On 16 March 2008 the daily newspaper for Eugene, Oregon, USA -- The Register-Guard -- published a guest commentary from mental health worker Chuck Areford highly critical of neuroleptic psychiatric drugs, also known as antipsychotics. On 25 March 2008 The Register-Guard printed this rebuttal by an Oregon psychiatrist.

Antipsychotic meds have proven role

Date Published: 2008-03-25 00:00

Author: Richard Staggenborg, MD

Source: The Register-Guard, Eugene, Oregon, USA

To read the Guest Commentary by Chuck Areford that led to the below response click here:

http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/areford-neuroelptics

To read the original of the below article in The Register-Guard web site (after a period of time registration is required) click here:

http://www.registerguard.com/csp/cms/sites/dt.cms.support.viewStory.cls?cid=83217&sid=5&fid=1

Commentary  - Guest Viewpoint

In a March 16 guest viewpoint, “Antipsychotic drugs are doing harm,” Chuck Areford makes some highly debatable, if not flatly false, assertions about the risks vs. benefits of antipsychotic medications.

Of equal concern, he only perfunctorily acknowledges the risks of discontinuing these meds without medical supervision before going on to argue essentially that they should never be prescribed.

His entire thesis undermines the credibility of the doctors under whose supervision he states patients should adjust their medication. The effect is to encourage them instead to make decisions to stop their medications on their own or on the advice of well-meaning but misinformed nonmedical “experts” such as himself.

Areford asserts that “the life expectancy of those treated in mental health centers has plunged to an appalling 25 years less than average (since the introduction of atypical antipsychotics).” I challenge him to explain how he came up with this statistic.

Rispiridone, the oldest antipsychotic in widespread use, was not introduced until 1993. Clearly, this remarkable claim is based on extrapolation from highly questionable assumptions.

It is indisputably true that some of these medications have substantial risks of metabolic side effects, such as high cholesterol and increased risk of diabetes. But others have not been clearly linked to these problems, despite the mandatory Food and Drug Administration class warnings that all atypicals share.

These risks have to be balanced against the devastating consequences of schizophrenia and bipolar disorder, the illnesses for which they are most clearly indicated. One of these risks is a substantially increased chance of suicide in untreated mania, bipolar depression or schizophrenia. Treatment of these conditions has been shown to reduce suicidality and therefore would be expected to increase life expectancy.

For other indications, the risk-benefit analysis is not always so clear cut. For this reason, I would agree that aggressive marketing of these agents to primary care providers for routine depression and bipolar disorders is unethical, although some of my colleagues would disagree.

Many in the psychiatric community also share the alarm of the general pubic at the tremendous increase in the diagnosis of bipolar disorder, depression and attention deficit hyperactivity disorder in children and believe that there is a tendency to reach too quickly for medications to treat what may be psychological problems or simply variants of normal behavior.

It is also true that research findings are highly skewed by pharmaceutical industry funding, despite some improvements due to newer requirements to report negative results as well as those demonstrating positive drug effects. However, this is only one of many reasons that medications are overused in general in psychiatry.

The most important causes of overreliance on psychoactive medications are lack of training and time, or the inclination to evaluate and address psychological factors in psychiatric conditions. When the psychiatrist’s only tool is drugs, everything looks like a disease. This bias toward the medical model is becoming increasingly problematic as our understanding of the brain increases, creating the illusion that we know what causes these illnesses and why our treatments work.

In reality, we have only tantalizing hints of the biological basis of most mental illness, and the reasons medications work are largely speculative. Furthermore, we do not even agree on what constitutes mental “illness.”

This does not stop the lay public from looking to these medications for answers to life’s problems, adding to the pressure for a quick fix. Often, the patient’s first treatment should be with a therapist, and competent psychiatrists will be quick to refer if they do not practice psychotherapy.

The other egregiously false assertion in Areford’s essay is that “people suffering psychosis recover more quickly and completely without medication.” He apparently expects us to accept his astounding assertion that “one study showed that those not taking medications had eight times the recovery rate (whatever that means) of those who remained medicated” without giving any details of the study itself, and despite a vast literature of studies showing precisely the opposite. This includes studies sponsored by the National Institutes for Mental Health, rather than drug companies.

The reality is that for serious mental illnesses, antipsychotics have a clear role that is evident to anyone who looks at the evidence with an impartial eye. Contrary to Areford’s assertion, untreated recurrent psychosis is known to correlate with deterioration over time, and antipsychotics have been demonstrated conclusively to reduce the risk of recurrence.

These are facts, not speculation based on animal and questionable human studies that purport to demonstrate clinically significant “brain damage,” without offering rigorous clinical correlation. In other words, we psychiatrists don’t just “believe” we are doing the right thing in using atypical antipsychotics, we can justify our position with sound clinical research.

The patient with serious mental illness is ill-served when led to believe otherwise.

###

Dr. Richard Staggenborg, a board certified psychiatrist working for the Department of Veterans Affairs in Bandon, is the former medical director of Coos County Mental Health.

- end -