October 6, 2011

The Rise And Fall Of Atypical Antipsychotics [sic]

vanillasky.jpg
the Seine is exactly like I wanted it to be

Dr. Kendall's editorial in the British Journal of Psychiatry is titled, "The Rise And Fall Of Atypical Antipsychotics."


The story of the atypicals and the SGAs ['second-generation antipsychotics'] is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing.

His point is that the atypicals aren't really better than the typicals (duh.)  Of course he's right, but in being factually accurate he is being deliberately deceitful.  Observe:

antidepressant history.JPG


Yes, those are antidepressants.  Note the progress from tricyclics.  The misleading thing about this timeline is that "tricyclic" is a classification based on chemical structure, while "SNRI" is a classification based on pharmacology.  Uh oh, trouble's coming.   If you type "tricyclic" into Google Translate and select Pharmacology it comes back with "SNRI."  In other words, they're the same.  No progress has been made there, either.  So what Dr. Kendall is not telling you is that psychiatry has always done this.  He wants to make it sound like atypicals are some big lie, but all of the terms psychiatrists hold as "objective" are less meaningful than any term Freud used.  Psychiatry has always been a branding game.

And the simple reason why it is so easy to fool psychiatrists with words like "atypical" and "tricyclic" is that most psychiatrists are stupendously ignorant of even kindergarten-level pharmacology and have barely any idea about how to interpret a study-- I don't mean p values, I mean looking at the y-axis; I mean the introduction.  Much, much easier to base all of their arguments on empty terms that are nothing other than branding choices.  Never mind the senseless term "atypical".  Gun to head, is Seroquel an "antipsychotic" or an "antidepressant"?  Confused?  Sometimes a cigar is just a cigar, I guess. 

You'll notice that academics never use the brand names of the drugs, always the generic, as if this is more objective, more scientific.  Who do you think came up with the generic name?  Or is it the capital letter you object to?  No: it is all to convey the appearance of scientific objectivity because you have absolutely no idea what the hell you're talking about.  "Seroquel is an atypical antipsychotic that is also useful as an adjunct to an existing antidepressant for the treatment of Major Depressive Disorder." How can I "sic" an entire sentence?

Here's an example.  He has a full orgasm about a recent study comparing a typical to an atypical that finds no difference in efficacy.

there were no differences on primary outcome measures, including time to remission, time spent in remission and symptom severity, by 12 months and at 9 years' follow-up. Girgis et al clear a little of the fog generated by the mass of cleverly constructed trials and selectively published data supporting a marketing strategy of 'smoke and mirrors' that has underpinned our collective misunderstanding about the so-called atypical antipsychotics.

The typical was Thorazine, and the atypical was Clozaril. Wow!   I'm sure he thinks he is being clever comparing "the worst typical" to "the best atypical" and finding them "the same", but that's because he salivates at the chance of using meaningless terms like "best", "worst", "atypical" and "second generation."  Thorazine, on any metric of "atypicality"-- serotonin antagonism, drug potency, D2 receptor dissociation times-- is an atypical on the order of Zyprexa, and certainly more atypical than Risperdal or Haldol.


dissociation thorazine.jpgThe point is not that Thorazine doesn't cause EPS; the point is that the "subtleties" of these drugs were known in 1999, if anyone cared to read about them.  No one did.  Instead they kept repeating the word "atypical" ten million times until it meant something.

To be clear: I am obviously aware of the buried data and the obfuscatory shell games of Big Pharma, but the truth of these medications has been available even without resorting to studies no one would have read anyway.  But in order to hide the fact that no one really paid much attention to the actual data that was in front of them (they took the word of the local thought leader and figured that was that) they pretend that the problem is the buried data.  "What we need in this country is more news." 

"...a marketing strategy of smoke and mirrors..."?  What studies did he read that said atypicals were more efficacious than typicals?  I realize that the perception was that they were better, but anyone who bothered to read the studies could not possibly have been left with that impression.

No one cares about this anymore, but the greatest fraud in all of psychiatry was Depakote, which had the excellent foresight to go generic and get the hell out of the game right before  the public turned on Big Pharma and the recession hit.  That's the kind of market timing you don't get with any commercially available trading platform.  Strong work.  Good luck with India.    But it's a med that had no evidence backing its efficacy, let alone safety, yet was the cornerstone of every clinical guideline and the lifeblood of most junior faculty looking to pad a CV.  If you type "divalproex" into PubMed, it will explode.  It was the Holy Grail, and to even spell it wrong resulted in immediate excommunication or a date with the guillotine.  Now I can't find one shrink who likes it, hell, I can't find one person who will own up to having prescribed it.  1998-2008:  oops?  You will observe that Kendall has nothing to say about it either, partly because antiepileptics are no longer prescribed but mostly because it's not fashionable to hate it.  The only way to get the populist press to care about a poorly reasoned rant in a British comic book is to include the words "atypical antipsychotics blow."  That got your attention.  "Well, we were wrong about Depakote, but we were deceived about Zyprexa."  Have another drink and keep telling yourself that.

II.

Kendall's chief complaint appears to be this:

In creating successive new classes of antipsychotics over the years, the industry has helped develop a broader range of different drugs with different side-effect profiles and potencies, and possibly an increased chance of finding a drug to suit each of our patients. But the price of doing this has been considerable - in 2003 the cost of antipsychotics in the USA equalled the cost of paying all their psychiatrists.
That's a great argument, and as he helps set the government's policies on healthcare it's really the one he should have stuck with.  But the solution is right in front of him: restrict the use of medications for all but the necessary cases, and pay the psychiatrists more.  Let the shrinks try something else.

I'm not saying this because I'm a psychiatrist.  I'm saying it because it is impossible.  Impossible because-- and I'm putting this in italics to make it harder for you to unsee it-- the point of the government's policy on psychiatry is to treat all patients as having exclusively organic diseases and not socially generated problems; and medications, regardless of cost, are absolutely necessary to maintain this narrative.

You think because you've discovered the word "atypical" is meaningless, ten years too late, that you've altered the dialectic?  Abre los ojos: 

unemployment-rate-meds.png

The era of industrial psychiatry is only just beginning and it will outlast us all.  It is inevitable.












Comments

What is the significance of... (Below threshold)

October 6, 2011 1:28 AM | Posted by Anonymous: | Reply

What is the significance of the last graph? I see you marked where all the drugs were released but I don't see the correlation between that and unemployment, or recession points. It might be that I lack context, or that the point was it transcends the economy(though looking at it I notice they are released during low points of unemployment, and at regular intervals).

Is there anyone out there with more knowledge and context to help explain what Alone is saying? I want to understand this but the subject matter is complicated. Specifically why is it inevitable for industrial psychiatry to outlast us/ be only the beginning. What does that mean? What does it imply, and what comes after it?

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Is this the "Psychiatry-Ind... (Below threshold)

October 6, 2011 2:00 AM | Posted by JohnJ: | Reply

Is this the "Psychiatry-Industrial complex" Eisenhower tried to warn us about?

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I somehow find it easier to... (Below threshold)

October 6, 2011 7:09 AM | Posted by Chatwin: | Reply

I somehow find it easier to unsee things in italics....

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"And the simple reason why ... (Below threshold)

October 6, 2011 9:20 AM | Posted by Anonymous: | Reply

"And the simple reason why it is so easy to fool psychiatrists with words like "atypical" and "tricyclic" is that most psychiatrists are stupendously ignorant...."

Except you. How nice.

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I'm going into my tenth y... (Below threshold)

October 6, 2011 10:21 AM | Posted by Harry Horton: | Reply

I'm going into my tenth year chronically sick from a risperdal created hyperglycemic condition after losing my health to the drug back in 2001. Just got finished dealing with a sand flea rash from immune dysfunction created by the drug this past late summer. This past March, in South Carolina, 7,000 doctors won a 326 million dollar class action suit against Johnson and Johnson for misleading prescribing information on risperdal. It seems that if the psychiatrists don't have to tell their patients about how they are going to destroy their health with these drugs that they prescribe to their patients, the drug companies, in turn, probably figured out they don't have to tell the doctors about the information on the drugs. That is, what the side effects are, or in other words giving the doctors accurate information on the drugs itself. That is the drug companies don't have to tell the doctors on how such doctors go about wrecking the health of their patients (I guess clients is the more accurate term these days)with the toxic capacities of the drugs the companies produce. After all the profit line is the ruling feature in their business not patient health. In any case the saga continues, since Federal prosecutors have initiated a one billion dollar law suit against Johnson and Johnson involving the TMAP in Texas this past late spring of 2011. And Louisiana finished up with a 376 million dollar fine against J&J over the past year or so with a group physican initiated lawsuit against the company.

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Here is Tim Kendalls email:... (Below threshold)

October 6, 2011 10:35 AM | Posted by John: | Reply

Here is Tim Kendalls email: tim.kendall@cru.rcpsych.ac.uk

I'm forwarding this to him. If he gets back to me, which I doubt, I will post any comments/replies he makes. I urge other readers to do the same, in order to increase chance of reply.

I suppose I do this for the slim chance of seeing a Pirate Doctor and a Doctor from the Royal College of Psychiatrists go at it. My money is on Alone!

To make things easier, this is the template for my email:

Hi Dr. Kendall-

I have found a piece dissecting and condemning your latest article. After reading it I don't know what to think. Could you please give me some feedback or reply on the arguments presented here about your study?

http://thelastpsychiatrist.com/2011/10/the_rise_and_fall_of_atypical.html

A concerned student,

~John

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Antipsychotics don't exist.... (Below threshold)

October 6, 2011 12:00 PM | Posted by Mark p.s.2: | Reply

Antipsychotics don't exist. We can not measure psychosis under a microscope like in an antibiotic. What is psychosis? Were the 9-11 suicide bombers psychotic? Are religious people psychotic? Who has the power to name who is sick?

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Great idea.But my ... (Below threshold)

October 6, 2011 12:17 PM | Posted, in reply to John's comment, by Anonymous: | Reply

Great idea.

But my message couldn't be delivered to that e-mail.

Is it really correct?

Cheers,

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You are right. It is not wo... (Below threshold)

October 6, 2011 12:57 PM | Posted by John: | Reply

You are right. It is not working. The only other thing I could find to contact him was this NCCMH contact site where he is the director:

http://www.nccmh.org.uk/contact.html

It would also help if Alone would start putting these people's emails on TLP. Although I don't know if that would put his anonymity at risk...

Already resent my message through previous link. Hope this one works!

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To October 6th, 1:28 AM, P... (Below threshold)

October 6, 2011 2:25 PM | Posted, in reply to Anonymous's comment, by Perry : | Reply

To October 6th, 1:28 AM, Please give yourself a name. Nice question you ask. I'll take a wild stab at part of it. Here goes.


I don't know pharma from a farm. So the "science" is out. But his "inevitable" statement is compelling, and I have an interpretation of it.

Lonely is suggesting that all these drugs and all these compliant psychiatrists are needed in order to justify the idea that the patients they serve might appear to be able bodied and otherwise capable of functioning in the world, but they aren't because they are "sick."

And, if the patient's problems were seen as "socially generated," many prescribed drugs wouldn't be needed. Others? yes. Counseling and therapy? I'm guessing. But not the kinds of drugs in the article.

Lonely did not say this next, but I'll add a further interpretational twist: By drugging the "patients" al least some of them become defused, meaning less dangerous to the culture. Many of those patients also receive disability payments, food stamps, section eight housing, medical coverage, etc. Some of those people vote, and a preponderance of those vote to keep the system going. As do many others in medicine and pharma and government service because that's how they earn their living. The system builds layers onto itself and then get barnacled in place. That's why, I think, he says change is impossible.

It looks to me like Lonely wants psychiatrists to be allowed to treat patients as they see fit rather than become a ten-patient-per-hour prescription writing machine.

He is seeing a very big picture and interpreting it in a way that exposes powerful people as ultimately becoming users of cruelty in their quest of money and power. That's the narrative that I see being outlined. If this is, in fact, what Lonely is up to, he is one courageous mofo, isn't he. This makes a lot of people who give off know-it-all airs as dark and manipulative.

The problem isn't the patient. The problem is the system.

How's that?

If you read this far, thanks.

As I say, that's my interpretation of his interpretation and I can't spell d-r-u-g.

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@Perry, In my opinion you n... (Below threshold)

October 6, 2011 10:44 PM | Posted by Marcus: | Reply

@Perry, In my opinion you nailed it. And with some nice style of your own :)

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I use generic names because... (Below threshold)

October 6, 2011 11:20 PM | Posted by Adam: | Reply

I use generic names because that's what I learned in school (nb I went to pharmacy school). To me, using brand names only, and not being able to recognize drugs by their generic names is a sign of having only learned about various drugs from industry sponsored talks and presentations and not from a textbook, or looked it up in a reference, or, well, done anything but prescribe it as per. If ramipril has been generic for a long time, why are people still saying altace? Nobody dispenses it. And if the original patent manufacturer invented both the "generic" name and the brand name, why do they go to the effort of inventing both? You'd think the better game would be to invent only the brand name and have the manufacturer name intimately associated with that. I can't tell you who first made ramipril, or valproic acid. You'd think the companies who made them would want me to know that. "Oh, yeah, company x, they made ramipril, I trust their next product will be amazing."

Further; this has made me think about the distinction between atypical and typical antipsychotics. I had typically differentiated them by side effects. Typicals = EPS; atypicals = diabetes. It rather makes sense that atypicals would have a lesser affinity for the dopamine receptor (EPS being caused by dopamine blockade). Is there really a more meaningful distinction than that? But then, you have every doc under the sun prescribing quetiapine for behavioural issues in dementia, even though every other "antipsychotic" has better evidence to support its use. One in particular when to a geriatrics conference and fancied herself a geriatrician; afterwards, every patient - and I mean every - had quetiapine 12.5 mg (or more) qhs ordered, and it was unusual to see otherwise. Almost certainly not the drug company's fault. But in a year or two, it will be Seroquel XR for behavioural issues in dementia, and whose fault will that be? I doubt the drug company will apply for approval due to increased mortality. But where does it come from? "Thought leaders"? The idea that a 24 hour dosing inteveral is necessary for treating sundowning? If so, those idiotic "thought leaders" need to be fired.

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Graph suggests drug inventi... (Below threshold)

October 6, 2011 11:50 PM | Posted by Anonymous: | Reply

Graph suggests drug inventions correlate with social problems - recessions comming or being in full swing.

I wholely disagree with this graph, because it is assinine to argue that the release of a drug can perfectly coincide with social/ market trends (react to them, much like a psychiatrist reacts to his client's stability). This is because the process to get a drug from imagination/lab to hand /stomach takes years and years of red tape and trials. It would be impossible to perfectly predict , and respond, with a new drug at every major crisis point in society.

Fortunately I do not think TLP meant this graph to be literal, but it was intended to be figurative; ironically it almost SEEMS that way and it drives the point home to show the release dates of various classes of drugs juxtaposed over the economy highs and lows.

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Yea, you have never worked ... (Below threshold)

October 6, 2011 11:53 PM | Posted, in reply to Mark p.s.2's comment, by Anonymous: | Reply

Yea, you have never worked in health care.

Psychosis is obvious when you see it.

Saying it does not exist does not mean it's true. Psychosis is real, and it must be nice to be healthy, with healthy family members, who do not have psychosis, but there are real people out there who start ranting, becoming paranoid and hostile, and stop sleeping and those people are psychotic.

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Psychiatrists are always wh... (Below threshold)

October 7, 2011 12:05 AM | Posted by Anonymous: | Reply

Psychiatrists are always whining that they have no choice but to prescribe abilify and serqoeul to bored house wives, and that drugs should be reserved for the truly ill, etc.

Hey, psychiatrists, YOU are the ones responsible for your field being the way it is. When someone comes into your office, obviously not severely psychiatrically unstable, obviously suffering from a social/situational problem, YOU ARE THE ONE who chooses to call it depression and write a prescription for zoloft/xanax, rather thant tell this person "lady you are healthy but you need to stop being so self centered and bored". You do this because you want the $$$ for writing the prescriptions and following up with her care. YOU make the choice to label the healthy as ill.


I've gone to shrinks, not one of them, not a single one, told me I was healthy (fact: I am healthy). THey were all ready to label me with something, psychosis and/or mania, and charge me / my insurance for the service of drugging me. Even the one who told me he thought I didn't need drugs, still wanted to give me drugs, come back for a follow up vi$it. In spite of the fact his "medical opinion" was that I did not need medicine, he expected me to take them for some reason. What a fucking idiot.

It's pretty ironic when a psychiatrist bitches and moans about how psych meds are being used to control non-psychiatric problems, meanwhile it's the individual practicing psychiatrist who is ultimately responsible for this epidemic. They CHOOSE to have a revolving door practice of non-mentally ill clients because this is where the $$$$ is. There aren't enough real schizophrenics/manics/severe depressives, and the ones out there do not have any money , because being a schizophrenic or a manic greatly impairs your ability to get a job with a good insurance company.

So, next on the docket, we will find that suddenly seroquel cures isolated bored housewifery and a diet of doritos chips + pepsi cola and staying up on facebook until 2 in the morning, i.e. general mental malaise common in a western lifestyle due to living like shit and fucking your brain up.

Because these are the people who have the money to purchase the drugs the psychiatrist gets paid to learn to prescribe.

If, tomorrow, every psychiatrist said " ya know what, I 'm gonna stop labeling healthy people with serius mental illnesses, and I'm also going to stop prescribing them medications" this problem would instantly stop.

If you want to know why things are the way they are, look in the mirror. Your job is only to help the psychiatrically unstable be less unstable. That is it.
iIt is not to resolve social ailments, and it certainly isn't to exploit the insurance companies who have clients which are unhappy due to ordinary non-psychiatric maladies. Problem is 100% of psychiatrists are in the "exploiting insurance companies" boat, and so, seroquel in the drinking water.

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re: you have never worked i... (Below threshold)

October 7, 2011 9:07 AM | Posted, in reply to Anonymous's comment, by Mark p.s.2: | Reply

re: you have never worked in health care.
I had a diagnosis of paranoid schizophrenia at age 19, I am now 43 and I am unmedicated/undrugged.

Saying psychosis exists, does not mean it's true.

"people out there who start ranting, becoming paranoid and hostile, and stop sleeping and those people are psychotic."
This behavior comes from too much stress.

Psychiatrists are giving (or forcing) people tranquilizers, drugs, not antipsychotics, not medicines.

You say "antipsychotics" instead of tranquilizer to ease your conscious when taking away a persons freedom. To make it appear what you are doing is medical.

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Anonymous 12:05- you make a... (Below threshold)

October 7, 2011 9:10 AM | Posted by Anon67: | Reply

Anonymous 12:05- you make a good point that each person in the system plays a role. There are however legal issues involved. If a client comes in a mentions anything tht fits anywhere into a potential condition that could be treated medically on the books, the system expects the doc to give a med. Failing to treat a condition with the accepted treatment is malpractice.

In the DSM and the psychiatry texts the conditions are designed to match the drugs. Meaning that the symptoms that any given drug could potentially treat are conveniently grouped together to fit what that drug does and then given a label based on what kind of drug treatment might change the symptoms.

The books are written for the pharmacology-- the accepted treatment is the pharmacology-- every symptom under the sun fits within the medical model and if you are practicing psychiatry you are expected to do the best that the system has taught you to do with your degree-- which is to treat every condition under the sun with the med that matches it.

If you have been listenced for this work, failing to do what the intent of psychiatry is means you are in fact not fulfilling your own licensure. The only option really is to say "I disagree with some of your tenant psychiatry so I'm leaving!"

At what point are you allowed to do this? how many thousands of dollars of student loan debt do you have for you degree to give treatments that not all of which you agree with will? How do you pay of such a debt if you just say "Well skrew ya'll I'm working at the burger joint and I'll have none of this unethical mess!"

Most people say "I'll stick with the system and try to change it from within."

Meanwhile the same system slowly degrades you and watch miserable people come and go and you become numb to the procedure of handing them pills and seems to make them feel better to recieve something you call "treatment" and you start thinking, well maybe this is really helping. There are those studies that DO say it helps some, so maybe this is really working. You still think "well I'm skeptical of big pharma" but you let yourself slide into a comfortable, well this mostly helps.

And then you aren't trying to change the system from within, you're in fact EXACTLY what the system wants (the system being any set of people happy with the status quo). A person who remembers the ideas of the rebellion and knows exactly how to sooth and quell them.

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"If a client comes in a men... (Below threshold)

October 7, 2011 2:07 PM | Posted, in reply to Anon67's comment, by Anonymous: | Reply

"If a client comes in a mentions anything tht fits anywhere into a potential condition that could be treated medically on the books, the system expects the doc to give a med. Failing to treat a condition with the accepted treatment is malpractice."

If I go to a shrink now, I'll "fit anywhere into a potential condition that could be treated medically on the books".

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Have you ever thought about... (Below threshold)

October 8, 2011 5:10 PM | Posted by Genee: | Reply

Have you ever thought about podcasting your posts? I'd love to listen to them!

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Alone doesn't have a clinic... (Below threshold)

October 11, 2011 4:57 AM | Posted, in reply to Anonymous's comment, by Rhizome: | Reply

Alone doesn't have a clinical practice as far as we know. This means he doesn't face the pressure of real cases every week, having to do something -- anything -- about it, even if it's for placebo/nocebo/slap in the face. Dude keeps bringing up he does forensic work, so he probably has an academic chair somewhere -- how does he get access to journal repositories elsehow?

Medicine is hard, as is stock picking. Alone is talking not about being dr. McCoy but about marketing and science; practicing MDs fall by the wayside, because they're not a class of supersmart people -- they'll inevitably be as good at their jobs as you and me.

Tell me (if you're not in academe anyway) that you're constantly at the top of your field and apply the state-of-the-art on a consistent basis, in institutional environments that resent change, learning more stuff -- damnit, they've already suffered through college -- constantly yadda yadda yadda. I know I'm not. I know sometimes I'm lazy and quote Lucas (1987) and go enjoy the good surfing weather.

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Let's all protect our egos.... (Below threshold)

October 11, 2011 10:08 AM | Posted by Rookie: | Reply

Let's all protect our egos. Let's go a step further, and protect, then augment our own egos.

I'm hard on myself and I see my own failings so obviously it hurts. I smell my own bullshit a mile off, and even if I persist in it, I feel bad about that and have a bad day. That means that when I try to excuse a fuckup, or failure to myself, it doesn't work and I have a bad day. It's not a nice feeling.

God I'm glad... that's not to say I don't fuck up. I fuck up. Speaking of which it's kinda late and I gotta go to bed. Work in the morning...

Oh... damn... there it is...

Good.

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I was diagnosed with bipola... (Below threshold)

October 13, 2011 12:50 PM | Posted by Andrea: | Reply

I was diagnosed with bipolar 1 disorder 21 years ago, when I was 19. Now I am 41. I was first treated with lithium and then cocktails became popular, so my doctors prescribed all kinds of medications. I have taken Depakote, Seroquel, risperdal, perphenazine, Saphris, Ativan, Nuerontin, trazadone, Restoril, Ambien, and possibly other medications over the years. I have taken lithium most of the time and now I take 1800 mg. lithium and 200 mg. Lamictal, and that is it. I told my psychiatrist that I feel the best with the least possible medication and know how to prevent psychosis without antipsychotics by reducing stress, eating a balanced diet, and getting enough sleep and exercise. I haven't become psychotic since quitting my last antipsychotic. I think that antipsychotics are overprescribed--possibly even for people with schizophrenia. I had a lot of unpleasant side effects while taking antipsychotics. The worst were extreme sedation, lactation, and a huge amount of weight gain.

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Tricyclics and SNRI's are n... (Below threshold)

October 16, 2011 8:05 AM | Posted by Daryl: | Reply

Tricyclics and SNRI's are not the same thing, and I certainly wouldnt use google to make my point!
atypicals are 'better' then typicals, it just depends what your measuring. Maybe not better for positive symptoms, but they are better for negative symptoms and reduced risk of TD and EPSEs.

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Inevitable — not just becau... (Below threshold)

October 17, 2011 12:00 PM | Posted by SLH: | Reply

Inevitable — not just because it's a juggernaut like the military-industrial, prison-industrial, agroindustrial complexes which alter the public sector like tumors that stimulate the growth of new blood vessels to support themselves. Inevitable because our society is plum out of other ideas for dealing with / avoiding dealing with social problems and choosing to give the money we used to use to paper over the problems to Warren Buffet & Halliburton.

Psychiatry's greatest fraud wasn't depakote, it's "treat[ing] all patients as having exclusively organic diseases and not socially generated problems" and treating anyone who attracts the system's attention as being a psychiatric patient.

No obvious correlation jumps out from that last chart. Perhaps the point is that, what ever happens, there will always be a steady beat of semiotic repackaging of the chemical suppressant?

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What about the side effect ... (Below threshold)

October 27, 2011 4:41 PM | Posted by Stutteringmedication: | Reply

What about the side effect profile of the new AAP's? With the new ones there is pretty much zero weight gain, and very little risk for EPS. They are getting better and better every day. I wouldn't take a pill of haladol if someone put a gun to my head.

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1. recycling rd laing does... (Below threshold)

November 13, 2011 3:16 PM | Posted by jk: | Reply

1. recycling rd laing doesn't make it true. i always thought laing's stuff applied much more to certain personality disorders than true psychosis.

2. i prescribed plenty of depakote and found it quite useful for bipolar disorders. i cut way back when i became convinced of the hormonal problems [polycystic ovarian syndrome] in young females, and the weight gain problem across the board. i think lithium remains tremendously underutilized, usually in combination with other agents. it's a rare patient who will respond to lithium as monotherapy.

3. i got interested in bipolar disorders in 1995, before it was chic- at least in my neighborhood. i wrote my first rx for lamictal for bipolar depression in '96. [just to establish my bona fides here.]

4. have you ever seen anyone with REALLY BAD td? it's impressive in a very disturbing way, and makes attractive anything you think might lower the risk.

5. don't let our limited abilities to help our patients drive you to therapeutic nihilism.

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I'm not aware of any new at... (Below threshold)

December 3, 2011 2:44 PM | Posted by Joanna: | Reply

I'm not aware of any new atypical antipsychotics which cause no weight gain, and this a major effect which is deeply distressing to service users. What disturbs me is that many psychiatrists treat this as though it's irrelevant trotting out 'the benefits outweigh the cost', as though gaining 4 stone is a mere trifle compared to feeling less anxiety in response to differences in perception.
The RCP will speak of how service users life expectancy are shorter than the rest of the population but how medication plays a part in this is conveniently never mentioned:
http://www.rcpsych.ac.uk/press/pressreleases2011/lifeexpectancy.aspx
I don't see how massive weight gain, diabetes, and the same mind numbing effects are any better than typicals. So there's less incidence of TD, I still think it should be down to the service user to decide whether the cost of any drug is tenable for them.
Benzodiazepines can be just as effective at reducing anxiety in response to differences in perception but hell no we must not use them because of dependence/withdrawal issues - some people have found withdrawal from antipsychotics just as gruelling.
What really gets to me is that I've rarely met anyone for whom medication removed their voices/paranoia, so all the effects for - less anxiety. It's hard to imagine drugs with such serious effects but not even removing the complaint being acceptable in any other area of medicine.
I like to imagine psychiatrists being restricted from prescribing medication and how they would then respond - some would flourish, others would hit the deck - but that would still require a very different political and social structure.
Capitalism ensures the pharmaceutical dominance and positions of people defined as mentally ill [or those unable to fit traditional structures] will continue for the rest our lives

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Good, I agree with your poi... (Below threshold)

January 8, 2012 10:39 PM | Posted by peuterey jacken: | Reply

Good, I agree with your point of view, thanks for your sharing!I think i am very close to your imagination. caiyifang/comment201201

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is there a way to ask quest... (Below threshold)

January 22, 2012 1:01 PM | Posted by andy : | Reply

is there a way to ask questions of the psychiatrist who created this blog? thanks andy

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was wondering what atypical... (Below threshold)

February 18, 2012 7:58 PM | Posted, in reply to Stutteringmedication's comment, by andy: | Reply

was wondering what atypical antipsychotics you mentioned that cause very little weight gain-- also am not familiar with the abbreviation EPS thanks andy

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I tried to look it up for y... (Below threshold)

February 18, 2012 8:41 PM | Posted, in reply to andy's comment, by ginnygeneva@gmail.com: | Reply

I tried to look it up for you, in case nobody else answers your post. But I'm a patient, not a professional. And I did not try too hard--I spent about five minutes on the computer. If you don't have a psychiatrist prescribing for you, you might consider getting one (I don't understand why your psychiatrist has not already answered your question for you ---you *can* get good help from others but I like psychiatrists best because I got better faster when I got one). Anyway, you could ask your psychiatrist about Latuda, it is an anti-psychotic. Or you could ask about medications that are not anti-psychotics but that have sometimes been used in addition to them for patients who are having significant weight gain. I've read that sometimes Topamax or Metformin are used but I have NOT looked at how safe or effective they are in this particular situation. Just that some doctors prescribe them, which is not what I call a ringing endorsement. And since you are concerned about weight gain, ask about what kind of exercise program might be best for you too.

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EPS= Extrapyramidal Symptom... (Below threshold)

February 18, 2012 8:50 PM | Posted by ginnygeneva@gmail.com: | Reply

EPS= Extrapyramidal Symptoms, or maybe Extrapyramidal System. That basically means a particular kind of potential side effect from taking anti-psychotic medications.

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