Do Antipsychotics Help or Harm Psychotic Symptoms?

This is the latest, and perhaps last, of several debates with Bob Whitaker on the role of antipsychotics in treating psychotic symptoms. It was triggered by a recent email exchange that clarified our areas of agreement and disagreement. Bob’s blog summarizing his views and how he arrived at them can be found here.

Bob and I agree strongly on the following:

1) Antipsychotic medicines are used far too often in people who don’t need them.

2) Even when necessary, doses are often too high and polypharmacy too common.

3) Antipsychotics are neither all good, nor all bad. Used selectively, they are necessary and helpful. They are harmful when used carelessly and excessively.

4) The treatment of people with psychosis relies far too much on medication alone, far too little on social engagement, psychotherapy, vocational rehabilitation, and providing adequate housing. We both like the normalizing, recovery models offered by Trieste, Open Dialogue, and Hearing Voices.

5) The care provided for the mentally ill in the U.S. is a disaster that shames our country.

Bob and I disagree strongly on the following:

1) Bob believes that long term use of antipsychotics makes psychotic symptoms worse. He therefore recommends that patients try to avoid antipsychotic medicine altogether or taper off them, whenever possible.

2) Bob believes that psychotic symptoms return when meds are stopped because of medication withdrawal, not relapse of the original disorder that first led to the use of antipsychotics.
3) Bob’s views and biases have been shaped by his training as an investigative journalist and his experiences with fairly healthy people who have been harmed by too much medication. My views and biases have been shaped by my training as a clinical and research psychiatrist. Like Bob, I have seen many people harmed —> Read More