Antipsychotics: Effects and Experience

Many people now know how antidepressants are overprescribed. Studies have shown that most taking them receive no benefit at all. Besides that, there are many negative side effects, including suicidality. But what few are aware of is how widely prescribed also are antipsychotics. They aren’t only used for severe cases such as schizophrenia. Often, they are given for treatment of conditions that have nothing to do with psychosis. Depression and personality disorders are other examples. Worse still, it is regularly given to children in foster care to make them more manageable.

That was the case with me, in treating my depression. Along with the antidepressant Paxil, I was put on the antipsychotic Risperdal. I don’t recall being given an explanation at the time and I wasn’t in the mindset back then to interrogate the doctors. Antipsychotics are powerful tranquilizers that shut down the mind and increase sleep. Basically, it’s an attempt to solve the problem by making the individual utterly useless to the world, entirely disconnected, calmed into mindlessness and numbness. That is a rather extreme strategy. Rather than seeking healing, it treats the person suffering as the problem to be solved.

For those on them, they can find themselves sleeping all the time, have a hard time concentrating, and many of them unable to work. It can make them inert and immobile, often gaining weight in the process. But if you try to get off of them, there can be serious withdrawl symptoms. The problems is that prescribers rarely tell patients about the side effects or the long term consequences to antipsychotic use, as seen with what some experience as permanent impairment of mental ability. This is partly because drug companies have suppressed the information on the negatives and promoted them as a miracle drug.

Be highly cautious with any psychiatric medications, including antidepressants but especially antipsychotics. These are potent chemicals only to be used in the most desperate of cases, not to be used so cavalierly as they are now. As with diet, always question a healthcare professional recommending any kind of psychiatric medications for you or a loved one. And most important, research these drugs in immense detail before taking them. Know what you’re dealing with and learn of the experiences of others.

Here is an interesting anecdote. Ketogenic diets have been used to medically treat diverse neurocognitive disorders, originally epileptic seizures, but they are also used to treat weight loss. There was an older lady, maybe in her 70s. She had been diagnosed with schizophrenia since she was a teenager. The long-term use of antipsychotics had caused her to become overweight.

She went to Dr. Eric Westman who trained under Dr. Robert Atkins. She was put on the keto diet and did lose weight but she was surprised to find here schizophrenic symptoms also reduce, to such an extent she was able to stop taking the antipsychotics. So, how many doctors recommend a ketogenic diet before prescribing dangerous drugs? The answer is next to zero. There simply is no incentive for doctors to do so within our present medical system and many incentives to continue with the overprescription of drugs.

No doctor ever suggested to me that I try the keto diet or anything similar, despite the fact that none of the prescribed drugs helped. Yet I too had the odd experience of going on the keto diet to lose weight only to find that I had also lost decades of depression in the process. The depressive funks, irritability and brooding simply disappeared. That is great news for the patient but a bad business model. Drug companies can’t make any profit from diets. And doctors that step out of line with non-standard practices open themselves up to liability and punishment by medical boards, sometimes having their license removed.

So, psychiatric medications continue to be handed out like candy. The young generation right now is on more prescribed drugs than ever before. They are guinea pigs for the drug companies. Who is going to be held accountable when this mass experiment on the public inevitably goes horribly wrong when we discover the long-term consequences on the developing brains and bodies of children and young adults?

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Largest Survey of Antipsychotic Experiences Reveals Negative Results
By Ayurdhi Dhar, PhD

While studies have attributed cognitive decline and stunted recovery to antipsychotic use, less attention has been paid to patients’ first-person experiences on these drugs. In one case where a psychiatrist tried the drugs and documented his experience, he wrote:

“I can’t believe I have patients walking around on 800mg of this stuff. There’s no way in good conscience I could dose this BID (sic) unless a patient consented to 20 hours of sleep a day. I’m sure there’s a niche market for this med though. There has to be a patient population that doesn’t want to feel emotions, work, have sex, take care of their homes, read, drive, go do things, and want to drop their IQ by 100 points.”

Other adverse effects of antipsychotics include poor heart health, brain atrophy, and increased mortality. Only recently have researchers started exploring patient experiences on antipsychotic medication. There is some evidence to suggest that some service users believe that they undermine recovery. However, these first-person reports do not play a significant part in how these drugs are evaluated. […]

Read and Sacia found that only 14.3% reported that their experience on antipsychotics was purely positive, 27.9% of the participants had mixed experiences, and the majority of participants (57.7%) only reported negative results.

Around 22% of participants reported drug effects as more positive than negative on the Overall Antipsychotic Rating scale, with nearly 6% calling their experience “extremely positive.” Most participants had difficulty articulating what was positive about their experience, but around 14 people noted a reduction in symptoms, and 14 others noted it helped them sleep.

Of those who stated they had adverse effects, 65% reported withdrawal symptoms, and 58% reported suicidality. In total, 316 participants complained about adverse effects from the drugs. These included weight gain, akathisia, emotional numbing, cognitive difficulties, and relationship problems. […]

Similar results were reported in a recent review, which found that while some patients reported a reduction in symptoms on antipsychotics, others stated that they caused sedation, emotional blunting, loss of autonomy, and a sense of resignation. Participants in the current survey also complained of the lingering adverse effects of antipsychotics, long after they had discontinued their use.

Importantly, these negative themes also included negative interactions with prescribers of the medication. Participants reported a lack of information about side-effects and withdrawal effects, lack of support from prescribers, and lack of knowledge around alternatives; some noted that they were misdiagnosed, and the antipsychotics made matters worse.

One participant said: “I was not warned about the permanent/semi-permanent effects of antipsychotics which I got.” Another noted: “Most doctors do not have a clue. They turn their backs on suffering patients, denying the existence of withdrawal damage.”

This is an important finding as previous research has shown that positive relationships with one’s mental health provider are considered essential to recovery by many patients experiencing first-episode psychosis.

Antidepressants and Placebos

I’ve been diagnosed with depression close to 15 years.  Like anything my mind becomes focused on, I’ve studied to a fair extent the subject of depression and the issues related to it.

Depression is a rather odd phenomena.  In some ways, it’s a socially acceptable mental disease.  Severely depressed people often look and act completely normal.  Unless someone is bi-polar, they won’t have any extremely noticable shifts in mood or behavior.  I know that I’m extremely capable of hiding my depression and no one would know if I didn’t tell them.  And yet it can be severely debilitating.  Because a depressed person may appear completely normal it makes it all the more challenging.  The depressed person can hide their illness which will just make them feel more isolated.  It’s extremely common for people to kill themselves, and afterwards their friends and family didn’t even know the person was unhappy.

It’s in ways just like life in general except magnified.  Depression has become a very popular disease considering how many people are on antidepressants.  In the past, people suffered and that was the way it was.  But I suppose such things as school shootings have made many people realize that private problems easily turn into public problems.  Depression is probably over-diagnosed and it makes sense.  Everyone wants to be happy.

Unfortunately, there is no effective happy pill.  Here are some links about research, analysis, and commentary on the effectiveness of antidepressants:

http://en.wikipedia.org/wiki/Placebo#Depression

http://en.wikipedia.org/wiki/Antidepressant#Review_studies

http://ajp.psychiatryonline.org/cgi/reprint/159/1/122

http://ajp.psychiatryonline.org/cgi/reprint/159/5/728

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

http://content.nejm.org/cgi/content/abstract/358/3/252

http://www.chelationtherapyonline.com/technical/p58.htm

http://www.time.com/time/health/article/0,8599,1717306,00.html

http://psychcentral.com/blog/archives/2008/02/26/antidepressant-data-showed-not-as-effective-as-thought/

Basically, antidepressants are only significantly effective for the severely depressed and even then it’s questionable.  They help some people, but not most.  Most people taking antidepressants probably might as well be taking sugar pills.

Research, however, is complex.  It’s hard for even research scientists to determine effectiveness.  Simply being involved in research causes a placebo effect.  The doctor is a placebo effect.  The hospital is a placebo effect.  The drug companies themselves are a placebo effect.  Generally speaking, new drugs are the most effective not because of better research but simply because they’re new and their effectiveness lessens the longer they’re on the market.  I’m not saying drugs are useless, but all of this is particularly true for antidepressants.  The drug companies have had a hard time finding antidepressants that work much better than a placebo.  Even considering the best antidepressants, most of the effectiveness comes from the simple placebo effect of being given a pill by a doctor.

This leads to a moral conundrum.  A placebo is probably most effective when someone doesn’t know it’s a placebo (although there is research that shows that even when a doctor tells a patient they gave them a placebo they can still sometimes gain benefit from it, but research also shows that the effect of a placebo goes down after the patient is informed).

Anyways, antidepressants are big business.  If I remember correctly, they are the most widely prescribed of the mental health drugs.  But I doubt doctors tell their patients about the questionable effectiveness of antidepressants before prescribing them.  They do work at least as placebos and so what is the harm?  It’s a moral question and depends on what are your moral values.  Does a doctor have the moral responsibility to always tell the truth?  There are plenty of cases, for example, where someone health quickly diminishes after getting a negative prognosis.  The relationship between doctor and patient isn’t an objective reality.  Most of the help a doctor can offer is simply himself, his presence and authority.

Nonetheless, one of my biggest moral values is truth.  To me, this has more to do with authenticity than honesty per se, but it’s hard to be authentic if you’re not telling the truth.  Can a doctor be authentic in caring about a patient while lying to them?  Is deception appropriate as long as it’s done with paternalistic good intentions?  Basically, should a doctor treat a patient like an equal human being or like a child?

Many people would say it doesn’t matter.  A doctor should do whatever helps.  The problem is that it isn’t always clear.  Deception can have negative effects if, for instance, a patient discovers the deception.  If the patient loses faith in the doctor or in doctors in general, then the whole placebo effect goes out the window.

Even this post brings up a moral issue.  Any person who reads this, will likely have an increase in doubts towards the effectiveness of drugs.  Placebos are given to patients all of the time without the patients knowing.  How do you actually know anything your doctor prescribes for you is actually an active drug?  You don’t.  And even if you’re taking a real anti-depressant, it might be no different from a sugar pill.  A depressed person who learns of these facts will probably experience less effective treatment by being prescribed antidepressants.  This post itself is a nocebo.