This sounds like a weird question – everyone knows that psychosis is often very disabling, and antipsychotic drugs are widely recognized for their effects in reducing psychosis in at least most people, and most often taking effect in just a few days. And when people become psychotic again, it’s often understood that it’s because they “weren’t taking their meds.”
But what if it’s trickier than that? What if “antipsychotic” drugs make things better in the short term, but make long term problems worse? How would we even know?
In a recent letter to the Psychiatric Times, psychiatrist Sandy Steingard outlined some of the ways we can know that there definitely is a problem with the long term use of antipsychotics. (Note that while she addressed a limited number of studies, that’s just because there actually are very few studies which look at really long term outcomes.)
She started her letter by writing about the Wunderink study, which found dramatically higher rates of recovery among the group that had been randomly selected 7 years earlier to receive a trial in getting off antipsychotic drugs, compared to those maintained on the drugs as usual.
It should be stated that the results of the Wunderink study are not perfectly clear in all respects. For example, of the members of the group that guided discontinuation of the drugs, most had resumed taking at least some drugs over time, though the dosages on average were much smaller than those of the “treatment as usual” group. So some have argued that the positive effects might have come from lower than average doses, and they argue that the study should not be taken to indicate that any use of drugs is detrimental long term.
But Sandy brought up more evidence, and the case against long term use of antipsychotics became more convincing as she continued. [click to continue…]