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|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...
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?
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.
|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.|
|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. 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.|
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