Anti-Psychotic Drugs: 10 Things You Should Know About Pills for Delusions and Hallucinations

© Ctacik | Stock Free Images & Dreamstime Stock Photos
© Ctacik | Stock Free Images & Dreamstime Stock Photos

Anti-psychotics (also known as neuroleptics and major tranquillisers) are a broad group of drugs routinely used within psychiatric services to treat the psychotic symptoms of what psychiatrists refer to as 'schizophrenia'. The most common psychotic symptoms are auditory hallucinations (hearing voices that others cannot hear), delusions (fixed beliefs held with total conviction in the absence of evidence to support them) and thought disorder (where a person’s thoughts seem jumbled and confused).

Standard textbooks of psychiatry typically claim that the development of anti-psychotic drugs revolutionised the treatment of mental illness and was pivotal in promoting care in the community by allowing the closures of the huge and soulless psychiatric asylums. Complementing these lofty assertions, the pharmaceutical industry spends vast amounts of money advertising their products, often claiming success rates in excess of that suggested by the scientific evidence.

If a person is unfortunate enough to experience distressing psychotic symptoms, and seeks help from psychiatric services, he will almost certainly be prescribed an anti-psychotic drug. But what is the truth about these chemicals? What follows are the facts about these medications. In providing this information it is hoped that it will help psychosis-sufferers to make an informed decision as to whether or not to voluntarily take anti-psychotic drugs.

1. Chlorpromazine: the first anti-psychotic drug

The original research effort that ultimately led to the discovery of chlorpromazine, the first anti-psychotic, was concerned with striving to develop a drug that produced more sedation and indifference in patients undergoing surgery. In 1950, a chemist named Paul Charpentier developed a number of substances for this purpose, the most effective being a compound he named RP4560 (chemical name, chlorpromazine). A surgeon, Henri Laborit, trialled it as an anaesthetic booster and found it worked well in calming patients during operations and reducing the risk of shock. Further research around the same time reported that chlorpromazine made rats indifferent to pain.

The transition to use with mentally-ill patients was conducted by two psychiatrists, Jean Delay and Pierre Deniker, who published a study in 1952 where they injected chlorpromazine into 38 psychotic patients residing in a Paris hospital. They reported marked improvements in psychotic symptoms and emotional behaviour. Other successful trials followed, and by the mid 1950s chlorpromazine was increasingly used in the USA and other western nations for the treatment of psychosis and mania. Chlorpromazine subsequently spawned the development of many other anti-psychotic medications (see next section).

2. The distinction between typical and atypical anti-psychotic drugs

Anti-psychotic drugs can be divided into two broad categories, typical and atypical. Typical anti-psychotics, of which chlorpromazine was the first, are also referred to as 'first generation' and were developed from the 1950s onwards. A list of the more common typical anti-psychotic medications, along with their trade names, is given in Table 1.

Typical anti-psychotics are believed to have their effects by blocking dopamine receptors in the brain. Dopamine is one of a group of chemicals called neurotransmitters that allow brain cells to communicate with each other. The specific roles of dopamine include muscle movement, motivation and the mediation of feelings of satisfaction. There is some evidence that too much dopamine activity in parts of the brain can result in hallucinations, delusions and thought disorder. By blocking the dopamine receptors, and thereby reducing dopamine activity, psychotic symptoms may be reduced.

Typical anti-psychotic drugs

Name of drug
Trade name
Chlopromazine
Largactil, Thorazine
Haloperidol
Haldol, Serenase
Droperidol
Droleptan, Inapsine
Pimozide
Orap
Trifluoperazine
Stelazine
Sulpiride
Dolmatil
Fluphenazine
Prolixin, Permitil
Perphenazine
Trilafon
Thioridazine
Mellaril
Promazine
 
Clopenthixol
Clopixol, Sordinol
Flupenthixol
Depixol, Fluanxol

The atypical anti-psychotics first emerged in the 1990s and are sometimes referred to as 'second generation'. A list of the more common atypical anti-psychotic medications, with their corresponding trade names, is given in Table 2.

Although atypical anti-psychotics also block dopamine receptors, they do it to a lesser degree than the older drugs. In addition, they target other neurotransmitters in the brain such as serotonin.

Atypical anti-psychotic drugs

Name of drug
Trade name
Amisulpuride
Solian
Aripiprazole
Abilify
Clozapine
Clozaril
Olanzapine
Zyprexa
Risperidone
Risperdal
Sertindole
Serdolect
Zotepine
Zoleptil
Quetiapine
Seroquel
© Terex | Stock Free Images & Dreamstime Stock Photos
© Terex | Stock Free Images & Dreamstime Stock Photos

3. Short-term effectiveness

A series of research studies has demonstrated that anti-psychotic drugs reduce the positive symptoms (hallucinations, delusions, thought disorder) more effectively than a placebo. In other words, if you take two groups of people experiencing a broadly equivalent degree of psychotic symptoms and give one group anti-psychotic medication and the other group an inert pill (without participants in the research knowing whether they were receiving the anti-psychotic or the placebo) those receiving the active drug will, on average, report a greater improvement in their psychotic symptoms.

Although psychiatrists and drug company sales representatives typically claim that this beneficial effect on psychotic symptoms is a direct result of the medication reversing a specific biochemical imbalance (in the same way that, for example, insulin treats diabetes) the evidence does not support this assertion. Indeed, anti-psychotic drugs may be no more effective than anti-anxiety drugs such as diazepam (valium) in alleviating the positive symptoms of 'schizophrenia'. To date, seven research studies have directly compared these two groups of drugs in the treatment of psychosis; two studies found in favour of the anti-psychotic drugs, a further three studies found in favour of the anti-anxiety drugs, and two were inconclusive (1). Therefore, the short-term benefits of anti-psychotics may be entirely due to their sedating effect.

Further doubt is cast upon the extent of the benefit associated with anti-psychotic medication when one considers some other research findings. It is known that at least one in three psychosis-sufferers can improve without medication (2). Also, it is well established that another third do not respond at all to anti-psychotic drugs – commonly referred to as being 'treatment-resistant'. It follows, therefore, that only one in three people experiencing psychotic symptoms will potentially benefit as a direct result of the medication.

4. Clozapine: the most effective anti-psychotic

Patients experiencing psychotic symptoms who do not respond to other anti-psychotic medications (the 'treatment-resistant' group referred to above) are commonly prescribed a drug called Clozapine.

Clozapine was the first atypical anti-psychotic drug to be developed but it was withdrawn voluntarily by the manufacturer in 1975 when it was shown in some patients to cause a life- threatening blood disorder, called agranulocytosis, involving a pronounced drop in the number of white blood cells thereby leaving the person unable to fight infections. In the late 1980s, it was demonstrated to be more effective than other anti-psychotics (3) and was approved for use with treatment-resistant 'schizophrenia'. The recipients are required to have regular blood tests so as to check for early signs of agranulocytosis.

5. Side effects of typical anti-psychotics

Common side-effects of typical anti-psychotics include:

· muscle stiffness

· shakiness

· restlessness (akathisia)

· sluggishness, reduced motivation

· sexual problems

· irregular heart-beat (arrhythmias)

· dry mouth

· constipation

· blurred vision

Chlorpromazine also renders the patient photosensitive and much more likely to burn if exposed to direct sunlight.

A rare, but very serious, short-term side-effect of typical anti-psychotics is the development of neuroleptic malignant syndrome. This disorder emerges in 1 in 200 people who start taking anti-psychotics and is characterised by high temperature and muscle-rigidity. It is fatal in 20% of cases.

With longer term use other side-effects may develop including bone-wasting (osteoporosis) and breast-growth and lactation in men. Particularly concerning is the risk of a movement disorder called tardive dyskinesia, characterised by facial twitches, involuntary tongue movements and lip-smacking. These symptoms can persist even after the drug is stopped and may be permanent. The incidence of tardive dyskinesia (commonly under-reported by psychiatric organisations) is at least 20% of long term typical anti-psychotic users(4).

Along with the movement disorders, some mental deterioration may also occur; Amercian psychiatrist, Peter Breggin, has referred to this intellectual decline as a dementia-like state. Indeed, several studies involving post-mortem examination of brain-tissue reported that the degree of brain shrinkage corresponds to the cumulative amount of anti-psychotics ingested (5)(6)(7)(8). Despite this evidence that their prescribed medications cause brain decay, biological psychiatrists persist in their attempts to explain away these findings on the basis of some assumed underlying 'schizophrenic' disease process.

6. Side effects of atypical anti-psychotic drugs

The atypical anti-psychotics have many of the same side-effects as the typical drugs, including tardive dyskinesia (despite initial claims to the contrary by the pharmaceutical companies) - risperidone, in particular, is potent in triggering these type of symptoms. Additional common side-effects with the atypical anti-psychotics include:

  • over-sedation
  • weight gain
  • sexual problems
  • diabetes
  • raised cholesterol

As already mentioned, clozapine is also associated with agranulocytosis (a potentially lethal blood disorder) as well as causing excess salivation, constipation and an increased risk of epilepsy.

Evidence for brain shrinkage with the atypicals is inconsistent, although clozapine may be particularly toxic in this regard (9).


7. The misuse of anti-psychotic drugs

Predictably, following the discovery of chlorpromazine in the early 1950s, the rate of anti-psychotic prescribing has risen exponentially. Within 12-months of chlorpromazine becoming available, two million Americans were receiving it; by 1970, about 250 million people worldwide had taken anti-psychotic medication (10). In the United Kingdom, Department of Health official figures indicate that the number of prescriptions for anti-psychotic drugs rose from 2.3 million in 1970 to 5.7 million in 2001.

Such pronounced increases in the use of anti-psychotics would be less alarming if all the recipients were adults suffering with hallucinations, delusions and thought disorder (the patient population for which the drugs were intended). The evidence indicates that this is not the case. Instead, anti-psychotic drugs have been used indiscriminately across a number of populations, particularly as a way of subduing people who are agitated or aggressive. Thus, people with learning difficulties in residential care may commonly receive them, despite the likelihood that anti-psychotics may further impair their mental functioning (11). Young people have also been targeted, particularly those from poorer backgrounds; the number of American children receiving anti-psychotics doubled between 1987 and 1996, with youths from poorer families outnumbering those from more affluent backgrounds by a ratio of almost six-to-one (12).

In addition to anti-psychotic use extending to young people and those with learning deficits, older people have also increasingly been recipients. A study in the United Kingdom found that 25% of elderly nursing home residents were being prescribed anti-psychotic drugs, usually for problems such as wandering or 'uncooperation' (13).

Encroachment of anti-psychotic drugs into non-psychotic populations is a cause for concern, given their side-effects and lack of evidence to suggest benefits with these groups of patients. It is reasonable to conclude that this expansion is testimony to nothing other than the effectiveness of the marketing strategies of the pharmaceutical industry.

8. Withdrawal from anti-psychotic drugs: the discontinuation effect

The human body has a remarkable capacity to return itself to balance. If a person’s biochemistry is artificially altered by the addition of a drug, the body will try to compensate to return the inner biology to the status quo. It is for this reason that people taking anti-psychotics typically experience withdrawal symptoms when they stop taking the drug, particularly if they have been on the drug for a long time and stop abruptly.

As described in section 2 (above), anti-psychotics have their effects by blocking receptors in our brain cells that allow chemical messengers to communicate between one cell and another. Most commonly, they block dopamine receptors. The brain responds to this blockage by producing more dopamine receptors so that withdrawal of the drug leaves the nervous system overactive, striving to increase dopamine activity. Hence, some rebound psychotic symptoms are likely to occur when anti-psychotics are stopped, a reaction referred to as a discontinuation effect. Other withdrawal symptoms include insomnia, nausea, anxiety, agitation and diarrhoea. This discontinuation effect can often be misinterpreted as a 'return of the illness' and (as described in the next section) may make research into the benefits of long-term anti-psychotic use difficult to interpret (14).

9. Long-term effectiveness

For patients who have suffered a psychotic episode, and acquired the diagnostic label 'schizophrenia', psychiatrists almost always recommend long-term use of anti-psychotic drugs to prevent relapse for those who have recovered or to stop deterioration in residual symptoms. This widespread recommendation is based on the findings of studies that have shown superior outcomes for those patients who remain on anti-psychotics compared to those who are switched to an inert substance (a placebo). There are, however, two major flaws to these studies that as yet make it unwise to draw firm conclusions about the appropriateness of long-term anti-psychotic use.

Firstly, many of the subjects who are switched to placebo will have been taking anti-psychotics for a long time and their abrupt termination will most likely produce a strong discontinuation effect. Thus, the main reason for deterioration in the placebo group might be drug-withdrawal rather than a worsening of the psychotic disorder per se. This possibility is almost completely ignored in the research, deterioration always being seen as a relapse in the 'schizophrenic' illness.

Secondly, most of the research suggesting the benefits of long-term anti-psychotic use have deployed 'relapse' as the sole outcome measure. Other important, quality of life indicators (general well-being, ability to work, rewarding relationships) have been ignored when comparing the progress of people continuing to take the anti-psychotics with those who have ceased taking the drugs. This failure to consider quality of life outcomes seems an important omission, particularly given the side-effects of the medication.

In conclusion, although long-term anti-psychotic use may in time be demonstrated to be beneficial for some psychosis-sufferers, as things stand, the research has not yet established whether on-going medication use is better than not taking them from the point of feeling well.

10. Anti-psychotic drugs suppress all brain activity

The traditional psychiatric view is that anti-psychotics have a specific action that reverses the biochemical imbalance thought to underpin 'schizophrenic' illness. An alternative viewpoint, one supported by the research evidence, is that anti-psychotic drugs have a global effect by generally slowing down all mental activity.

The original name for an anti-psychotic drug was 'neuroleptic' based on a Greek word literally meaning 'seize hold of the nervous system'. Such a definition tallies with the results of studies where non-psychotic volunteers have taken an anti-psychotic and subsequently described their experiences. For example, when two Israeli doctors were injected with haloperidol they described being unable to read, use the telephone or carry out basic household tasks unless they were told to do so (15). This general lack of initiative as a consequence of taking anti-psychotic drugs has been further demonstrated by subsequent studies, volunteer recipients having slower reaction times, impaired learning, poorer coordination and less capacity to experience joy and sadness (16)(17).

It therefore appears likely that anti-psychotic drugs achieve a beneficial effect on hallucinations and delusions via a general slowing of all brain activity, in much the same way that a hefty dose of alcohol might cure a person’s shyness. For someone tormented by distressing voice-hearing and delusions this general suppression of psychotic symptoms may be highly desirable, at least in the short-term. But it would be wrong to assert, as most psychiatrists do, that these benefits are the direct consequences of anti-psychotics treating a specific biochemical imbalance.

References

1. Wolkowitz, O.M. and Pickar, D. (1991). Benzodiazepines in the treatment of schizophrenia: A review and re-appraisal. American Journal of Psychiatry, 148(6), 714 – 726.

2. Lehtinen, V. et al. (2000). Two year outcome in first-episode psychosis treated according to an integrated model. Is initial neuroleptilisation always needed? European Psychiatry,15(5), 312-320.

3. Moncrieff, J. (2003).Clozapine versus conventional anti-psychotic drugs for treatment-resistant schizophrenia: A re-examination. British Journal of Psychiatry, 183, 161 - 166.

4. Jeste, D.V. et al. (1995). Risk of tardive dyskinesia in older patients. Archives of General Psychiatry 52(9), 756-765.

5. Cahn, W. et al. (2002). Brain volume changes in first-episode schizophrenia: a 1-year follow-up study. Archives of General Psychiatry, 59, 1002 – 10.

6. Dorph-Petersen, K.A. et al. (2005). The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: a comparison of haloperidol and olanzapine in macaque monkeys. Neuropsychopharmacology, 30, 1649 – 61.

7. Arnone, G. et al. (2009). Magnetic resonance imaging studies in bipolar disorder and schizophrenia: meta-analysis. British Journal of Psychiatry, 195, 194 – 201.

8. Ho, B.C. et al. (2011). Long term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Archives of General Psychiatry, 68, 128 – 37.

9. Gil-Ad, I. et al. (2001). Evaluation of the neurotoxic activity of typical and atypical neuroleptics: relevance to iatrogenic extrapyramidal symptoms. Cell Molecular Neurobiology, 21, 705 - 16.

10. Jeste, D.V. & Wyatt, R.J. (1979). In search of treatment for tardive dyskinesia. Schizophrenia Bulletin, 5, 251 – 293.)

11. Johnstone, L. (2000). Users and Abusers of Psychiatry: A critical look at psychiatric practice (2nd edition). Routledge.

12. Zito, J.M. et al., (2003). Psychotropic practice patterns for youth. Archives of Pediatric and Adolescent Medicine 157, 17-25.

13. McGrath, A. and Jackson, G. (1996).Survey of Neuroleptic Prescribing in Residents of Nursing Homes in Glasgow. British Medical Journal 312,611-612.

14. Moncrieff, J. (2009). A Straight Talking Introduction to Psychiatric Drugs. PCCS Books, Ross-on-Wye.

15. Belmaker, R.H. & Wald, D. (1977).Haloperidol in normals. British Journal of Psychiatry 131,222-223.

16. McClelland et al., 1990. A comparison of central nervous system effects of haloperidol, chlorpromazine and sulpiride in normal volunteers. British Journal of Clinical Psychopharmacology.30(6), 795 – 803.

17. Ramaekers, J.G. et al. (1999).Psychomotor, cognitive, extra-pyramidal and affective functions of healthy volunteers during treatment with an atypical (amisulpuride) and typical (haloperidol) anti-psychotic. Journal of Clinical Psychopharmacology 19(3),209-221.

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Comments 34 comments

lambservant profile image

lambservant 4 years ago from Pacific Northwest

Excellent article, and well researched and documented. Antipsychotics are also used for mood stabilization. I am on Seroquel and the only side effect has been weight gain. It's not pleasant, but for me, it's better than the other alternative.


KrystalD profile image

KrystalD 4 years ago from Los Angeles

This is full of a lot of useful information. Thanks doe sharing.


meloncauli 4 years ago

What a wonderful thought provoking article! I have been aware of the tardive dyskinesia side effects for many years. The sad fact is that a huge majority of patients are not made aware of this potential side effect. These medications help to make the patient look more mentally ill than they are. The grimacing, salivating, tics and gait all paint a picture to those who know nothing of these side effects. It's not a good picture!

Another form of quietening mental illness. It's sad to say the least in my opinion. Great hub voted up.


gsidley profile image

gsidley 4 years ago from Lancashire, England Author

lambservant - Thank you so much for taking the time to comment.

Despite holding strong views about what I see as an overuse of medication (and lack of information provision) in psychiatric services, I respect the right of any person to opt for what works for them. Therefore I'm pleased to hear you get benefit from your medication.

Best wishes


gsidley profile image

gsidley 4 years ago from Lancashire, England Author

I appreciate you dropping by, KrystalD


gsidley profile image

gsidley 4 years ago from Lancashire, England Author

meloncauli - I'm delighted you found the hub of interest.

I think your point about tardive dyskinesia is a valid one; these involuntary facial movements are (on top of everything else) so stigmatising. It sounds like we have both worked in similar places!

Thanks again.


SaritaJBonita profile image

SaritaJBonita 3 years ago from Upstate New York

gsidley, This article is written in a way that makes it very believable. My main problem with it is that you utilize some very outdated sources. Many of the medications you list on your charts are (at least here in the US) newer than the sources you quote.

As far as the lack of a biological or biochemical basis for schizophrenia, there has been a huge amount of promising research on this disorder, and on Bipolar Disorder as well.

Despite my disagreements, I do feel as if there's an over-emphasis on medication in some areas of psychiatry. In my experience as a patient with Bipolar Disorder, there is a major emphasis on behavioral modification and different therapies in addition to a medication regime. Mental illness is much more complicated than just taking a pill, but most of the time medications are a necessary part of the solution.


gsidley profile image

gsidley 3 years ago from Lancashire, England Author

I appreciate you dropping by and leaving comments. In response to the issues you raise:

With regards to out-dated sources, new drugs, with specific names, may have come on to the market but they all derive from the chemical groups described. The brand names may be different but their chemical structures will be similar. I’d also suggest not giving too much weight to drug-company hype as it has been established beyond any doubt that they have routinely distorted the results of their trials in favor of their own drug (see the recent book Bad Pharma by Ben Goldacre, 2012) for a very thorough review.

With regards to evidence of a biochemical basis, I agree there has been an incredible amount of research done to try to discover a primary biochemical cause of “schizophrenia” (most of it funded by the drug companies) but very limited progress. In fact the outcomes for psychosis in the under-developed world (where much less medication is used) are notably better than those in the USA and UK (see evidence provided in my hub on “Recovery rates.” )

I’m not anti-medication, as I recognize that it can be of benefit to many people at some points in their struggle with mental health problems. My main motivation in writing about these things is to allow service-users to make an informed choice about the medication they take rather than passively absorbing the realms of misinformation peddled for decades by the pharmaceutical industry in alliance with many psychiatrists.

Thanks again for your interest.


SaritaJBonita profile image

SaritaJBonita 3 years ago from Upstate New York

You have a good point about different recovery outcomes for people in the "under-developed" world. I think this is due in large part to the vastly different support system that people with mental illness have in these countries. Mental illness is seen in a completely different way, and the treatment focuses more on supporting the individual within their own community (though sometimes in seemingly "barbaric" ways). The concept of "recovery" is also radically different.


michelerampa profile image

michelerampa 2 years ago from Boston, MA

When antipsychotics are compared to anxiolitics there is a problem to face: it is the efficacy in inducing the sleep in patients. I would not suggest to substitute an antipsychotic with an anxiolitic, and I would not say that the sleep is the only main etiologic factor of the disease. The disease is too complex to reduce the potential of a therapy, whichever it is.

By the way, thank you for the suggestions of the hub.


gsidley profile image

gsidley 2 years ago from Lancashire, England Author

Thank you for your interest, and taking the time to read and comment.

With regards to the point you raise, I am highlighting that no specific/distinctive antipsychotic effect of antipsychotic medication has yet been established. They undoubtedly dampen psychotic symptoms, but this may be entirely due to their generalized tranquillizing effect rather than any specific, targeted action - hence their superiority to drugs like valium and ativan can not yet be assumed. (The Moncrieff book, "The Bitterest Pills" is well worth reading, as it provides a comprehensive review of all the relevant literature).

Also, schizophrenia is not a "disease", and I believe there are a number of important disadvantages to referring to it as such. I suggest we should reserve the term "disease" for disorders where a primary biological aetiology has been established (e.g. cancer, diabetes, dementia); no such brain aberration/biochemical imbalance exists for those labelled as suffering with schizophrenia.

Thanks again for your interest.


michelerampa profile image

michelerampa 2 years ago from Boston, MA

Yes, I agree in not calling the Schizophrenia a "disease"...


sparkleyfinger profile image

sparkleyfinger 21 months ago from Glasgow

An interesting article. I have been prescribed antipsychotics, at a low dose, to treat vertigo! Quite strange when you consider how they work... And the side effects that can occur too...


Venkatachari M profile image

Venkatachari M 21 months ago from Hyderabad, India

Very interesting and useful article. You have done a very good research and presented this article for the help of victims of these drugs. But, once people get used to these drugs, they do not stop or want to stop their consumption. It is a very serious problem for many of them which they do not realize and even after advices they are unable to leave these drugs.

So, prescription of drugs should be avoided as far as possible by the Doctors and cure patients through counselling only.


tsmog profile image

tsmog 21 months ago from Escondido, CA

Congratulations for Hub of the Day here at HubPages. A great model to follow. Regarding the article I am in agreement while disagreeing as well. A discussion in and of itself. Of importance is this article regarding antipsychotics does share windows for views and open doors to opportunity. Thank you!


cathylynn99 profile image

cathylynn99 21 months ago from northeastern US

loxapine (older) and geodon (newer) are two more antipsychotics. not all of the newer drugs have the side effect of sexual dysfunction and some are less likely to cause weight gain. one side effect of the newer drugs that frequently goes unmentioned is that on the wallet.


Lady Guinevere profile image

Lady Guinevere 21 months ago from West Virginia

Good Grief, this was an old hub and got HOTD?? Congrats to you on getting the HOTD and it is a great hub and so full of information. I wonder if anything and what if has changed or has been added to the list of drugs that you have here. I wonder if you are still here to know that this hub did get the HOTD?

I read in one part of your article that most of the poorer children gots lost more of these drugs than anyone other group. Hmmm give yet another meaning to dumbing down america.


FlourishAnyway profile image

FlourishAnyway 21 months ago from USA

Congratulations on HOTD. Well deserved, good citations. We need excellent writing like this.


Larry Fields profile image

Larry Fields 21 months ago from Northern California

Hi Gary,

Good job! Your article is definitely worthy of HOTD recognition. Two points.

First, with the introduction of Thorazine, lobotomies became appreciably less frequent. Would you believe that there was a lobotomy Nobel in 1949? I've even written a hub on the subject.

Second, many years ago, I remember reading a disturbing article in Science News about antipsychotic medications. There is a problem with patient compliance. Why? Because of the dosages used. Old saying from Paracelsus: The dose makes the poison. Patients from wealthier families can afford to have their individual doses optimized.

However it's a different story for poorer people. They get the 'bureaucratic dose', which a sufficient to suppress all of the positive symptoms in the overwhelming majority of cases. And which all but guarantees that there will be serious side-effects in the majority of patients.

It would be of interest to see studies on the safety and efficacy of anti-psychotic meds, when sufficient time is taken to titrate the doses for each of the patients in the studies.


Exam Masters profile image

Exam Masters 21 months ago from Toronto

Wow, very informative article! I've seen some of the side effects of these meds in patients and it can be really neat and scary at the same time.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

sparkley finger - Thanks for your interest and supportive comment. Antipsychotics are prescribed for a wide range of problems (although I had forgotten about its use with vertigo). I would imagine low dose & time-limited would be OK.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

Venkatakari - I agree, these kind of drugs are grossly over-prescribed; their increasing use with children is particularly disturbing.

tsmog - Thanks for the positive feedback. I'd be happy to further discuss your points of agreement and disagreement - I'm always open to constructive challenge.


Jlbowden profile image

Jlbowden 21 months ago from Long Island, New York

Enjoyed your article and great overall summary about anti psychotic drugs and their uses in mental health capacities for one. It's a real shame that these drugs are marketed for their intended purpose, but do not treat the persons underlying condition. Instead they tend to deaden the individuals emotional response to external stimuli.

Psychiatrists also,nand unfortunately write these classes of drugs like they were giving out candy. And where a Diazepine such as Alprazolam, or Clonazepam can be just as effective for some symptoms, including sleep issues. They tend not to use this class of drugs, which cause far fewer side-effects. But continue to prescribe drugs like Seroquel (Quetapine) in an effort to treat multiple issues, but in a useless effort to treat the treat, or think they are actually treating schizophrenia for example.

I've also seen psychiatrists and other physicians use a newer product called Silenor, to treat sleep issues, particularly in the elderly. Silenor is actually low dose Doxepin. And Doxepin in higher doses, like Trazodone is used to treat moderate depressive episodes. But Even though a drug is not indicated for off label use. The Doctor still has the first call whether he/she wants to use a antipsychotic or antidepressant for a condition like a sleep disorder.

Again thank you for sharing a very interesting, as well as very useful article, which deserves to be a hub of the day!

Jlbowden


ThisIsRidiculous 21 months ago

"make an informed decision"? Really? With this heavily biased article? An article that openly accuses doctors/psychiatrists of "targeting poor children"? You realise that these drugs have other uses, right? They may be called anti-psychotics, but they are useful for a massive range of things. You also quote statistics and figures without mentioning the myriad other factors that go into deducing them so that it suits your rhetoric. The fact that 1 in 3 patients get better on their own is by chance, that can happen with anything, it is irrelevant to the effectiveness of the drug so your deduction that only 1 in 3 patients benefit from the drug is just nonsense. I'm not saying it's any better or any worse, I'm just calling out your purposefully misleading and flat out false figures/stats/claims.

"Informed decisions"? based on your "facts" and "truth"? For one to make an "informed decision", they require ALL the facts, both sides of the coin and without bias. What you present is a knowingly biased, entirely one sided account aimed at scaring people out of treatment because of your INDIVIDUAL experience and perception. You seemingly forget that drugs are a subjective experience.

"targeting young poor persons" is an outrageous claim, and completely voids your article. It unveils your intent. The fact that statistics show more poorer youths are prescribed this drug than affluent youths are is not evidence enough to make a ridiculous claim of "targeting poor youths". There are too many other factors not taken into account to make comparing these figures valid.

Absolutely laughable claim that elderly patients are forcibly given the drug for being "uncooperative"; this isn't some movie, darling. We have absolutely no information or context for you to imply what you so clearly are implying to add a bit of flare to your fantastical attack.

You list these side effects (selected very specifically to suit your rhetoric), avoiding any that might contradict your argument; and completely ignore the fact that millions of people have been saved by these drugs; have been given a new life. No one denies that there are side-effects; patients are given a test run to see how the side-effects affect them and if they are suitable. It is a rather easy trade-off: A new life in which you are able to return to some normality and to begin to recover but being lethargic; issues with sex organs; dry mouth; constipation... Or continued psychosis without any concept of reality. Yes, drugs aren't miracle cures (and everyone knows this), but they very often get people into a position and mindset where they are able to begin recovering. And yes, some people don't agree with some drugs. So you try other ones until you find one that suits you.

You are talking as if the American healthcare system is the only system in the world. This cliché idea that every doctor everywhere is just a sell-out to drug companies who will prescribe anything to collect the cash is just straight false. It's a minority. Yes, doctors prescribe anti-psychotics for a lot of issues, why does that make them evil? It's not some scheme to just pacify people or to hurt them. What do they have to gain from that? And back to the healthcare system; most other countries are not even associated with the drug companies. They get no payments for prescribing particular drugs, they don't even have contact with them. And they certainly don't hand out heavy sedatives like candy. Marketing has no connection to whether a drug is prescribed or not. In fact, they are very reluctant to prescribe drugs unnecessarily here and there are no financial benefits for a prescription of a certain drug. We also don't have any sort of advertising for drugs, in any form. Most are generic where possible and without all the flashy names and packaging seen in America. However, the fact that drugs are an industry in the USA and perhaps a large problem DOES NOT mean that the drugs themselves are ineffective or harmful. why would anyone buy a drug that harmed people? Surely they would just stop taking it and then they would lose a 'customer'? People aren't being forced to take these pills.

Why are you ignoring the many positive effects of these drugs? I thought this was supposed to be presenting the "facts" for an "informed choice"?

Of course drugs have withdrawal symptoms... What doesn't? Why is that a relevant point? That doesn't take away from the benefit the drug may give. And, anyway, there are methods of avoiding withdrawal symptoms.

Funny, you decide to take into account other factors when interpreting data when it works in favour of your argument... Funny, too, that you draw these conclusions from your own assumptions. Don't you think researchers are aware of withdrawal symptoms? Don't you think this would be a control in the experiment? You are not more intelligent than the scientists. This is obviously a factor that would interfere and void the statistics, they will have taken this into account and adjusted the experiment accordingly to make control it and make it an accurate comparison. Please cite your sources for the allegations you make, how did you come to these conclusions to justify your claims?

Do you understand how long-term effectiveness of drugs is tested?

You also speak as if there is little scientific evidence or research on these drugs... They undergo rigorous, extensive, peer reviewed testing carried out in multiple stages by many independent research teams that look into every aspect of the drug and that's before the thing is even allowed to the next phases of testing (this is at least 2 stages away from release to the public).

So what makes your assertion and implication that these drugs are likely unbeneficial more valid than the medical and scientific community's findings? Are you a medical professional? Why are "most psychiatrists" wrong in asserting that these drugs are beneficial? What would they gain from an incorrect assertion? Again, you are not in a position to nullify extensive research and testing based on anecdotal evidence and amateur interpretation of data; or to nullify the psychiatric community's findings in the 'field', so to speak.

These drugs are not without their negative effects. This is known. They are sedating. They are not a cure, they are a solution to distressing symptoms that place most in a better position than they were.

The thing with this internet craze of posting horror stories of how evil corporate doctors have poisoned you with some mind-control substance to cash in and enslave you; is that the only people who will go online and post this kind of thing are people who have had bad experiences. People who have had good experiences don't really have much reason to go online saying how great they're feeling, do they? So you've got the silent millions of patients who are benefiting from these drugs who you simply don't hear from. It gives a hugely unbalanced picture.

My current anti-psychotic can cause a deadly skin disease (necrotising fasciitis I believe) in the rarest of cases, so my doctor made me aware of this and told me what to look out for. Thankfully, I've made it through the time period where it occurs, and my life is finally back on track and my bipolar and psychosis is practically non-existant. It's not been some evil attempt to kill me without telling me anything, it's just that the drug works so well that the fact there's a minuscule chance of a skin condition is negligible. That's why it has been approved by all the agencies. Not because they were paid to allow it. The healthcare here is free and they can't afford to hand out fancy, expensive medications that pharmaceutical companies try to pedal, unless it is a serious case that requires them.

Have you suffered from depression, psychosis, schizophrenia etc.? Have you been prescribed any medications? Have you tried many? Some work. Some don't. Everyone reacts differently. This no way you can claim that all people will experience negative effects from the drug, you are scaremongering vulnerable people out of treatment because you personally had a bad experience (I'm willing to assume).

Christ!


cathylynn99 profile image

cathylynn99 21 months ago from northeastern US

he is a psychologist who can't prescribe drugs, this is ridiculous. psychologists in general tend to be biased against drugs. that said, he points out a truth when he says antipsychotics are over prescribed to the elderly for behavior control, even though death may result.


Larry Fields profile image

Larry Fields 21 months ago from Northern California

ThisIsRidiculous wrote:

"'targeting young poor persons'" is an outrageous claim, and completely voids your article."

I searched for the word, "targeting." I was unable to find the EXACT quote that you provided. If you want people to take you seriously, you should only put exact quotes between quote symbols. In this case, it appears that you have put words into Gary's mouth. Can you say, "Straw man argument?"

Misquoting "completely voids" your comment. See, two can play at that game.

By the way, I'm glad that you found a medication that works for you.

I'm still struggling with Sensory Integration Dysfunction, aka Sensory Processing Disorder. I do not like the latter name. It suggests that physicians, in their infinite wisdom, can reorder the disorder. And that is misleading.

Thousands of dollars later, I've come to the conclusion that I am mostly on my own. I've optimized my daily exercise routine, and am avoiding foods and beverages that exacerbate my problem. It's not enough, but something is better than nothing.

One of several meds that have been prescribed for me was low-dose Haldol. It was somewhat helpful at times. However it had the unacceptable side-effect of making me as hungry as a wolf. Diabetes runs in my family, and obesity is a major risk factor for that disease. I definitely want to avoid the misery that my late father went through with complications of diabetes.

My physician at the time conveniently neglected to mention that one pesky side effect. As Maxwell Smart would say, "Sorry about that."


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

tsmog - Thank you for reading and commenting. I'm always interested to hear both points of agreement and disagreement.

cathylynn99 - Granted, the severity of each side effect can vary from drug to drug. And living in the UK, with its National Health Service, I've never considered the issue of the drain on personal finances; drugs that are commonly advertised as needing to be taken for many years must represent a major hit on the wallet.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

Lady Guinevere - I'm grateful for your interest and comment. The hub was written in July 2013 and a couple of details are due for updating, although the thrust of the arguments presented remain as relevant as before.

FlourishAnyway - Your generous feedback is much appreciated. Thank you.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

Larry Fields - I appreciate your contributions to this discussion. Your point about antipsychotic dosage is a valid one; sadly, many patients endure doses well above the recommended limits and/or find themselves on a combination of more than one antipsychotic. And we should not forget that antipsychotics are brain suppressants, irrespective of dose; after all, the original antipsychotic (or 'major tranquillizer' as they were, more accurately, called) chlorpromazine was used to dampen pain during surgical procedures!


Jen Card profile image

Jen Card 21 months ago

Thank you for sharing this information. I am at the starting line of pursuing a degree in psychology, reading information like this is both helpful and inspiring! Thank you!!!


mariam. 21 months ago

your hub pages are wonderful....I myself is caring for someone (fam.) with schizophrenia. this site has so much to give and take....good stuff....thank you for letting me share....

My pages are all about "LIGHTUPYOURLIFEand mine. about mental Illness and hope...

question: is there any other new med that doesn't have the terrible side effects of Arrythmia and RLS (Haldol) I am his guardian. very terrible side effect this inj. med does for the mind and body.....I does not help.. we are talking about one whole month in misery. thank you


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

Exam Masters - Yes, the side effects can be severe, particularly for the longer-term users. I appreciate your feedback.

JlBbowden - I appreciate your thoughtful feedback. It is interesting how general medical practitioners seem much more twitchy about prescribing anxiolytic drugs (dependency-forming/low toxicity) but will often dish out antipsychotics (less dependency/high toxicity) to a wide range of people with a variety of problems. Thanks again.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

Thisisridiculous -

Thank you for reading and taking the time to leave a detailed response.

Before I comment on the specifics of your criticisms I’d like to emphasise that I’m not against the use of medication; I believe it has a useful role in some instances, particularly in the short term. What I do feel strongly about, however, is that we should be honest about how these chemicals have their effects – non of this ‘restoring balance to brain biochemistry’ nonsense. Also I believe the gross over-prescribing, particularly to children and young people, is impossible to justify.

Furthermore, I’m pleased to hear that the medication works for you. I’d always defend the right of anyone to use a drug – antipsychotic, cannabis, alcohol, anxiolytic etc. – if it is deemed to be helpful and does not break the law.

Now to the specific criticisms:

1. Evidence for efficacy with recurrent psychosis is modest; evidence for efficacy with the other disorders is even weaker or non-existent.

2. If 33% of psychosis sufferers can improve without medication, and 33% don’t respond to medication, I don’t think it is illogical to suggest that only 33% may benefit as a broad estimate of their utility. This is a reasonable challenge to the dominant psychiatric view that virtually everyone with psychosis will need antipsychotics to improve, and will need to stay on them for many years to remain well.

3. The widespread misuse of antipsychotics with elderly people is generally accepted (I refer you to the reference in the body of the article as an example – there are many more). In the UK, government policies are currently striving to reduce this damaging misuse with confused, often demented, elderly people. To dispute this is, in your own words, ‘ridiculous’.

4. Which of my stated side effects are you claiming to be bogus? I’m unaware of any of these potential side effects being contentious.

5. I acknowledge (and state in the article) that antipsychotics do reduce psychotic symptoms and that many people may find them helpful.

6. Nowhere did I suggest that all doctors are evil, although a number have been prosecuted for taking bribes from drug companies as incentives to over-prescribe their products or to make exaggerated claims about efficacy.

7. Your absolute faith in the research purportedly underpinning these drugs is somewhat naïve. Don’t just take my word for that; I suggest you read the book ‘The Bitterest Pills’ by Joanna Moncrieff (a British psychiatrist) for an overview.

8. It is probably best not to get into the argument about whose opinion, based on what qualification, is the most valid. Evaluate the evidence as presented and argue why you believe it to be flawed. Although I would mention that a growing number of psychiatrists are expressing concern and dissatisfaction with the way the Western world responds to mental health problems.


gsidley profile image

gsidley 21 months ago from Lancashire, England Author

cathylynn99 - Thank you for reading and commenting.

You're correct in pointing out that I am a clinical psychologist, but it would be wrong to imply that the criticisms of Western psychiatry are largely the product of turf wars between professions. It's best to address the evidence presented. I understand the research process and therefore feel justified in criticising studies & practice when it warrants it.

And I totally agree with your comment about over -prescribing with the elderly.

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