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
I am very interested in this and I am glad to find your post on the subject.
As I understand it most, if not all, of the drugs used have very difficult side effects including significant weight gain in many cases. In the current time, May 2020, COVID19 is killing thousands of people around the world. Obesity and diabetes appear to make people particularly vulnerable to severe or fatal illness with this virus.
Given other factors putting individuals with a diagnosis of psychosis at risk, for example their living arrangements or care needs, I believe this side effect should be viewed as potentially life threatening, in current circumstances.
Given fact you state that “there is no basis in science” for advocating the positive effects of these drugs the Hippocratic Oath to “do no harm” seems especially pertinent.
That’s a good point, that antipsychotics could indirectly increase risk from Covid 19.
By the way, a lot of psychiatrists these days are arguing that antipsychotics are actually likely to reduce the fatality rate for people diagnosed with schizophrenia. A critical analysis of the evidence pro and con about that is at https://www.madinamerica.com/2020/05/do-antipsychotics-protect-against-early-death-a-review-of-the-evidence/
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