When a young person or the family of a young person just diagnosed with psychosis is considering whether or not to try antipsychotic drugs, it makes sense they might want to know the results of randomized controlled trials of these drugs compared to placebo in people who have never taken the drugs.
It would be important to see this comparison with placebo in people who have never taken the drugs, since placebo could be expected to work more poorly in people undergoing drug withdrawal.
So what can we tell people about such trials?
According to a recent systematic review, what we can say is that…..well, that we don’t actually have any good studies of this nature! The reviewers found just one study that met this criteria, but it was a flawed study done in China, with ambiguous results.
This means that the push to get young people diagnosed with psychosis on antipsychotic drugs has no basis in science.
That is, there are lots of studies with no placebo comparison at all, and there are lots of studies of people already on antipsychotics that compare something like taking a new antipsychotic with getting placebo while withdrawing from previously taken drugs, but no good studies comparing drugs to placebo for people diagnosed with psychosis who have never before taken antipsychotics.
If we take the concept of “informed consent” seriously, then it seems this is something we have to disclose.
And if we disclose this, then we might find ourselves also pushed to offer treatment alternatives, since many people will not choose a drug known to have substantial risks when that drug has never been shown to outperform placebo for people with their condition.
The review article is “Benefits and harms of antipsychotic drugs in drug-naïve patients with psychosis: A systematic review” which is available in full at https://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs195063