March 2, 2008
Christian was slouched in a chair in Bradford psychiatric unit. He was, seemingly, only half-conscious, half alive. He could hardly speak, let alone raise his head. Christian had been diagnosed with schizophrenia. Two days before, in a haze of paranoia, he had punched a colleague of mine at a day centre. So Christian was sectioned and medicated, heavily, with neuroleptic drugs.
Most people, on seeing Christian, would have described him as being so
whacked out he was a dribbling wreck. The drug-advisory body, the National
Institute of Health and Clinical Excellence (Nice) would say the neuroleptic
treatment had successfully "calmed" Christian, in preparation for treating the
"underlying psychiatric condition".
Neuroleptics - such as Clozapine, Olanzapine, Risperidone and Seroquel - are the "primary treatment" for psychosis, particularly schizophrenia. Indeed, 98%-100% of people diagnosed with schizophrenia inside our psychiatric units - and 90% living in the community - are on neuroleptics, also called antipsychotics. Nice's guidelines for the treatment of schizophrenia say: "There is well established evidence for the efficacy of antipsychotic drugs."
A similar efficacy used to be claimed for Prozac and other SSRIs in the treatment of depression. But a study published last Tuesday could well have pulled the plug on Prozac.
And now a London NHS psychiatrist, Joanna Moncrieff, has similarly endeavoured to expose the "myth" of antipsychotics. Whereas Moncrieff has already highlighted antidepressant non-effectiveness, it is her research on antipsychotics that is more shocking. The evidence shows, she says, that antipsychotics not only do not work long-term they also cause brain damage - a fact which is being "fatally" overlooked. Plus, because of a cocktail of vicious side-effects, antipsychotics almost triple a person's risk of dying prematurely.
Moncrieff particularly strikes out at her own profession, psychiatry,
claiming it is ignoring the negative evidence for antipsychotics. In her book,
The Myth of The
Chemical Cure, Moncrieff argues, effectively, that psychiatry is guilty of
gross scientific misconduct.
Having examined decades of clinical trials, Moncrieff's first point is that once variables such as placebo and drug withdrawal effects are accounted for, there is no concrete evidence for antipsychotic long-term effectiveness. This is a radically different interpretation of the meta-analyses and trials Nice used to arrive at its opposite conclusion. But Moncrieff is confident her scrutiny of the evidence is valid.
At the heart of years of dissent against psychiatry through the ages has been its use of drugs, particularly antipsychotics, to treat distress. Do such drugs actually target any "psychiatric condition"? Or are they chemical control - a socially-useful reduction of the paranoid, deluded, distressed, bizarre and odd into semi-vegetative zombies?
Historically, whatever dissenters thought has been ignored. So, it appears,
have new studies which indicate that antipsychotics do not work long-term. For
example, a US
study last year in the Journal of Nervous and Mental Disease reported that
people diagnosed with schizophrenia and not taking antipsychotics are more
likely to recover than those on the drugs. The study was on 145 patients, and
researchers reported that, after 15 years, 65% of patients on antipsychotics
were psychotic, whereas only 28% of those not on medication were psychotic. A
staggering finding, surely? So where were the mainstream media yelps of
"breakthrough in schizophrenia treatment". Not a squeak.
Moncrieff's second point is that the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that antipsychotics cause extensive damage - the most startling being permanent brain atrophy (brain damage) or tardive dyskinesia. As in Parkinson's Disease, patients suffer involuntary, repetitive movements, memory loss and behaviour changes. Antipsychotics cause atrophy within a year, Moncrieff says. She accuses her colleagues of risking creating an "epidemic of iatrogenic brain damage".
Moncrieff is a hard-nosed scientist, so she is respectfully reserved. But gross scientific misconduct is her accusation. "It is as if the psychiatric community can not bear to acknowledge its own published findings," she writes.
How worrying it is, then that the Healthcare Commission should report last year that almost 40% of people with psychosis are on levels of antipsychotics exceeding recommended limits. Such levels cause heart attacks. Indeed, the National Patient Safety Agency claims heart failure from antipsychotics is a likely cause for some of the 40 average annual "unexplained" deaths of patients on British mental health wards. Other effects of antipsychotics include massive weight gain (metabolic impairment) and increased risk of diabetes.
Two years ago, The British Journal of Psychiatry - Britain's most respected psychiatry journal - published a study reporting that people on antipsychotics were 2.5 times more likely to die prematurely. The researchers warned there was an "urgent need" to investigate whether this was due to antipsychotics. But so ingrained is the medication culture in mental health that many psychiatrists feel that not medicating early with antipsychotics amounts to negligence, Moncrieff notes.
Moncrieff does acknowledge there is evidence for the short-term effectiveness
of antipsychotics. But again Moncrieff asks psychiatry to be honest. Moncrieff
points out that when antipsychotics, such as chlorpromazine, were first used in
the 1950s they were "major tranquillisers". Why? Because that's an accurate
description of their effect, particularly short term. They sedate, or
tranquillise, the emotions, so reducing the anxiety of paranoia and delusions.
Any person on antipsychotics is likely to verify this (go to
askapatient.com). Now, however, these
drugs are referred to as "antipsychotics". For Moncrieff, this is a wheeze
because there's no evidence that antipsychotics act directly on the "symptoms" -
paranoia, delusions, hallucinations - of those diagnosed with psychosis. There's
nothing antipsychotic about antipsychotics.
So what are the alternatives? Moncrieff - like her fellow psychiatrists in a group called the Critical Psychiatry Network - asks services to look seriously at non-drug approaches, such as the Soteria Network in America. She believes psychiatrists such as herself should no longer have unparalleled powers to forcibly detain and treat patients. Instead, they should be "pharmaceutical advisers" engaging in "democratic drug treatment" with patients.
Psychiatrists should be involved in "shared decision-making" with patients, and would have to go to civil courts to argue their case for compulsory treatment. "Psychiatry would be a more modest enterprise," writes Moncrieff, "no longer claiming to be able to alter the underlying course of psychological disturbance, but thereby avoiding some of the damage associated with the untrammelled use of imaginary chemical cures."
The mental health establishment should learn from the Prozac story and pay attention. It's about time.