The myth of 'new is better'
The newer antipsychotics (see glossary here) have been widely promoted by the drug companies as superior and safer than the older antipsychotic drugs. This is more spin than substance as they come with serious risks and clozapine/Clozaril is in fact an old drug (previously withdrawn for serious safety issues) and reintroduced through astute marketing. In fact, it was clear 10 years ago (and remains so today) that “No convincing evidence has ever been forthcoming that any of the new ‘atypical’ antipsychotics are superior to the older ‘typicals’ in either safety or efficacy 10” and they are associated with causing a metabolic syndrome (see glossary here) leading to increased risk of weight gain, diabetes and stroke.
Psychiatric drugs can damage and disable many parts of the body
The damage from psychiatric drugs can affect many parts of the body, even down to the structure and functioning of cells, including the microscopic mitochondria (which are within most of the cells in the body) and are the cells "power houses". “All classes of psychotropic [psychiatric] drugs have been documented to damage mitochondria…”9 and this can put high-energy organs, such as the heart and brain, at particular risk 4.
Dopamine, in one way or another, influences sexual behaviour, lactation, our emotions, thinking and memory, movement, bone density and even the regulation of blood pressure and heart rate. It should therefore come as little wonder that drugs that affect dopamine (such as the antipsychotic drugs) will have widespread effects across the body. Not surprisingly, they play havoc with emotions, memory, sexual activity and are also a serious heart risk too. Sadly, due to hormonal disruptions by antipsychotics, we hear of children developing breasts (see here) and males lactating. We also hear of the disfiguring and disabling effects of tardive dyskinesia (TD), causing uncontrollable movements - arms, lips, tongue, and facial movements - that can also result from the newer so-called atypical antipsychotic drugs. The patient information by the makers of Risperdal/risperidole (one of the newer drugs) points out that TD can develop “after relatively brief treatment periods at low doses.” (see here).
The antipsychotics, not unlike other psychiatric drugs, can slow down movement, impede thinking and memory and inhibit any zest, enthusiasm or spontaneity for life. This is even more pronounced when they bring about the symptoms of Parkinson’s disease. When I hear doctors insist that these drugs are helpful I invariably think to myself: “But what about the permanent damage, especially with long-term use?” The shaking, slow faltering steps, and grave difficulty thinking and remembering are typical of Parkinson’s disease. As I think of a friend of mine who was so mentally and physically agile, but who is now being destroyed by Parkinson’s disease (not through mental health drugs), it seems that taking these drugs seems a perverse risk to take, and requires a very careful balancing of risks versus benefits.
Most drugs are toxic - there is always a need for caution and balancing benefits with risks
Some of the psychiatric drugs are seriously toxic; consider the toxic metal Lithium, which is used for so-called mood disorders. As one former neuroscientist writes: "I hope that one day soon we will come to regard lithium given to children as a treatment with the same disbelief that we now consider mercury, white lead and arsenic.” Clearly, this applies to adults too.
Having said that, it is true that most drugs (those in general medicine too) are toxic in varying degrees and come with a measure of harm. Doctors aim to balance the risks by using only a “therapeutic dose” and by not prescribing the drugs for too long. In mental health, high doses are often prescribed [see this Healthcare Commission Report here] and with the use of a number of drugs in combination (sometimes referred to as polypharmacy) and for extended periods – often many years – thus increasing the risks of harm. Even though the practice of co-prescribing mental health drugs is common place, this raises serious additional concerns as the drugs are unlikely to have been safety-tested in combination.
In deciding whether or not to take a drug, a risk-benefit analysis is made: weighing up the hoped for benefits against the known (and possibly unknown) risks. If the disease is life-threatening and the drugs are highly risky, a person may still opt for the treatment as there is little to lose; on the other hand, we are unlikely to risk taking a drug with the potential to seriously maim of kill us if we only have a headache or common cold. Hence, the risk taken is usually relative to the seriousness of the disease. This is one reason why people need to be told the breadth and depth of the risks associated with psychiatric drugs - so a reasoned choice can be made.
Doctors may consider different ways of reducing risk. With psychiatric drugs this could be by trying to avoid combinations of drugs (as the full risks of co-prescribing are not known); by reducing the dose to the minimum dose possible once a crisis has passed; and/or by exploring the possibility of periodic use - prescribing the drugs during times of crisis and gradually weaning the person off as the situation resolves and settles - though there is no guarantee that the drugs themselves will not exacerbate the problems and appear to necessitate their long-term use. The fact that the drugs are associated with adverse effects (including paradoxical effects) makes the concurrent use of additional drugs difficult to avoid and raises the risk stakes.
Being aware of the risks and respecting personal choice
Whether or not to take these drugs should be a matter of personal choice (though this choice is sometimes overruled by the Mental Health Act here in England - more here). Hence, in practice I work with those people who choose to take these drugs in spite of the risks, as well as with those who choose to gradually reduce their doses and who may decide, over time, to stop them.
But if you are taking mental health medications and are considering making any changes please do not rush to stop taking them but take note of the SAFETY ADVICE to the right. This is very important. Thank you.
Take time to make carefully considered decisions with the support of those you trust
There are numerous other risk factors that are associated with mental health drugs, such as lowering the threshold for epileptic fits, and the fact that they can cause some people to be violent and/or to be suicidal. This is something of an overview. But I am also concerned that psychiatric drugs can disempower people by severely hampering thinking and decision making, and by the fact that they can create social problems by causing disfigurement and sexual dysfunctions. We take a closer look at these here.
Each person's circumstances are of course unique, and it is for each person, with the support of trusted friends and, where appropriate, the advice of trusted doctors too, to decide whether the risks are worth taking within the context of their life and circumstances. Ultimately it is a personal decision, and especially difficult to make if there is little alternative support available. As I say here, this website supports the freedom to choose (including to take or not to take
these drugs) and the right to be fairly informed of the limitations, risks and
alternatives. And for those thinking of reducing or even coming off their mental health drugs some day, I discuss some of the key issues here.
References - Bibliography
Abbott, N.J. et al (2010) Structure and function of the blood-brain barrier. Neurobiol Dis
. 2010 Jan;37(1):13-25. Abstract here
2 Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House
3 Cooper, J. et al. (2003 edition) The Biochemical Basis for Neuropharmacology. New York: Oxford University Press
4 Jackson, G. (2009) Drug-induced dementia - a perfect crime. USA: Anchor House
5 Billioti, S. et al. (2012) Benzodiazepine use and risk of dementia: prospective population based study. BMJ 2012;345:e6231. Full study here.
6 Grandjean, P. et al (2006) Developmental neurotoxicity of industrial chemicals. The Lancet. November 8 2006
7 Breggin, P. (2001) The Antidepressant Fact Book. US: Da Capo Press
8 Navari, S. & Dazzan, P. (2009) Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings. Psychological Medicine (2009), 39, 1763-1777. Full study here.
9 Neustadt J, et al. (2008) Medication-induced mitochondrial damage and disease. Mol Nutr Food Res. 2008 Jul;52(7):780-8. Abstract here.
10 Dr D. Healy. House of Commons Health Committee: The influence of the Pharmaceutical Industry 2004. Quoted section available here.
11 Tiihonen, J. et al. (2012) Polypharmacy With Antipsychotics, Antidepressants, or Benzodiazepines and Mortality in Schizophrenia. Arch Gen Psychiatry. 2012;69(5):476-483.
12 I am of course not claiming that the apparent association proves the drug is culpable.
Further reading - Might be worth checking out
For a short and easy-to-read, but informative introduction to psychiatric drugs you might find this helpful:
Moncrieff, J. (2009) A Straight Talking Introduction to Psychiatric Drugs. UK: PCCS Books Ltd
The following are perhaps a more comprehensive read:
Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House
Healy, D. (2002) Psychiatric Drugs Explained. UK: Churchill Livingstone
Moncrieff, J. (2008) The Myth of the Chemical Cure. UK: Palgrave MacMillan
For those with a more in-depth interest in the physiological damage caused by psychiatric drugs:
Breggin, P. (2008) Brain-Disabling Treatments in Psychiatry. New York: Springer Books
Jackson, G. (2009) Drug-induced Dementia - A Perfect Crime. USA: Anchor House