I keep reading comments from people wondering how anyone could possibly support Donald J. Trump. Fact checking his statements demonstrates how wrong he is on much of what he says. And then there are the numerous comparisons of statements that he makes that contradict each other.
Not so surprising, sadly enough, when we look at the people who believe what Robert Whitaker and the anti-psychiatry movement believe.
Put simply, Whitaker and the Mad in America anti-psychiatry folks are adamant that anti-psychotic medication for schizophrenia makes people sick and shortens their lives. Research fails to support these contentions but they persist and the data is ignored. The two latest studies provide overwhelming evidence that anti-psychotics help -- but more on that in a moment.
The late Dr. William M. Glazer of Yale, writing in Psychiatric Times four years ago, had this to say of Whitaker:
Should we accept the analysis of a journalist who (1) to my knowledge, has not treated a patient or implemented a study and (2) reaches conclusions that run counter to well-established practice guidelines? Whitaker's ideological viewpoint, which is implied throughout the book, is that our guidelines are inaccurate and driven by industry and our own need for income -- that we are dishonest brokers. Beauty is in the eye of the beholder.
Criticisms of Whitaker have been done by many eminent psychiatrists, but my favourite is by blogger Natasha Tracy in HealthyPlace.com. Natasha explained why she refused to even read his book with these words:
Sure, he cites studies, he just contraindicates what the study actually proves. And nothing ticks me off more than this because people believe him just because there is a linked study -- no one ever bothers to check that the study says whatever Whitaker says it does.
Except, of course, the people who do -- the doctors. You know, the people who went to medical school for over a decade. You know, the people actually qualified to understand what all the fancy numbers mean. You know, those people.
And I, for one, rely a lot on what doctors make of medical data and they are the ones most able to refute Whitaker's claims.
As for the contention by Whitaker and his minions that anti-psychotics make people sick, Dr. Joe Pierre, a psychiatrist who works in psychiatric hospitals, explored that in Psychology Today a few years ago. His conclusion was:
Of course, every patient wants to have the kind of schizophrenia that doesn't require long-term medications, just as every patient wants to not have schizophrenia at all. Unfortunately, that hope doesn't predict the benefit from and need for antipsychotic medication. Neither does the unfounded belief that antipsychotics cause a worsening of schizophrenia in the long run.
Two recent studies support the position that anti-psychotics are beneficial and, for the most part, do not lead to greater health problems.
In 2013, the highly respected British Medical Journal, The Lancet, published a German meta-analysis on the efficacy and side-effect profile of all anti-psychotics. The results are summarized simply in a blog by Dr. Gerhard Gründer with a link to the original study.
The meta-analysis combined 212 studies with a total of 43,049 patients. All of the anti-psychotics produced improvements that were statistically better than placebo. The best agent was clozapine.
The most recent study was conducted in the Province of Quebec and published in July and was based on real-world evaluations of all people prescribed with anti-psychotics for schizophrenia between January 1998 and December 2005. The cohort consisted of 18,869 patients. Outcome measures consisted of mental health event (suicide, hospitalization or emergency visit for mental disorders) and physical health event (death other than suicide, hospitalization or emergency visit for physical disorders).
The researchers pointed out that data from randomized control trials are often limited in terms of generalizability, thus real-world studies like this one are much more realistic. What they found was that taking anti-psychotics reduced the risk of having either a mental or a physical problem compared to those who discontinued taking them. The only anti-psychotic that performed poorly was quetiapine (seroquel), while clozapine had the best results.
The other criticism from the anti-psychiatry bunch is that taking anti-psychotics results in premature death for people with schizophrenia. Studies have shown that people with schizophrenia do die years earlier than others, but the reasons are not well understood.
One hypothesis that I mention in my book, Schizophrenia Medicine's Mystery Society's Shame, is discrimination by health-care practitioners. Studies show that people with schizophrenia often do not get adequate basic medical care and treatment.
Researchers in Sweden conducted a real-world analysis of 21,492 patients with schizophrenia. Subjects were followed up from 2006 through 2010. Data on drug use and outcomes was obtained from national registers.
What was found was that antipsychotics and antidepressants were associated with a significant reduction in mortality compared with no use, the opposite of what the anti-psychiatry crowd claim. However, there was a clear dose-response curve for benzodiazepine exposure and mortality -- more benzos, greater mortality.
Note that benzodiazepine drugs are not anti-psychotic medications. They provide short-term relief from anxiety, but they are addictive when used over a long period, which means people develop tolerance and then crave more with long-term use. And if they stop them they experience serious withdrawal symptoms. They are never prescribed alone to treat psychosis.
Psychotropic medications prescribed properly to those who need it are beneficial despite what you may hear from some journalists and a vocal minority.
A slightly different version of this first appeared in the blog Mind You earlier this month.
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