of medications, experts have suggested. A Manchester University study shows patients respond just as well, and perhaps better, to the older ones.

The Archives of General Psychiatry findings run contrary to the widely held view that newer and more expensive drugs are safer and more effective.

But critics say the newer drugs are better and preferred by patients because they have fewer side effects."

Read the full story: Dispute over schizophrenia drugs

More Information: Study Suggests Newer Drugs not Better than Older Drugs


There is no "dispute" over this. It is almost self evident that there is a mass need for more effective medication with less side effects which focus on treating the negative symptoms.

Posted by: Cory Schulz at November 25, 2006 01:16 AM

It is similar to the CATTIE trial of europe.But the purpose of drug MNCs in these trials are not very clear.same BBC carried a story about two months back how CLOZAPINE is the ultimate drug for about 25% of schizophernics in all of UK and they have no other medication which can be tried.
If CATTIE trial is true then when a new molecule is introduced by drug MNCs must not have PLACEBO trial but effectiveness of the newmolecule must be tested against existing molecule and CLOZAPINE IS THE BEST OF THEM.why drug MNCs shy away from this comparative trial?
Same BBC carried a story about how they conduct drug trials in countries like India where Drug companies consider psychiatrists AS consumers but not patients!!!!!!!!!!!!!!

Posted by: captainjohann at November 26, 2006 06:50 PM

The argument that the older anti-psychotics are as good as the atypicals is simply horseshit. As a schizophrenic I refused to take the phenothaizines while I have gladly taken risperdal and abilify for years.

Posted by: Ray Kinserlow at November 27, 2006 09:18 AM

This BBC report refers to medication in pill form. But the UK uses depot injection meds as well.

ABC TV news in the USA added excellent information to it’s website in 2005. Click on the web url to read the latest version of this information:

ABC interviewed : CAMH psychiatrist from Toronto, Canada Dr Joel Jeffries
Q--Are there any new medications or treatment options on the horizon?

A--There have been some long-acting drugs available for 40 years. These are> injections last anywhere from two to four weeks and, of course, they help deal with the issue of compliance, of not taking all medications. Those drugs, however, never caught on in the United States. In England, maybe as many as 25 percent of the patients would be on long-acting injections. In the United States it's only 5 percent. Then, when the new antipsychotics came along, even that 5 percent went down. But I think there is going to be a resurgence of interest in the long-acting injections now that a new long-acting risperidone injectable is available. There will probably be other new long-acting injectables coming along soon. So, I think that's going to be a bit of a switch in treatment. It's not really new drugs, just a new way of delivering them.

Posted by: dugal at November 27, 2006 09:33 PM

Umm.. noo... I would never want to take one pill of risperidone, better yet an entire months worth in one shot! Are they crazy! Have any of these doctors ever felt what these medications feel like and how much they lower a persons quality even more then the disease itself already does? They are still treating symptoms and fail to properly address the main problem and malfunction, which they have absolutely no clue what it is considering the 100+ theories that could possibly cause or lead to schizophrenia. I would not go so far as to call these types of medications actual "treatments". That would be quite an exaggeration and far from the truth.

Posted by: Cory Schulz at November 28, 2006 10:05 PM

When I first started taking risperdone I was put off somewhat by the fact that it made me sleepy. I guess you could call that the zombie effect. I was considerably encouraged by the absence of the horrendous side effects of earlier antipsychotics, so I persisted. After many years of taking risperdone, I consider the chaos and upheaval that occurs if I don't take my risperdone to be the unatural state. I cannot imagine life without it.

Posted by: Ray Kinserlow at November 29, 2006 08:54 AM


There is some sort of gimick, or ignorance related to the dispensing of the new Atypical Medications. It is probably that with the newer drugs are prescribed as listed in the PDR, but are not reduced in dosage, for long term maintenance medication.

The newer medications are not manufactured in small enough concentrations to allow for dosage reductions. The older medications are available in a variety of dosages and can be reduced to a minimum daily dosage for the patient.

A few of the newer medications are must be taken two to three times daily to achieve a good overall effect.

The patient has few consumer rights with the newer medications, he is required to take the dosage prescibed by the psychiatrist.

The newer medications are much better, but the available dosages each manufaturer provides is not broad enough for long term maintenance therapy.

Posted by: Ken1 at November 29, 2006 02:18 PM

When I was first starting out with risperdal, I would break a 3mg tab in half and take that in the morning. It was a little less numbing doing it that way. Now I take 10mg abilify in the morning, 3mg risperdal early evening and bedtime and never bat an eyelash.

Posted by: Ray Kinserlow at November 29, 2006 06:32 PM

I would imagine that anyone taking a drug for numerous years will eventually adapt to it and then feel unnatural when they don't take it. That is probably the same for any drugs that effect you psychologically.

To me it is the exact opposite. The depression, lack of creativity, lack of memory, constant tranquilizing feeling, and overall distant reality that I experience from antipsychotics is what I would call unnatural. I suppose that if I took them for numerous years, then things would be differnt.

It is overall a very frustrating situation for all of us on all sides of this topic.

Posted by: CorySchulz at November 30, 2006 10:59 AM

It is a personal choice. To me, I felt my unmedicated state to be diseased, hence I welcome a good drug that will treat my symptoms. I don't know if I'm less creative or insightful, but I am a lot more interactive with people which is worth more to me than artistic talent. Being a sick schizophrenic is the lonliest feeling in the world.

Posted by: Ray Kinserlow at November 30, 2006 12:17 PM

"Being a sick schizophrenic is the loneliest feeling in the world."

I know... I was just telling this to my girlfriend the other day... It really is completely isolating. And doctors and friends don't really seem to understand... The only people that do understand are others with the same problem. But when my body feels like it's not working properly and I feel like I'm falling apart and losing pieces of me and like I'm not designed to exist anymore... It really is the loneliest feeling...

You're lucky that the meds help you. Hopefully in the future there will be better ones that help me too.

Posted by: Cory Schulz at December 1, 2006 11:43 AM

I always felt that song sung by Barbra Streisand entitled "People Who Need People" was written about schizophrenics.

Posted by: Ray Kinserlow at December 1, 2006 02:29 PM

Cory, in your opinion, what causes schizophrenia?

Posted by: Uncle Sam at December 2, 2006 06:24 AM

I believe schizophrenia is a complex of primarily genetic and secondary enviromental causes. It is found in all human cultures. Many people probably have the markers for schizophrenia who never develope the disease due to environmental reasons. I believe schizophrenia, like sickle cell anemia, gives protection from another disease or diseases which has allowed it to remain in the gene pool. The trick is have enough of the schizophrenic markers to enjoy some protection from the diseases it helps resist without getting mentally ill, just like it is ideal to have a mild case of sickle cell anemia which helps you resist malaria.

Posted by: Ray Kinserlow at December 2, 2006 11:43 AM

My boyfriend take Risperdal 2mg in the morning & 1mg in the evening. If he didnt take it, he cant go out in public. I agree that taking Risperdal make him tend to sleep. He refuse to work, always has the feeling that people reading his mind. And quick temper as well. I need someone that has schizophrenia but manage to cope with their life at least talk to my boyfriend. Coz, he thinks no one understands him. I really need help from you guys.

Posted by: Ally at December 2, 2006 08:09 PM

My ex-wife will tell you dealing with schizo-affective disorder or schizophrenia is a very exsperating task. I counsel patience. Tell him you may not be able to understand him, but you do love him. I also recommend you get him online with some of these people who do understand him in the forum for those with schizophrenia. I have a psychologist whom I trust and she helps me a lot and I think she understands me. Maybe your boyfriend could find a psychologist like I have.

Posted by: Ray Kinserlow at December 2, 2006 09:13 PM

As Ray has stated above, I agree that schizophrenia is caused by a mix of genetic predisposition and environmental triggering. I also agree that the genetics give people certain abilities that allow them to better survive. I believe that these abilities involve increased linguistic abilities, overall creative abilities, increased memory abilities, and an overall increased awareness of ones self and ones surroundings. There is a reason why people with schizophrenia are often better at complex mathematics, better at playing musical instruments, better at art, understand abstract concepts more easily, and are more aware of their surroundings. These are just observations I have made.

I believe the unfortunate symptoms begin to emerge when the mental system is pushed to its limits and begins to malfunction under the stress. It is like pushing a car to accelerate faster and run better, until something in the transmission accidentally falls out of place under the stress, and then begins to damage the entire transmission and engine. Having a naturally high level of dopamine in a persons brain would naturally allow for them to handle more information and function better, but if another system fails, then this naturally high level of dopamine might begin to get out of control, and could potentially damage other systems. Naturally, taking too many drugs (LSD, cannabis) could also increase these chemicals and cause a similar malfunction. That is my theory/understanding of the disease. That is why it is so complicated. There is no one reason that the system loses its harmony, there could be an infinite amount of things that could cause the system to stop functioning properly, each of them causing their own type of symptoms. That is why there are so many subclasses of schizophrenia and why some people experience positive symptoms and others experience negative symptoms.

The anti-psychotic drugs that they give us help prevent the system from further destroying itself and help it maintain a somewhat balanced, although still malfunctioning, system. Treating the disease means understanding exactly what system is malfunctioning, what other systems it is effecting, and how it can be fixed. Considering that we have no idea what half of the genes, proteins, or neurotransmitters in our brain completely do, we are still far off from developing procedures for fixing, or curing, the system.

This is why the medication works so well for some people, and has no effect on others, or might make thing even worse. The best thing we can do is wait, which sometimes time is not something we have. And so I sit here knowing that I am no longer a complete human being and that I am no longer designed to survive in todays world. I still can think okay on most days, but I doubt I will ever make it through college, and have a stable job, or have a quality relationship, or have children, or ever really enjoy my own life. People keep telling me to stay optimistic, but it is difficult when the part of the system that is supposed to stay optimistic is also part of the malfunction, and when my brain feels like it is melting and my symptoms get a little worse every day, and the disease slowly rots its way into my personality leaving empty holes that a quality human being once occupied.

Sorry if this is kind of long. It is something that never leaves my mind.

Posted by: Cory Schulz at December 2, 2006 11:22 PM

Cory, can you talk more about the environmental factors you see in our society that influence the development or perpetuate the illness schizophrenia?

Posted by: Uncle Sam at December 3, 2006 11:20 AM

The one thing which I had the most problems with is emotional stressors. I learned to avoid people because they were emotionally stimulating. It did not seem to matter whether the stressor was positive or negative in context, the effect was the same. I recall a woman schizophrenic in one of my group therapies who could not understand why she felt so bad after a pleasant vacation. I feel like I have been relatively insightful though most of my disease history. I didn't hallucinate, I dealt with the delusions, but the isolation tormented me nearly to death.

Posted by: Ray Kinserlow at December 3, 2006 11:58 AM

I would assume that any emotionally stimulating experience could be considered "traumatic" or "stressful" if a person did not have the mental resources necessary to properly deal with and understand the situation. I also believe that in schizophrenia the amygdala becomes overactive and causes the paranoia and fear. After that, pretty much anything stimulating could seem stressful simply because the amygdala is malfunctioning and constantly releasing stress hormones which tell your body and your mind that "You are stressed out!" and then naturally we think it is because of the experience or other people that we are stressed out, when that is actually not the case. We kind of misplace stress on outward causes, when the malfunction is actually internal. And so slowly every even could become stressful over time.

In our society... hmm... I live in America, I'm not sure where the rest of your are from (Europe, Asia?). But I remember reading that schizophrenia occurs evenly across all cultures. But America is the Capitalist God. We all live in a world of fierce competition and competition causes stress. The need for education, and money, and transportation, and entertainment, and relationships, and bills, and sleep, and having a family... We live in a very complex economic system, and naturally any of these things could cause extreme stress for even a normal person who isn't necessarily predisposed to mental disease, better yet someone who is very sensitive and aware of their surroundings.

Isolation is one of the hardest things for me as well. No one understands my situation, and I don't really have any friends. The people at my job all think I'm kinda weird, but they still like me and get along with me well. I definitely live in a very different reality then any of them.

For me survival is the hardest thing. Keeping a job and going to school and just managing my daily activities. When I was young I used to wake up and get all excited! I used to hang out with friends and meet new people and learn new things and have new experiences every day. It was great! I loved being alive and feeling like I was a growing, developing human being. Now waking up is the most painful thing in the world. I open my eyes and look around and think "crap... not this world again..." and I go about my routines and then take an Ambien and go back to sleep. I'm not living... just killing time...

Posted by: Cory Schulz at December 4, 2006 11:26 AM

Cory, I'm sorry to hear about your struggles. You seem like a very smart person. Is there anything any of us can do?

Posted by: Uncle Sam at December 4, 2006 02:27 PM

I guess just keep doing what you're already doing: Talking about the problem and working towards a solution. I have a lot of problems in my life besides my head, and unfortunately I was kind of born into them and there isn't much I can do, and sometimes that just how life is. I blame my parents and our society mostly. If I would've had enough money to support myself through high school and college, so that I could get an education like a normal child, then I'm certain none of this ever would've happened.

I do think that we will see numerous advances in treatment in our lifetime if our country is able to survive. Right now I fear for out dependence on energy resources that could possibly disappear within the next 50 years and the polluted atmosphere that could destroy us. How will we function without gasoline and plastics? We are in a dangerous spot. I'm more concerned about our species as a whole then I am about myself. I don't mind dieing as long as I know everyone else will be ok.

Posted by: Cory Schulz at December 4, 2006 09:04 PM

That is a very difficult problem you are grappling with. I have dealt with similar issues - I have taken it upon my self to do so. The advice I am always given is to worry about myself more and less about others. You can only really affect yourself. You can influence others, and you can do your part to cut down on your usage of gas and plastics, recycle etc.. but you can't worry about that stuff all the time. It will only exacerbate your mental illness, as it is enough to drive anyone "crazy" who thinks about it too much. Live your life as best you can and let the chips fall where they may.

Posted by: Uncle Sam at December 5, 2006 08:42 AM

Hello all, I am a recently diagnosed schizophrenic who is looking to complete a PhD in pharmacology. Hence I have a pretty close feel for the benefit-risk ratio attached to taking the medications we take. We are in a precarious position whereby, in my instance anyway, the medication risperdone seemed to be the helping factor for releasing the acute delusions and voices which were extremely distressing. So for that the medication would seem to have been a help however the side effects, mental and physical numbness, loss of sex drive, general loss of self in the process are doing my head in. I no longer have the delusions and think that the medication distorts what I hear on occasion. This medication also gives me an unreal view, I see differently to when I was well. Thus I am looking to decrease my medication gradually and monitor my well being along the way. The awful thing being that long term all of these medications can still give the extrapyramidal side effects, in particular tardive dyskenisia, which is a truly horrible disease also. Has anyone had any success with natural treatments or are these synthetic products the best we can do for the time being ? Understanding. I wish for peace for us all.

Posted by: James at February 1, 2007 07:46 PM

Is there an ally out there?, write back if there is!

Posted by: Lizardking at February 22, 2007 08:03 PM

Hello, I am a suffering mental patient. I have read most of the comments here and would like to say Cory's comments on schizophrenia are right on the dot. While a schizophrenic patient might be slow possibly seem dumb or stupid he is actually more aware or more acute to his surroundings than an average person. The problem lies is they get to focused or simply unfocused on everything around them, thoughts get distorted and causes them to zone out and lose attention at the task at hand. My disorder has been classified as a thought disorder and after a few years of seeing a doctor I understand he is very good at seeing my thought disorder. While at many times I feel focused on what I am trying to explain or emphasize he can see my confusion to explain or emphasize what I am trying to get across. The best thing I have done with my life is to have a positive attitude. Really that's all you can do. A quote I really have kept to myself is. "One thing is for sure, nothing is certain" Or "One things is certain, nothing is certain." Which basically shows the positive and negative to life. You never know what can happen but you will always know that and to try your best and even if you feel bad about your life just understand that you can only move forward in life and to try to keep going and take it one day at a time. While you may feel disabled with your disease or feel that your medication is not helping you just understand that you are unique and your disease may make you different but at least you don't have to be the same as everyone out there. I know life is hard and while after my first pschychosis I wanted to kill myself and even sometimes today I have thought about it but I am glad I didn't because I realize the amazing things life has to offer you. Even though you are alone you can always find help, everyday the sun rises everyone and everything. I goto bed and take my medication every night, and I hate it so much, except for the fact it slightly makes me sleepier which helps me to fall asleep faster and many days I wish to stop my medication but I understand that if I go to fast and don't stay focus there is a good chance like Cory said the whole system will fall apart and then crash into a dismal of confusion.

Well to sum up everything I just believe that mental illness is apart of ourselves and even if it makes us weaker it displays the fact of our individuality. I have been taking my medication and for the most part it has been keeping me focused and on track of my life, I have at times tried to stop my medication and sometimes had success. So I just think basically the illness affects you try not to let it affect your life.

Posted by: Blake at January 22, 2008 09:49 PM

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