The medical and mental health community speak out about the dangers of “antipsychotic” drugs and proven, non-drug alternatives

The medical and mental health community speak out about the dangers of “antipsychotic” drugs and proven, non-drug alternatives

A couple of decades ago, big pharma promised to revolutionize the treatment of serious mental health concerns with a new class of atypical antipsychotic drugs such as Abilify and Seroquel. In terms of financial success, those two drugs were “revolutionary.” They are now the 5th and 6th most commonly prescribed drugs in America — despite mounting evidence that questions the efficacy and safety of these drugs (e.g. the huge CATIE and CUtLASS trials). Prominent members of the psychological and psychiatric communities are sounding the alarm about the overuse of these drugs and the erosion of other forms of treatment, particularly evidence-based psychosocial approaches.

In a recent article in the New York Times, Richard Friedman, M.D., expresses concern over increasing use of these drugs for unproven conditions, calling the use of “antipsychotic” drugs to treat everything from anxiety to insomnia as “unbelievable.” Studies on the use of antipsychotics to treat anxiety have failed to show that they are effective and there is no FDA approval for any atypical antipsychotic for the treatment of any anxiety disorder. Despite this lack of evidence, a recent study showed that prescribing of antipsychotics by psychiatrists for anxiety almost doubled between 1996 and 2007.  In this study, 21% of individuals who sought treatment from a psychiatrist for an anxiety disorder in 2007 were prescribed an antipsychotic drug versus  11% in 1996. Moreover, as Dr. Friedman points out, antipsychotics, including  newer “atypical” drugs, frequently have serious side effects such as increased blood lipids and cholesterol, irreversible movement disorders, and weight gain. If these statistics are correct, there are hundreds of thousands of people in the US alone who are taking antipsychotic medications for conditions they have been shown to not work with and suffering under the serious side effects of these medications.

Dr. Friedman is not alone in sounding the alarm. Just this year, the editor of the British Journal of Psychiatry (BJP), probably the most influential psychiatry journal in Britain, called for an “end to the psychopharmacological revolution.” In this piece in BJP, he stated that the prescription of antipsychotic medications needs to be drastically reduced. He stated that the side effects of antipsychotic drugs are too extreme to justify their limited benefit, even in the treatment of schizophrenia and bipolar disorder, for which there exists the largest evidence base supporting the use of these drugs. He stressed that non-drug therapies, such as cognitive behavioral therapy, are proven, effective, and affordable alternatives that need to be used much more frequently. This statement comes from someone who is a prominent member of the medical and psychiatric communities, where drug treatments are usually preferred over psychosocial interventions.

Psychological treatments for schizophrenia, anxiety, and other mental health conditions continue to advance and are becoming more readily available. Based on the current state of the evidence on the use of antipsychotics and the rapidly growing evidence for the use of psychological versus pharmacological treatments, consumers of mental health services need to understand that there are effective alternatives to medications. While it is our opinion that there can be a role for medication in the treatment of mental health difficulties, we want consumers to be informed about the limited effectiveness of antipsychotics, the large potential downsides of using this kind of medication, and the availability of effective psychological treatments. Big pharma is not going to send this message, and people need to be able to make informed choices about their mental health care.

Many in the scientific community are sounding the alarm about the rapidly growing use of antipsychotic medications. But is that alarm loud enough to be heard above the incredibly well-funded big pharma marketing campaigns? We hope so.

Do Antipsychotics Help With PTSD? A New VA Study Says, “No”

Do Antipsychotics Help With PTSD? A New VA Study Says, “No”

This may be just my limited, subjective impression, but I’ve noticed lately more and more clients who’ve been prescribed antipsychotic medications for reasons other than psychosis—sleep   problems, rumination, or suicidal ideation, for example. I’m not anti-med, but given the documented side effects of antipsychotics—weight gain, diabetes, and motor control problems—I think we should be cautious in how these meds are used.

When a recent New York Times article came across my desk that suggested a commonly prescribed antipsychotic, risperidone, may not be very useful in the treatment of PTSD, I was intrigued. Being a dutiful scientist, I tracked down the original article in the Journal of the American Medical Association.

What Did the Study Look At?

In this study, patients were recruited from multiple Veterans Affairs Hospitals across the country. Veterans with PTSD who had not responded to at least two trials of antidepressants were recruited. The 296 participants were randomly assigned to receive either risperidone or a placebo for 6 months. The vast majority of the veterans were Vietnam era and male (96.6%). Nearly three-fourths had also received outpatient mental health services in the preceding month.

The results: There were no difference between antipsychotic medication and placebo

At the end of 6 months, there was no difference between veterans who received risperidone and those who received placebo on PTSD symptoms or anything else that was measured, including depression, anxiety, and quality of life. I will note that contrary to my concern about the potential dangers of antipsychotics, the researchers didn’t find any notable adverse effects of risperidone—at least within the 6-month trial. Given that most of these veterans are Vietnam era and older, it’s very sad that no treatment has been very successful in addressing their PTSD.

Antipsychotics May Not Be an Effective Treatment for PTSD

According to this study, antipsychotics don’t appear to contribute to improvements in PTSD—at least for veterans with whom antidepressants didn’t work. Knowing what doesn’t work can be as important as knowing what does work. It was also heartening to see that, despite listing multiple ties to various pharmaceutical companies, the two main authors of this study let the data speak for itself. Too often, I read about researchers receiving pharmaceutical money massaging data to look more favorably for the meds they’re studying. The authors here seemed very conscientious in how they interpreted the data.

In the same issue of JAMA, Dr. Charles Hoge offers a commentary on treating veterans with PTSD. He supports the use of psychotherapy, antidepressants, and the hypertensive medication prazosin, and warns against the use of antipsychotics and benzodiazepines.

Off label use of antipsychotics seems to be a growing trend. A study that came out last month found that antipsychotic prescriptions for anxiety disorders more than doubled in 10 years—even though there’s no published data suggesting antipsychotics are an effective treatment for anxiety! This trend is worth keeping an eye on.

UPCOMING TRAINING EVENTS

January 31, 2020, 8:30 am – 4:30 pm · Portland, OR · Details

This workshop is intended to be part 1 of a two day workshop, but can also be taken on its own. This workshop is useful for therapists who want an update on the current clinically applicable research on how shame functions, including an overview of how and when shame tends to be adaptive versus maladaptive. This day has two primary goals: 1. To provide an overview of research on shame and self-criticism that can guide clinical practice and 2. To allow therapists to experience the model from the inside-out so as to develop greater personal self-compassion and a deeper intuitive understanding of compassion-based intervention strategies. Read more

February 1, 2020, 8:30 am – 4:30 pm · Portland, OR · Details

This workshop is intended to be part 2 of a two day workshop, but can also be taken on its own. If you already have a thorough understanding of the functions of shame and a good understanding of Acceptance and Commitment Therapy, then it is you will probably be OK taking just the second day of this workshop. The workshop proceeds to discuss how ACT processes can be focused on addressing chronic and pervasive shame-based difficulties, with a particular focus on flexible perspective taking. Demonstrations of how to use perspective taking and compassion-fostering strategies with clients will be provided and attendees will also practice in small groups. An overview of chair work in the context of ACT will be provided. Read more

February 29, 2020, 9:00 am – 12:15 pm · Portland, OR · Details

Exposure is one of most the effective treatments for anxiety, trauma, and obsessive compulsive and related disorders (e.g., OCD, PTSD, panic disorder). A transdiagnostic intervention, exposure involves the repeated and systematic engagement with avoided stimuli that cause anxiety. Unfortunately, exposure remains underutilized by clinicians (e.g., Scherr, Herbert, & Forman, 2015), mostly due to misunderstandings of how exposure works and perceived difficulty of using it with clients. This half-day workshop will address these gaps by drawing from research on enhancing clinician understanding of and ways to overcome barriers to delivering exposure therapy (Farrell et al., 2016). Using didactics, role-play, and experiential exercises, participants will learn flexible application of exposure for a variety of clinical targets. Read more

April 17 and 18, 2020, 9:15 am – 5:00 pm · Portland, OR · Details

Do you ever “get stuck” as a therapist? Do some of your clients press your “hot buttons”? Do you ever find yourself struggling and thinking about “what do I do next” or feeling anxious, scared or stressed in therapy? In this workshop we will work on clarifying your therapist values and defining what is “difficult” about “difficult” clients. Through discussions, demonstrations and roleplays we will then work on these difficult clients and look at the processes from a compassionate ACT perspective. Read more