Setting the Record Straight on Antipsychotics

My first experience with antipsychotic medication was in the early 1960s, shortly after they were introduced. As is usual with new treatments, benefits were appreciated before harms were realized. Delusions and hallucinations improved, but patients developed many very unpleasant side effects- a strange fixed stare, muscle rigidity, uncontrollable movements, agitation, sedation, and lots of others.

I and others hoped that “expectant treatment” with antipsychotics could provide patients with benefits, while minimizing harms. The idea was to reduce the lifetime burden of side effects by limiting meds to episodes of relapse. Medication would gradually be tapered once the patient was stabilized, to be restarted promptly only if, and when, symptoms later returned.

I led one of the research teams doing controlled studies of expectant treatment. About one-third of patients taken off meds did fine, but two thirds had relapses, sometimes terrible ones- while the group kept on antipsychotics had only half their rate of relapse. I learned the painful lesson that, for people with severe and chronic mental illness, going off meds is a risky gamble, one that is usually not worth taking. This was confirmed by hundreds of clinical experiences working in emergency rooms and hospitals. By far the most common cause of psychotic relapse is going off antipsychotic medicine.

In the 1990s, a new generation of antipsychotics was introduced that initially showed great promise. The new meds were no more effective than the old. But they were much better tolerated because they usually didn’t cause the muscle rigidity or agitated restlessness that had made patients feel so uncomfortable and look so strange .

The honeymoon didn’t last long. Too often, the new meds caused massive weight gain, increasing the risks of diabetes, cardiovascular disease, and shortened life expectancy. And because their side effect profile was less overt, the new —> Read More