NIMH acknowledges that antipsychotics worsen prospects for long term recovery

Mad in America
Mad in America (Photo credit: Wikipedia)

Thomas Insel, the Director of the National Institute on Mental Health comments on a recent study of the long term effects of antipsychotic maintenance for schizophrenics. The study looked at patients who discontinued antipsychotics compared to those who were maintained on antipsychotics.

…by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group.

…antipsychotic medication, which seemed so important in the early phase of psychosis, appeared to worsen prospects for recovery over the long-term. … At least for these patients, tapering off medication early seemed to be associated with better long-term outcomes.

…It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness.

Mad in America reports that this information has been around for years and the establishment has willfully ignored it. He adds that there’s also a better way to respond to psychosis.

The Open Dialogue therapy protocol delays the use of antipsychotics in first-episode patients, instead utilizing psychosocial support and selective use of anxiety-reducing benzodiazepines (e.g. Ativan, Klonopin,Valium) with the hope that patients can “chill out,” and get through their first crisis without ever going on antipsychotic medications. And if patients need to go on antipsychotics, the Open Dialogue protocol allows for them to subsequently try to taper from the drugs.

The results? “With this selective use of antipsychotics,” Whitaker reports, “Open Dialogue has produced the best long-term outcomes in the developed world. At the end of five years, 67% of their first-episode patients have never been exposed to antipsychotics, and only 20% are maintained regularly on the drugs. With this drug protocol, 80% of first episode patients do fairly well over the long-term without antipsychotics.”

This begs a critical question. If antipsychotics are impede the recovery of many schizophrenics, what do they do to the millions of non-psychotic adults and children that are prescribed them?

One other observation. This notion of “functional recovery rate” sounds a lot like quality of life. Interesting that this is the kind of measurement exposed this pharmacological treatment as harmful for many patients and some prominent advocates of a pharmacological treatments have dismissed quality of life as an outcome measurement.

UPDATE: This is precisely why so many of us have been so concerned about mergers between mental health and addiction treatment systems. Many of these mergers are really the mental health system taking over addiction treatment systems.

Less is more – Antipsychotics and Recovery from First-Episode Psychosis

A very interesting finding with profound implications for addicts who experience a psychotic episode. (Particularly since it’s so difficult to tease out whether it was substance -induced.)

Importance  Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before.

Objective  To compare rates of recovery in patients with remitted FEP after 7 years of follow-up of a dose reduction/discontinuation (DR) vs maintenance treatment (MT) trial.

Design  Seven-year follow-up of a 2-year open randomized clinical trial comparing MT and DR.

Setting  One hundred twenty-eight patients participating in the original trial were recruited from 257 patients with FEP referred from October 2001 to December 2002 to 7 mental health care services in a 3.2 million–population catchment area. Of these, 111 patients refused to participate and 18 patients did not experience remission.

Participants  After 7 years, 103 patients (80.5%) of 128 patients who were included in the original trial were located and consented to follow-up assessment.

Intervention  After 6 months of remission, patients were randomly assigned to DR strategy or MT for 18 months. After the trial, treatment was at the discretion of the clinician.

Main Outcomes and Measures  Primary outcome was rate of recovery, defined as meeting the criteria of symptomatic and functional remission. Determinants of recovery were examined using logistic regression analysis; the treatment strategy (MT or DR) was controlled for baseline parameters.

Results  The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%). Logistic regression showed an odds ratio of 3.49 (P = .01). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates.

Conclusions and Relevance  Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates compared with the rates achieved with MT. To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice.