Is the juice worth the squeeze? Reassessing the use of antipsychotics taking into account the evidence of the effects of long-term use

Journal title RIVISTA SPERIMENTALE DI FRENIATRIA
Author/s Giuseppe Tibaldi
Publishing Year 2016 Issue 2016/2 Language Italian
Pages 21 P. 43-63 File size 223 KB
DOI 10.3280/RSF2016-002004
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Short-term efficacy of antipsychotics is known and agreed upon, while, from the 60’s onwards, medium and long-term benefits have been questioned. Recent studies - which compare samples of patients undergoing continuous treatment with patients on reduced, or suspended, antipsychotic medications - highlight that strategies of reduced or suspended antipsychotic medications present significantly higher long-term recovery rates. Recovery consists in regaining high levels of social functioning. Furthermore, there is growing evidence on specific risks caused by antipsychotic treatments: i.e. cognitive decline and mortality. With antidepressants equally alarming evidence has emerged regarding medium and long-term effects. These evidences, little known among Italian mental health professionals, should bring about a reduction in the role played by psychiatric drugs, currently the primary - and often the only - therapeutic offer at onset, or during the subsequent phases of the illness. Nowadays, other therapeutic (or rehabilitative) proposals play a lesser, or subservient role, usually offered later on in the treatment program. Persons who have experienced a psychotic episode and play an active role as "experts by experience" request strongly the use of non-pharmacological interventions, based on the comprehension of the psychotic or depressive experiences, and on shared decision making ("nothing about us without us"). The movements of "experts by experience" require psychotherapeutic proposals, without asking to give up drugs, however they suggest reducing medications: i.e. less often, for less time, at lower doses, accompanied by fewer certainties.

Keywords: Antipsychotic drugs, effectiveness, long-term outcomes

  1. [9] Van der Win L. Un legame materno non si recupera più? Autobiografia di una schizofrenica guarita. Milano: Mimesis editore; 2010.
  2. [10] Romme M, Escher S, Dillon J, Corsten D, Morris M. Vivere con le voci. 50 storie di guarigione. Milano: Mimesis editore; 2010.
  3. [1] Tyrer P. The end of the psychopharmacological revolution. British Journal of Psychiatry 2012; 201 (2): 168. DOI: 10.1192/bjp.201.2.168
  4. [2] Whitaker R. Indagine di un’epidemia. Lo straordinario aumento delle disabilità psichiatriche nell’epoca del boom degli psicofarmaci. Roma: Giovanni Fioriti Editore; 2013.
  5. [3] DeAngelis CD, Fontanarosa PD. Ensuring integrity in industry sponsored research. Primum non nocere, revisited. Journal American Medical Association 2010; 303(12):1196-8. DOI: 10.1001/jama.2010.337
  6. [4] Smith R. Medical Journals are an extension of the marketing arm of pharmaceutical companies. PLoS Medicine 2005; e138: 364-6 DOI: 10.1371/journal.pmed.0020138
  7. [5] Gøtzsche P. Medicine Letali e Crimine Organizzato. Come le grandi aziende farmaceutiche hanno corrotto il sistema sanitario. Roma: Giovanni Fioriti Editore; 2015.
  8. [6] Ho BC, Andreasen N, Ziebell S, Pierson M, Magnotta V. Long-term antipsychotic treatment and brain volumes. Archives General Psychiatry 2011; 68(2): 128-137. DOI: 10.1001/archgenpsychiatry.2010.199
  9. [7] Nauert R. Loss of Brain Tissue in Schizophrenia Tied to Antipsychotics. Psychiatry Central. Retrieved on October 20, 2013, from http://psychcentral.com/news/2013/09/12/loss-of-brain-tissue-in-schizophreniatied-toantipsychotics/59443.html.
  10. [8] Steele K, Berman C. E venne il giorno che le voci tacquero. Milano: Mimesis Editore; 2005.
  11. [11] Longden E, Corstens D, Escher S, Romme M. Voice hearing in a biographical context. A model for formulating the relationship between voices and life history. Psychosis: Psychological, Social and Integrative Approaches 2012; 4(3): 224-234. DOI: 10.1080/17522439.2011.596566
  12. [12] Davidson L. Living outside mental illness: qualitative studies of recovery in schizophrenia. New York; New York: University Press; 2003. [13] Dillon J. Recovery from psychosis. In: Geekie J, Randal P, Lampshire D, Read J. Experiencing Psychosis. Personal and professional perspectives. New York: Routledge; 2012.
  13. [14] Frese FJ, Knight EL, Saks E. Recovery from schizophrenia: with views of psychiatrists, psychologists and other diagnosed with this disorder. Schizophrenia Bulletin 2009; 35 (2): 370-380. DOI: 10.1093/schbul/sbn175
  14. [15] Tibaldi G, Govers L. Evidence based hope for recovery in “schizophrenia”: a common objective for all stakeholders in the mental health field. Psychosis: Psychological, Social and Integrative Approaches 2012; 4(2): 105-114. DOI: 10.1080/17522439.2011.584349
  15. [16] Wunderink L, Roeline M, Wiersma D, Sytema S, Nienhuis FJ. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/ discontinuation or maintenance treatment strategy long-term follow-up of a 2-years randomized clinical trial. JAMA Psychiatry 2013; DOI: 10.1001/jamapsychiatry.2013.19
  16. [17] Whitaker R. The case against antipsychotic drugs: a 50-year record of doing more harm than good. Medical Hypotheses 2004; 62: 5-13. DOI: 10.1016/S0306-9877(03)00293-7
  17. [18] WHO Schizophrenia: An International Follow-up Study. Chichester, UK: John Wiley & Sons; 1979.
  18. [19] Jablensky A, Sartorius N, Ernberg G, Ansker M, Korten A, Cooper J, et al. Schizophrenia: manifestations, incidence and course in different cultures, A World Health Organization ten-country study. Psychological Medicine 1992; 20(Monograph Suppl): 1–95.
  19. [20] Adams CE, Tharyan P, Coutinho ESF, Stroup TS. The schizophrenia drugtreatment paradox: pharmacological treatment based on best possible evidence may be hardest to practise in high-income countries. British Journal Psychiatry 2006; 189: 391-392 . doi : 10.1192 / bjp . bp .106. 029983.
  20. [21] Cole J, Klerman G, Goldberg S. The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group. Phenothiazine treatment in acute schizophrenia. Archives General Psychiatry 1964; 10: 246–61. DOI: 10.1001/archpsyc.1964.01720210028005
  21. [22] Schooler N, Goldberg S, Boothe H, Cole J. One year after discharge: community adjustment of schizophrenic patients. American Journal Psychiatry 1967; 123 (8): 986–95. DOI: 10.1176/ajp.123.8.986
  22. [23] Prien R, Levine J, Switalski R. Discontinuation of chemotherapy for chronic schizophrenics. Hospital Community Psychiatry 1971; 22: 20–3.
  23. [24] Gardos G, Cole J. Maintenance antipsychotic therapy: is the cure worse than the disease? American Journal Psychiatry 1976; 133 (1): 32–6. DOI: 10.1176/ajp.133.1.32
  24. [25] Bockoven J, Solomon H. Comparison of two five-year follow-up studies: 1947–1952 and 1967–1972. American Journal Psychiatry 1975; 132 (8): 796–801. DOI: 10.1176/ajp.132.8.796
  25. [26] Carpenter W, McGlashan T, Strauss J. The treatment of acute schizophrenia without drugs: an investigation of some current assumptions. American Journal Psychiatry 1977; 134 (1): 14–20. DOI: 10.1176/ajp.134.1.14
  26. [27] Rappaport M, Hopkins H, Hall K, Belleza T, Silverman J. Are there schizophrenics for whom drugs may be unnecessary or contraindicated? International Pharmacopsychiatry 1978; 13: 100–11.
  27. [28] Mathews S, Roper M, Mosher L, Menn A. A non-neuroleptic treatment for schizophrenia: analysis of the two-year postdischarge risk of relapse. Schizophrenia Bulletin 1979; 5 (2): 322-333. DOI: 10.1093/schbul/5.2.322
  28. [29] Bola J, Mosher L. Treatment of acute psychosis without neuroleptics: twoyear outcomes from the Soteria Project. Journal Nervous Mental Disease 2003; 191 (4): 219–29.
  29. [30] Harrow M, Jobe TH. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. Journal of Nervous Mental Disease 2007; 195 (5): 406–414. DOI: 10.1097/01.nmd.0000253783.32338.6e
  30. [31] Jobe T, Harrow M. Schizophrenia course, long-term outcome, recovery, and prognosis. Current Directions in Psychological Sciences 2010; 19: 220–225. DOI: 10.1177/0963721410378034
  31. [32] Harrow M, Jobe TH, Faull RN. Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine 2012; 42: 2145–2155. DOI: 10.1017/S0033291712000220
  32. [33] Harrow M, Jobe TH. Does Long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Schizophrenia Bulletin 2013; DOI: 10.1093/schbul/sbt034
  33. [34] McGorry P, Alvarez-Jimenez M, Killackey E. Antipsychotic medication during the critical period following remission from first-episode psychosis. Less is more. JAMA Psychiatry, 2013, DOI: 10.1001/jamapsychiatry.2013.264
  34. [35] Thornicroft G Physical health disparities and mental illness: the scandal of premature mortality. The British Journal of Psychiatry 2011; 199: 441-442. DOI: 10.1192/bjp.bp111.092718
  35. [36] Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community cohort with schizophrenia. British Journal Psychiatry 2010; 196(2): 116-21. DOI: 10.1192/bjp.bp.109.067512
  36. [37] Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia. Is the differential mortality gap worsening over time? Archives General Psychiatry 2007; 64: 1123-31. DOI: 10.1001/archpsyc.64.10.1123
  37. [38] Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A, et al. No mental health without physical health. The Lancet 2011 19; 377(9766): 611. DOI: 10.1016/S0140-6736(11)60211-0
  38. [39] Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. British Medical Journal 2011; 13: 343:d5422. DOI: 10.1136/bmj.d5422
  39. [40] Tibaldi G, Frau S. Promuovere il monitoraggio attivo dei rischi derivanti dall’uso degli antipsicotici. L’eccesso di mortalità nei soggetti trattati con antipsicotici come priorità ineludibile, in termini di sanità pubblica. Dialogo sui Farmaci 2012; 3: 123-129.
  40. [41] Wahlbeck K, Westman J, Nordentoft M, Gissler M, Munk Laursen T. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. British Journal of Psychiatry 2011; 199: 453-458. DOI: 10.1192/bjp.bp.110.085100
  41. [42] Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal Medicine 2009; 360: 225-35. DOI: 10.1056/NEJMoa0806994
  42. [43] Schneeweiss S, Avorn J. Antipsychotic agents and sudden cardiac death – how should we manage the risk? New England Journal Medicine 2009; 360: 294-6. DOI: 10.1056/NEJMe0809417
  43. [44] Joukamaa M, Heliovaara M, Knekt P, Aromaa A, Raitasalo R, Lehtinen V. Schizophrenia, neuroleptic medication and mortality. British Journal of Psychiatry 2006; 188: 122–127. DOI: 10.1192/bjp.188.2.122
  44. [45] Waddington JL, Youseff HA, Kinsella A. Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. British Journal of Psychiatry 1998; 173: 325–9. DOI: 10.1192/bjp.173.4.325
  45. [46] Kline N. The practical management of depression. Journal of the American Medical Association 1964; 190(8): 732-740. DOI: 10.1001/jama.1964.03070210038007
  46. [47] Winokur G, Clayton PJ, Reich T. Manic depressive illness. St. Louis: Mosby; 1969.
  47. [48] Hales RE, Yudofsky SC, Talbott JA, ed. The American Psychiatric Press Textbook of Psychiatry (Third Edition). APA Press; 1999.
  48. [49] Posternak MA, Solomon DA, Leon AC, Mueller TI, Shea MT, Endicott J, et al. The naturalistic course of unipolar major depression in the absence of somatic therapy. Journal of Nervous and Mental Disease 2006; 194: 324-349. DOI: 10.1097/01.nmd.0000217820.33841.53
  49. [50] Goldberg D, Privett M, Ustun B, Simon G, Linden M. The effects of detection and treatment of major depression in primary care. British Journal of General Practice 1998; 48: 1840-44. [51] Fava G, Offidani E. The mechanisms of tolerance in antidepressant action. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2011; 35: 1593-1602. DOI: 10.1016/j.pnpbp.2010.07.026
  50. [52] Balter M. Talking back to madness. As the search for genes and new drugs for schizophrenia stalls, psychotherapies are getting new attention. Science 2014; 343: 1190-1193. DOI: 10.1126/science.343.6176.1190
  51. [53] Arnkil T, Seikkula J. Metodi dialogici nel lavoro di rete. Per la psicoterapia di gruppo, il servizio sociale e la didattica. Trento: Edizioni Erickson; 2013.
  52. [54] Seikkula J. Il Dialogo aperto. L’approccio finlandese alle gravi crisi psichiatriche. Roma: Giovanni Fioriti Editore; 2014.
  53. [55] Seikkula J, Alakare B, Aaltonen J, Haarakangas K, Keränen J, Lehtinen K. 5 years experiences of first-episode non-affective psychosis in Open Dialogue approach: Treatment principles, follow-up outcomes and
  54. two case analyses. Psychotherapy Research 2006; 16: 214–228. DOI: 10.1080/10503300500268490
  55. [56] Aaltonen J, Seikkula J, Lehtinen K. The Comprehensive Open-Dialogue Approach in Western Lapland: I. The incidence of non-affective psychosis and prodromal states. Psychosis: Psychological, Social and Integrative Approaches 2011; 3: 179-191. doi.org/10.1080/17522439.2011.601750.
  56. [57] Seikkula J, Alakare B, Aaltonen J. The comprehensive open-dialogue approach (II). Long-term stability of acute psychosis outcomes in advanced community care: The Western Lapland Project. Psychosis 2011; 3 : 1–13. DOI: 10.1080/17522439.2011.595819
  57. [58] Read J, Agar K, Argyle N, Aderhold V. Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice 2003; 76: 1-22. DOI: 10.1348/14760830260569210
  58. [59] Longden E, Sampson M, Read J. Childhood adversity and psychosis: generalized or specific effects? Epidemiology and Psychiatric Sciences 2015; 7: 1-11. DOI: 10.1017/S204579601500044X
  59. [60] https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head
  60. [61] Hall W. Interrompere l’uso degli psicofarmaci. Guida alla riduzione del danno. (disponibile online) The Icarus Project – Freedom Center; 2012.
  61. [62] Szymborska W. La gioia di scrivere. Tutte le poesie (1945-2009). Milano: Adelphi; 2009.

  • Il contributo dei servizi ai processi di cronicizzazione. Quali ombre del manicomio gravano ancora sulle pratiche della "nostra" psichiatria di comunità? Giuseppe Tibaldi, in RIVISTA SPERIMENTALE DI FRENIATRIA 3/2018 pp.9
    DOI: 10.3280/RSF2018-003002
  • Hanno ucciso l’Uomo Ragno. Nascita, splendore, declino di una fase mitica della psicopatologia clinica e della psicoterapia. C’è ancora margine per una loro dignità scientifica? Una proposta connessionista complessa Miriam Gandolfi, in Ricerca Psicoanalitica /2022
    DOI: 10.4081/rp.2022.608

Giuseppe Tibaldi, Il gioco vale la candela? Riconsiderare l’uso degli antipsicotici alla luce delle evidenze sugli esiti derivanti dal loro utilizzo a lungo termine in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2016, pp 43-63, DOI: 10.3280/RSF2016-002004