Antipsychotics: Scary if true

[dingogirl]

(Whitaker originally was a highly regarded medical reporter at the Albany Times Union and also wrote off and on for the Boston Globe. A series he co-wrote for the Boston Globe on harmful psychiatric research was a finalist for the Pulitzer Prize in 1998. When he began his investigative research into psychiatric issues, Whitaker was still a believer in the story of progress that psychiatry has been telling the public for decades.)

SS: Let’s now move from the antidepressants like Prozac to consider another new group of supposed wonder drugs -- the new antipsychotic drugs. You write that long-term use of antipsychotic drugs -- both the original neuroleptic drugs like Thorazine and Haldol and the newer atypicals like Zyprexa and Risperdal -- cause pathological changes in the brain that can lead to a worsening of the symptoms of mental illness. What changes in brain chemistry result from the antipsychotics, and how can that lead to the most frightening prospect you describe -- chronic mental illness that is locked in by these drugs?

RW: This is a line of research that goes across 40 years. This problem of chronic illness shows up time and time again in the research literature. This biological mechanism is somewhat well understood now. The antipsychotics profoundly block dopamine receptors. They block 70-90 percent of the dopamine receptors in the brain. In return, the brain sprouts about 50 percent extra dopamine receptors. It tries to become extra sensitive.

So in essence you’ve created an imbalance in the dopamine system in the brain. It’s almost like, on one hand, you’ve got the accelerator down -- that’s the extra dopamine receptors. And the drug is the brake trying to block this. But if you release that brake, if you abruptly go off the drugs, you now do have a dopamine system that’s overactive. You have too many dopamine receptors. And what happens? People that go abruptly off of the drug, do tend to have severe relapses.

SS: So people that have been treated with these antipsychotic drugs have a far greater tendency to relapse, and have new episodes of mental illness, as opposed to people who have had other kinds of non-drug therapies?

RW: Absolutely, and that was understood by 1979, that you were actually increasing the underlying biological vulnerability to the psychosis. And by the way, we sort of understood that if you muck with the dopamine system, that you could cause some symptoms of psychosis with amphetamines. So if you give someone amphetamines enough, they’re at increased risk of psychosis. This is well known. And what do amphetamines do? They release dopamine. So there is a biological reason why, if you’re mucking up the dopamine system, you’re increasing the risk of psychosis. That’s in essence what these antipsychotic drugs do, they muck up the dopamine system.

Here’s just one real powerful study on this: Researchers with the University of Pittsburgh in the 1990s took people newly diagnosed with schizophrenia, and they started taking MRI pictures of the brains of these people. So we get a picture of their brains at the moment of diagnosis, and then we prepare pictures over the next 18 months to see how those brains change. Now during this 18 months, they are being prescribed antipsychotic medications, and what did the researchers report? They reported that, over this 18-month period, the drugs caused an enlargement of the basal ganglia, an area of the brain that uses dopamine. In other words, it creates a visible change in morphology, a change in the size of an area of the brain, and that’s abnormal. That’s number one. So we have an antipsychotic drug causing an abnormality in the brain.

Now here’s the kicker. They found that as that enlargement occurred, it was associated with a worsening of the psychotic symptoms, a worsening of negative symptoms. So here you actually have, with modern technology, a very powerful study. By imaging the brain, we see how an outside agent comes in, disrupts normal chemistry, causes an abnormal enlargement of the basal ganglia, and that enlargement causes a worsening of the very symptoms it’s supposed to treat. Now that’s actually, in essence, a story of a disease process -- an outside agent causes abnormality, causes symptoms...

http://www.laleva.org/eng/2005/09/ps...on_humans.html

Anyone else hear about this? What do you think?

[kimkabob5]

Considering that my dd and I both take Abilify, I find it very disturbing, especially since the drug has been so effective for both of us (she has a mood disorder along with psychotic disorder, and I'm bipolar). I'll be bringing this article to my doc.

[frowningfrog]

I have heard this , and believe that docs have known this for many many years. I havent been able to find anything on it.
I to take these types of meds as I am bipolar. Right now I am fighting my docs on taking them. I am taking a very very small dose to thwart my swings. So far I have done wonderfully in doing this.
I have mentioned to myu doc about the long term effects on my brain from these meds ..he argued that there is no proof....ya right....
I will be bringing this article to him ...and tell him how I have appreciated his help and will be looking for a new doc who will hear and work with my concerns...thanks for posting the article.

[kimkabob5]

I've also heard that the anticonvulsant medication actually prevents the brain from being damaged in bipolar disorder because it stops kindling. Have any of you heard of this, or that untreated bipolar disorder leads to brain damage?

[frowningfrog]

Originally Posted by kimkabob5

I've also heard that the anticonvulsant medication actually prevents the brain from being damaged in bipolar disorder because it stops kindling. Have any of you heard of this, or that untreated bipolar disorder leads to brain damage?

I do also take anti convulsants for a seizure disorder as well...I have not heard anything about that, However I do know that they can damage the liver after long term use, but thats all I know.

I am not sure of an untreated Bipolar , but I have heard of that for untreated sychsofrenic(SP).

[Snowdrift]

I've heard this and other scary things about antipsychotics. That's why I stopped taking them, as well as the SSRI's and anticonvulsants. From 2000-2003 I was on, at various times: paxil, zoloft, seroquel, risperdal, klonopin, ambien, and sonata. At the same time I also took vioxx for a shoulder injury; we all knwo how well that one worked out.

I have recurrent major depression and kinda' sorta' borderline personality disorder (my doctor refused to officially DX me with that one, but that was why he rpescrbed the antipsychotics. his reasoning was that everyone acts like a borderline personality if they're under enough stress and it's not a nice DX to have). I've never had a true psychotic episode, although I had an adverse reaction to the seroquel that apparently was borderline psychotic, but that was artificially produced.

I have the luxury of being able to choose not to take meds becaue while I may have to deal with pretty bad depression from time to time I'll always be able to tell what's going on with me in case I do need to go back to meds.

The problem with *all* psychiatric medications is that there is not an established causal connection between the various chemical imbalances and the resultant behavioral changes. No one really knows if a lack of serotonin causes depression or if depression causes a lack of serotonin.

Anyway, off my soapbox, my brother is here Fun, fun , fun...

[Shantimama]

I would question a doctor who prescribes anti-psychotic medication for borderline personality disorder - it is NOT an illness that has psychotic episodes ANYWHERE in its definition. The most effective way to treat borderline personality disorder is through long term psychotherapy - a heck of a lot more work for the doc, not as easy as writing an Rx, but appropriate, nonetheless. Many of the therapists who are most effective at helping people overcome BPD are not psychiatrists, maybe that is why some docs prescribe - they don't want to refer to someone else.

Your doctor's reasoning that it is not a nice diagnosis to have may be true, but more true is that it is not a nice disorder to HAVE - or for your family and friends to support you through. If he wants to make your life easier, how about referring you for appropriate treatment instead of artificially calming things down with a powerful but inappropriate drug for the disorder?

The difference between BDP and being under stress is that if it is just stress, people will revert to healthy coping mechanisms when the stress ends. People with BPD behave the way they do regardless of external events (even though they usually blame their behaviour on external things - it is one of the flags of BPD!). It is like saying that most people will hallucinate if their fever gets high enough, so let's not treat hallucinations.

Sorry to be so about this. I have had two people in my life with untreated BPD and I have learned a lot. One friendship I have had to distance myself from because it was so draining. The other person is my mother and because of her age and other health concerns the BPD will never be treated so I have had to learn a lot of coping skills and a lot about the disorder. There is a lot of misinformation out there.

[Snowdrift]

Originally Posted by Shantimama

I would question a doctor who prescribes anti-psychotic medication for borderline personality disorder - it is NOT an illness that has psychotic episodes ANYWHERE in its definition.

but it does include self-injury. Some research has indicated that low-dose anti-psychotics, as well as low dose anti-convulsants can help get this under control.

The most effective way to treat borderline personality disorder is through long term psychotherapy - a heck of a lot more work for the doc, not as easy as writing an Rx, but appropriate, nonetheless. Many of the therapists who are most effective at helping people overcome BPD are not psychiatrists, maybe that is why some docs prescribe - they don't want to refer to someone else.

I was actually seeing a therapist as well as a psychiatrist. Both were aware of their complementary treatment and obtained permission from me to communicate with each other. In my experience most p-docs expect people to see a therapist as well. I'm sorry to hear that sometimes people
have a hard time getting thier doctor to acknowledge/encourage the need for this. I'm hopeful that in the future psychologists gain the authority to prescribe medications.

Your doctor's reasoning that it is not a nice diagnosis to have may be true, but more true is that it is not a nice disorder to HAVE - or for your family and friends to support you through.

I think both are equally true. BPD is well known to be treated fairly perjoratively. See _Girl Interupted_, an episode of the tv show _ER_, and professional literature (I don't have cites handy). Cutters tend to receive the same dismissive/unsympathetic treatment. It's not a nice dx to have.

Nor is it a nice disorder to have, although I don't know if I can speak from personal experience or not on this.

The difference between BDP and being under stress is that if it is just stress, people will revert to healthy coping mechanisms when the stress ends.

Almost, not quite. When someone is under stress for an extended period of time they will develop coping mechanisms that may be effective for dealing with the stress but that are maladaptive in the long run. Couple of things: first, a major stressor rarely resolves itself quickly or in some cases, ever. Second, even when the stressor is removed (to whatever degree possible) it can take time and effort to learn more effective interpersonal skills. Is this borderline? I dunno. But I'm pretty proud of having recovered from ten pretty hideous years of various kinds of emotional and sexual abuse, including a level of forced isolation that precluded developing adaptive skills. I was 22 when a professor of mine caught on that there were some issues there (he was tipped off by lots of self-injury) and he helped me get into counseling. Two years later I was effectively functioning normally and aside from a relationship with my family-of-origin that will never recover adn a whole lotta scars, I'm doing pretty well.

People with BPD behave the way they do regardless of external events (even though they usually blame their behaviour on external things - it is one of the flags of BPD!). It is like saying that most people will hallucinate if their fever gets high enough, so let's not treat hallucinations.

On the other hand, it might not necessarily be a good idea to treat people with high fevers for hallucinations. Treating them for the fever might work better.

Sorry to be so about this.

I understand where you are coming from. I'm a little embarrassed to be so about this because I know that I am taking it kinda personal (another symptom of BPD ). But I kind of feel unfairly maligned. I mentioned the reason I was prescribed a particular drug. It's not an unusual drug to be used for that dx with my symptoms, especially since BPD is not really an illness per se, more a combination of behaviors. Because of this it is usually necessary to treat the behaviors, either through drugs or therapy. In response to my mention of a dx/drug combo I was told that my doctor was wrong and that I need a different treatment.

I don't actually need any treatment at the moment (although pg is a challenge, as is common in people with pasts similar to mine). I don't think it's fair of you to malign me or my doctor for not following your idea of how I should be treated.

I have had two people in my life with untreated BPD and I have learned a lot. The other person is my mother and because of her age and other health concerns the BPD will never be treated so I have had to learn a lot of coping skills and a lot about the disorder. There is a lot of misinformation out there.

You have my sincere sympathy. My former therapist is convinced my mother has narcissitic PD, which perhaps explains some of of my and my siblings' problems. I can identify with your frustration. Please keep in mind though that not all people who have had signs of BPD are untreated, require particular coping skills on the part of the people around them, are lacking insight into their personality or insight into BPD, or even require therapy on an ongoing basis.

Your post responded to one parenthetical sentence in my post on an unrelated topic. From that one sentence you not only told me how i should be treated, but that the person who was treating me needed to be questioned. As far as I'm concerned, every doctor needs to be questioned, but the point is that he and I trusted his treatment and later agreed to end it and avoid medication. This worked for me, and my doctor, so why not leave well enough alone? You've never met me, so unless I ask, why tell me what type of psychiatric treatment I need?

[Shantimama]

I am sorry my post hit you the wrong way. I had no intention of judging or offending you in any way.

To clarify, I did not tell you how you should be treated. I would not presume to do so. If I had had more information I probably would not have posted anything - I went with what was in your post, I did not specifically say that your doctor was wrong and that you needed different treatment. I was responding to your comment that you had never had an anti-psychotic episode and the way you described your doctor not formally diagnosing you with BPD. You did not mention that self-injury was an issue or that you were also seeing a therapist. My comments were made out of concern, not judgement. Not all people with BPD self-injure.

I agree that if someone is hallucinating because of a high fever, the fever should be treated. Some people under extreme stress will exhibit some borderline behaviours - your description of what your psychiatrist said sounded like your psychiatrist was dismissing BDP because that could happen. My reference to fevers and hallucinations was because I wouldn't dismiss someone in a psychotic state because anyone can hallucinate given the right circumstances. Lots can get lost and misinterpreted in online communication - I guess this was one of those times.

I know that not all people with BPD are unteated. Some are. Some may not need much therapy, but some do and it is not unusual for them to be resistant to the idea. I am not saying how many or anything about you or your insight there, just my own observation.

I disagree with your comment that being in relationship with someone with BPD does not necessarily require particular coping skills for the non-BPD person. Books like "Stop Walking On Eggshells" and "Surviving A Borderline Parent" would say otherwise. Living with or being raised by someone who is self-injurious, has unstable and intense relationships that alternate between extremes of idealization and devaluation, identity disturbance, potentially self-damaging impulsivity, recurrent suicidal behaviour, gestures or threats, affective instability, chronic feelings of emptiness, inappropriate, intense anger, difficulty controlling anger, frantic efforts to avoid real or imagined abandonment or severe dissociative symptoms most certainly CAN require coping skills beyond the realm of the every day. All of those examples were taken from the DSM-IV definition of BPD. It may not be necessary for people who have a mild form of the disorder, but I have seen too many situations where a person with BPD dismisses the concerns or unique difficulties of those who love them.

Again, I am sorry that I offended you. I did respond to just one part of your post and for that, I apologize. I believe you misunderstood my response too.

I just re-read your post and see that you did say that not all BPD people with BPD require special coping skills in those around them - I assume you mean that some will and some won't. Sorry for my above paragraph thinking you said that special skills were not necessary.

peace,
Shantimama

[Snowdrift]

Shantimama,

I really appreciate your reply. I have a tendency to mention loaded words and concepts in passing without fully explaining the situation, and that tends to lend itself to creating misunderstandings.

To a great degree I understand the frustration you are dealing with regarding mis- or dis-information about BPD. I've reacted in a nearly identical way when self-injurers give a formidable list of medications they've been prescribed and when I ask if they've considered doing dialectical behavior therapy they ask what it is. Or when parents tell me it's no big deal, it's just a middle school fad (which it can be, but usually not when the middle-schooler in question is getting stitched up after).

Awfully presumptuous of me seeing as how I've never done DBT myself!

When there is so much ignorance floating around it is very make the leap from partial information to assuming a lack of information exists.

Sara

[Snowdrift]

And to everyone else: sorry for hijacking the thread.

[crazy_eights]

NPR had someone on recently (sorry, I heard it doing carpool - one of many - and am not sure what show it was on) that was talking about the 'modern' anti-psychotic meds. Basically said they are not as effective as we have been led to believe and have more side effects than we have been told. I think there was a new study out?

[Arwyn]

I've known this for a while. I think like pretty much all medications or medical procedures, antipsychotics can be livesafers - but they can also be dangerous and damaging.

I've read about there being a similar effect with antidepressants and bipolar disorder. I haven't heard anything about the anti-convulsant mood stabilizers - other than potential liver (and pregnancy) problems, they're frequently considered the safest of the psychoactives. I hope that continues to be true - it'd be nice to have SOMETHING those of us who need long term medication can take that won't, well, screw us up even more in the long term.

[frowningfrog]

Yes I do believe that the use of anti-convulsants is safer and more effective.
I actualy take 2 ..one for siezures
and another for my bipolar.
I do not like either of the meds, but it is sure better then taking a pill that puts me into manic states, and gives me all kinds of side effects that I do not wish to have. I have enough problems as it is....