There is a new intellectual framework recently arrived within the psychiatric profession that will dramatically affect the way we will think about mental health in the decades ahead. It’s called “interpersonal neurobiology.”
In this new mental health science our mind is seen as being derived from the interaction of the brain and interpersonal processes, especially in our early development. Because this new science is more broadly based on both biological and social science research, it becomes a much more integrated medical discipline. The present molecular or psycho-pharmacological emphasis alone is no longer sufficient.
Perhaps the most significant and salient finding from recent neural science research is best expressed by the principal architect, Dr. Daniel J. Siegel, in Mindsight – The New Science of Personal Transformation. Siegel states:
“Interactions with the environment, especially relationships with other people, directly shape the development of the brain’s structure and function.
There is no need to choose between brain or mind, biology or experience, nature or nurture. These divisions are unhelpful and inhibit clear thinking about an important and complex subject: the developing brain.”
While our genes remain an important component of our mental functioning, developmental factors are also significant and continue throughout the life span. For example, recent neural research, including the latest brain scanning technology, shows that learning produces physical alterations both in gene expression, brain structure and functioning. Thus human interaction both shapes and is shaped by an ever-changing and dynamic brain throughout life.
The corollary is that heredity alone does not necessarily need to be perceived as a permanent condition and that human experience throughout the life span has the potential to modify, neutralize and repair both constitutional and psychosocial determinants. Such life-long brain plasticity findings can bring hope to millions who are seeking healing and daily transformation.
These latest neural findings have long-term mental health policy and funding implications for persons suffering with serious chronic mental diseases. With modern brain scanning technology and ever-increasing neural evidence that supports an ever-changing brain ---whether psychopharmacological and/or psychosocial therapeutically induced --- it now becomes morally necessary to consider scheduling major periodic psychiatric and/or neurological exams for persons suffering from “chronic” mental illness.
Persons suffering from “chronic” mental disorders should not be stuck with old dead-end and long-term diagnoses but regularly and comprehensively reviewed in the light of these latest neural science findings.
That not all schizophrenic patients need to be on antipsychotics all their lives was recently rigorously demonstrated in Dr. Martin Harrow’s fifteen year old long-term, evidenced based, outcome study conducted at the Illinois College of Medicine.
Based on 68 young patients, and using global assessment scales at three year intervals, forty percent of those off medications recovered over the long run compared to only five percent of those still taking antipsychotics.
These research findings, presented at the 2008 American Psychiatric Association meeting, are presented in both readable and graphic form in Robert Whitaker’s “Anatomy of an Epidemic,” along with fourteen other long-term, evidenced based, outcome study findings which further support Harrow’s findings.
This will be welcome news to younger patients and their parents, and will bring hope especially to our youngest love ones.
Mental health policy makers and practitioners who are in search of a more open, holistic and balanced mental health model will also find both Siegel and Harrow’s work a valuable addition to their therapeutic literature.
Readers can learn more at Mindgains.org and MindsightInstitute.com
and at Robert Whitaker’s Psychology Today’s blog.
Benedict is a family mental health reform advocate
Monday, June 27, 2011
Saturday, June 18, 2011
New Mental Health Paradigm is Good News
Capital Times, Saturday, June 18, 2011
There is a new intellectual framework recently arrived within the psychiatric profession that will dramatically affect the way we will think about mental health in the decades ahead. It’s called “Interpersonal Neurobiology.”
In this new mental health science our mind is seen as being derived from the interaction of the brain and interpersonal processes, especially in our early development. Because this new science is more broadly based on both biological and social science research, it becomes a much more integrated medical discipline. The present molecular or psycho-pharmacological emphasis alone is no longer sufficient.
Perhaps the most significant and salient finding from recent neural science research is best expressed by the principal architect, Dr. Daniel J. Siegel, in Mindsight – The New Science of Personal Transformation. Siegel states:
“Interactions with the environment, especially relationships with other people, directly shape the development of the brain’s structure and function. There is no need to choose between brain or mind, biology or experience, nature or nurture. These divisions are unhelpful and inhibit clear thinking about an important and complex subject: the developing brain.”
While our genes remain an important component of our mental functioning, developmental factors are also significant and continue throughout the life span. For example, recent neural research shows that learning produces alterations in gene expression and in our synapses. Thus human interaction both shapes and is shaped by an ever-changing and dynamic brain throughout life.
The corollary is that heredity alone does not necessarily need to be perceived as a permanent condition and that human experience throughout the life span has the potential to modify, neutralize and repair constitutional determinants. Such life-long brain plasticity findings can bring hope to millions who are seeking healing and daily transformation.
These latest neural findings have long-term policy and funding implications for long-term mental health care of persons with serious chronic mental diseases. With modern brain scanning technology and ever-growing neural evidence that supports an ever-changing brain -- whether psycho-pharmacological and/or psycho therapeutically induced -- it now becomes morally necessary to consider scheduling major periodic psychiatric and/or neurological exams for persons suffering from “chronic” mental illness.
Persons suffering from “chronic” mental disorders should not be stuck with old dead-end and long-term diagnoses but regularly and comprehensively reviewed in the light of these latest neural science findings.
These findings presented in readily readable form, will be welcome news to those who daily suffer from mental disorders and their families, and for mental health practitioners who are in search of a more open and holistic and balanced therapy strategy.
Readers can learn more at Mindgains.org and MindsightInstitute.com.
Benedict is a family mental health reform advocate.
There is a new intellectual framework recently arrived within the psychiatric profession that will dramatically affect the way we will think about mental health in the decades ahead. It’s called “Interpersonal Neurobiology.”
In this new mental health science our mind is seen as being derived from the interaction of the brain and interpersonal processes, especially in our early development. Because this new science is more broadly based on both biological and social science research, it becomes a much more integrated medical discipline. The present molecular or psycho-pharmacological emphasis alone is no longer sufficient.
Perhaps the most significant and salient finding from recent neural science research is best expressed by the principal architect, Dr. Daniel J. Siegel, in Mindsight – The New Science of Personal Transformation. Siegel states:
“Interactions with the environment, especially relationships with other people, directly shape the development of the brain’s structure and function. There is no need to choose between brain or mind, biology or experience, nature or nurture. These divisions are unhelpful and inhibit clear thinking about an important and complex subject: the developing brain.”
While our genes remain an important component of our mental functioning, developmental factors are also significant and continue throughout the life span. For example, recent neural research shows that learning produces alterations in gene expression and in our synapses. Thus human interaction both shapes and is shaped by an ever-changing and dynamic brain throughout life.
The corollary is that heredity alone does not necessarily need to be perceived as a permanent condition and that human experience throughout the life span has the potential to modify, neutralize and repair constitutional determinants. Such life-long brain plasticity findings can bring hope to millions who are seeking healing and daily transformation.
These latest neural findings have long-term policy and funding implications for long-term mental health care of persons with serious chronic mental diseases. With modern brain scanning technology and ever-growing neural evidence that supports an ever-changing brain -- whether psycho-pharmacological and/or psycho therapeutically induced -- it now becomes morally necessary to consider scheduling major periodic psychiatric and/or neurological exams for persons suffering from “chronic” mental illness.
Persons suffering from “chronic” mental disorders should not be stuck with old dead-end and long-term diagnoses but regularly and comprehensively reviewed in the light of these latest neural science findings.
These findings presented in readily readable form, will be welcome news to those who daily suffer from mental disorders and their families, and for mental health practitioners who are in search of a more open and holistic and balanced therapy strategy.
Readers can learn more at Mindgains.org and MindsightInstitute.com.
Benedict is a family mental health reform advocate.
Monday, May 16, 2011
New book changes the conversation on mental illness: Long-Term Mental Health Outcome Follow-Up Studies Surface
(This review of Robert Whitaker’s latest book is primarily focused upon the long-term mental health outcome studies identified in his book, see Part Three: Outcomes: Chapter 6 (Schizophrenia) A Paradox Revealed, Chapter 7 (Anxiety) The Benzo Trap, Chapter 8 (Depression), An Episode Illness Turns Chronic, Chapter 9 (Bipolar), The Bipolar Boom, Chapter 11, The Epidemic Spreads to Children. Also see Notes: pages 368 – 384.)
Introduction
Welcome to this presentation this morning. Much of what I will share with you today can be found in Robert Whitaker’s latest book, Anatomy of an Epidemic – Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America.
Whitaker is an investigative medical reporter and has written one other book on this same topic. It’s called Mad in America. Some of the studies contained in Whitaker’s latest book also appear and are discussed in Mad in America. Maybe some of you have heard of both of these books. How many of you are familiar with either of them?
With respect to Anatomy of an Epidemic, I am convinced that Whitaker makes a strong case that indeed there is an epidemic of chronic disabled mental health patients, actually over four million, who have been diagnosed with a mental disability sufficient to be eligible for government assistance. Every day 1,100 adults and children are added to these rolls because they have become newly disabled by mental illness. Of this number 250 of these citizens are children. Using SSI and SSDI and other epidemiological data he argues that this epidemic is now spreading most rapidly among our nation’s children.
I am not here this morning however to try and persuade you to accept Whitaker’s admitally controversial chronic epidemic thesis --- in part because there is not enough time to do so, and because it would seriously detract from and compromise the larger long-term research studies presented in his book. Many readers of this book will argue that perhaps the greatest contribution to the mental health and medical research literature is Whitaker’s systematic documentation and grouping of the scientific long-term outcome studies by the four major mental disorders and for children.
As noted on my bio my expertise and experience includes thirty years as a clinical and program evaluator. I have conducted and have had published several papers on both clinical and program evaluation studies of my own, including an 18 month follow-up study on emotionally disturbed adolescents who were treated in a Wisconsin residential treatment facility.
During these three decades as a professional mental health clinician and evaluator I have tried to keep up on mental health research of all kinds. In fact it was due to such training and experience that my own interest was piqued when Whitaker’s recent book appeared. I just happened to have the good fortune to hear Whitaker interviewed about his book on Wisconsin Public Radio and I was both dismayed and confused when Whitaker began citing several long-term mental health outcome studies which until then I didn’t know even existed. Needless to say I bought the book and here I am.
Before turning to our very first long-term outcome follow-up study I suggest that we begin by comparing what you will hear today with the story presented by the American Psychiatric Association and large pharma. This latter story is one that we all know. It is a story that begins after WW 2 with the experimentation with certain chemical compounds or substances like dyes and their various reactions on caged rats. These various compounds were soon used on humans as an anesthetic in surgery to calm the patient.
Using rats and mice scientists observed that various compounds produced certain effects or behavior in these animals. Some substances produced less hyperactivity, greater calmness and manageability. By 1955 an antipsychotic drug called Thorazine appeared on the market for humans.
American psychiatry and pharmaceutical companies soon began to credit this drug with ending the suffering of the chronically ill and for making deinstitutionalization possible. The APA touted this drug as our first antidote to a mental disorder. One writer haled Thorazine for initiating a revolution in psychiatry, comparable to the introduction of penicillin in general medicine. This was the start of the psychopharmacological revolution. Now all of us are familiar with the story told by big pharma. It is a story that began with the National Institute of Mental Health’s first drug trials what was later called the magic or silver bullet era that now is regularly stoked with ever newer miracle drugs. About this same time the Diagnostic and Statistical Manual also appeared and drew a line as to what is normal and what is not. Also during this early period there was the need to discover and demonstrate an antibiotic-like pill that would “treat the brain by curing chemical imbalances that causes mental disorders.” Slightly before and during the same time period something called “community psychiatry” which was threatening to redefine American psychiatry and vigorously opposed by a more conservative branch of the AMA.
During this same period there was also pressure on the psychiatric profession to adopt a more rigorous research design in order to increase its scientific credibility. They chose a research design that had been recently used and proven in infectious disease: studies which included placebo-controlled, double-blind, randomized clinical trials. Thorazine came on the market over a half century ago in June of 1951 to treat psychotic disorders.
Whitaker asks the reader to compare this idealized and more sexy version of American psychiatric history with a more realistic and candid story told by the numerous long-term mental health outcome studies that his book has just recently brought into public light, and presented to you here today.
Chapter 6: A Paradox Revealed
This story, told in the narrative of long-term scientific studies, really begins when the National Institute of Mental Health was asked to design and conduct the first Thorazine drug trials and evaluate its safety and effectiveness. Here it would be helpful to first consider briefly the difference between Food and Drug Administration’s approved clinical drug trails versus long-term mental health outcome follow-up studies.
As you know, most clinical drug trials are designed to run for as little as four to six weeks, while long term follow-up studies might run for up to one to ten years or more. Unlike clinical trials which target only clinical symptoms typically observed during the intake or initial office visit, such as anxiety, depression, mental confusion, long-term follow-up studies are more likely to use global rating scales and broader and more concrete social functioning indicators such as employment, family relationships, relapses, physical health and medication status.
And, while clinical trials use more narrow industry-driven rating scales often routinely administered by the treating clinician themselves to rate the patient’s progress, long-term outcome studies tend to use several different broad social functioning measures and are rated by more independent and objective verification sources, who are usually, not involved in the treatment or clinical process per se.
Now, what does the long-term scientific mental health evidence tell us with regard to the treatment of schizophrenia with antipsychotic drugs?
In 1961 the Psychopharmacology Service Center using symptom-based rating scales in short term placebo studies researcher found 75 percent of the drug-treated patients to be “much improved” versus 23 percent of the placebo (non-medicated) patients.
Following this study hundreds of smaller studies have since produced similar results. Sixty-six such short-term studies were reviewed and found that 53 percent of the drug withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medications. These results prompted the researcher to conclude that “The efficacy of these medications in reducing the risk of psychotic relapse has been well documented.” 1995 See: NIMH investigators, and Patricia Gilbert, “Neuroleptics withdrawal in schizophrenic patients.”
Later in 1967 the NIMH’s conducted a one year after discharge follow-up study with 299 schizophrenia patients who had been treated with either neuroleptics or placebo upon their admission to a hospital.
In this landmark study the researchers found that patients who received placebo “were less likely to be re-hospitalized than those who received any of the three active phenothiazines.” See: Schooler, N. American Journal of Psychiatry, 123 (1967):986-995.
After this study the researchers described these results as “ so unexpected” but stated that despite these findings, they “were unprepared to recommend placebo as the treatment of choice.”
This study was soon followed by NIMH’s first two relapse studies.
The first such study investigated whether relapse rates increased in direct relation to dosage. The critical finding of this NIMH funded study was that relapse rates rose in direct relation to dosage—the higher the dosage that patients were on before the drugs were withdrawn, the greater the relapse rates.
At the start of this study, 18 patients were on placebo, and only one got worse over the next six months (6%). Sixty-five patients were on 300 mg. of chlorpromazine at the start of the study, and 54% of these patients got worse after drug withdrawal. One hundred thirteen patients were on more than 300mg. of chlorpromazine at the start of the study, and 66% of these patients got worse after drug withdrawal. See: Relapse in Chronic Schizophrenics following Abrupt Withdrawal of Tranquilizing Medication, Prien, R. British Journal of Psychiatry, 115 (1968) 679-86.
In the second relapse study, the earlier finding that relapse rates rose in correlation with neuroleptics dosage was confirmed. Only 2 of 30 patients who were on placebo at the start of the study relapsed during the next 24 weeks (7%). Twenty-three percent of the 99 patients who were on under 300 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal. Fifty-two percent of the 91 patients who were on 300 to 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal, and sixty-five percent of the 81 patients who were on more than 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal.
The researchers concluded: “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo—the higher the dose, the greater the probability of relapse.” See: Discontinuation of Chemotherapy for Chronic Schizophrenics, Prien, R. Hospital and Community Psychiatry, 22 (1971), 20-23.
It seems paradoxical that drugs that ameliorate acute psychotic symptoms over the short term will actually increase the likelihood that a person diagnosed with schizophrenia will become chronically ill. But as we have just seen, that disturbing fact showed up in the very first outcome studies presented here.
In 1997 Ross Baldessarini of Harvard Medical School reviewed 145 of such clinical trials and found that the antipsychotic proved superior to a placebo in 83 % of them. The Brief Psychiatric Rating Scale (BPRS) adopted by the American Psychiatric Association was regularly employed in these trials. The APA eventually decided that a 20 percent reduction in total BPRS score represented a clinically significant response to a drug. Based on this measurement, an estimated 70 percent of all schizophrenia patients suffering from an acute episode of psychosis “respond” over a six week period, to an antipsychotic medication.
Once the NIMH investigators determined that the antipsychotics were efficacious over the short term they naturally wanted to know how long schizophrenia patients should stay on the medication.
To investigate this question, they ran studies that, for the most part, had the following design: Patients who were good responders to the medication were either maintained on the drug or abruptly withdrawn from it.
In 1995, Patricia Gilbert at the University of California at San Diego reviewed sixty-six relapse studies, involving 4,365 patients and found that 53 percent of the drug-withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medication. Gilbert concluded that “The efficacy of these medications in reducing the risk of psychotic relapse has been well documented.” It was later discovered after repeating this study that when the drugs were gradually withdrawn, the relapse rate was only one-third as high as in the abrupt-withdrawal studies.
Based on these relapse studies, in a 2002 John Geddes, a prominent British researcher, wrote in an article in the New England Journal of Medicine, “Anti-psychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.
Nevertheless, in 2007 the Cochrane Collaboration, an international group of scientists that doesn’t take funding from pharmaceutical companies, raised questions about the drug’s short-term efficacy.
They conducted a meta-analysis of all chlorpromazine-versus placebo studies in the scientific literature, and after identifying fifty of decent quality, they came to the following conclusion: (Most briefly, a meta-analysis study is one that combines the results of several studies that address a set of related research hypotheses. In the simplest form, this is normally by identification of a common measure effect size, for which a weighted average might be the output of a meta-analysis.)
They calculated that seven patients had to be treated with chlorpromazine to produce a net gain of one “global improvement” and that even this finding may be an overestimate of the positive and an underestimate of the negative effects of giving chlorpromazine.” These investigators noted that they were startled by their results. This was the first attempt to assess the long-term efficacy of these drugs when a long-term measure was applied.
Even if one accepts the objectivity of this clinical trial procedure many investigators have pointed to the large hole in this evidence base. Joseph Zubin warned that when it came to evaluating a therapy for psychiatric disorder, a six-week study induced a kind of scientific myopia.
“It would be foolhardy to claim a definite advantage for a specified therapy without a two-to five-year follow-up. A two year follow-up would seem to be the very minimum for the long-term effects.
Lisa Dixon, psychiatrists at the University of Maryland School of Medicine in 1995 went still further in her criticism. “Little can be said about the efficacy and effectiveness of conventional antipsychotics on nonclinical outcomes.” Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.
After reviewing a robust number of such clinical trial results, Whitaker noted, “Evidence that the drugs might worsen long-term outcomes showed up in the very first follow-up study conducted by the NIMH, and then it appears again and again in the research literature over the next fifty years. Some of these researchers include: J. Cole, 1977, Bockover 1975, Rappaport 1978, W. Carpenter 1977, L. Mosher 2003, C. Harding 1994, M. Harrow 2007, World Health Organization 1998
Evidence that long-term recovery rates are higher for non-medicated patients appears in studies and investigations of many different types. It shows up in the randomized studies conducted by Rappaport, Carpenter, and Mosher; in the cross-cultural studies conducted by the World Health Organization; and in the naturalistic studies conducted by Harding and Harrow.
Once a new tool for studying brain structures came along called electro-magnetic resonance imagery (MRIs), investigators discovered that antipsychotics fail to maintain or increase the size of the frontal lope and the white matter found there. These morphological changes in the brain reflect a “progressive neurodevelopmental disorder” in the schizophrenic patient which is associated with negative symptoms and both cognitive and functional impairments, which antipsychotics fail to arrest. (See: Nancy Andreason, American Journal of Psychiatry, 2003.
Whitaker makes the point that for the most part, the psychiatric researchers who conducted these studies hoped and expected to find the reverse. They wanted to tell a story of drugs that help schizophrenia patients fare well over
Conclusion - Now to summarize, what does the long-term scientific mental health evidence tell us about the record of antipsychotic medication for the treatment of schizophrenia?
1.Beginning in 1961 using symptom-based rating scales in short term placebo studies researcher found 75 percent of the drug-treated patients to be “much improved” versus 23 percent of the placebo (non-medicated) patients.
Following this study hundreds of smaller studies produced similar results. Sixty-six such short-term studies were reviewed and found that 53 percent of the drug withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medications. See: NIMH investigators, and Patricia Gilbert
2. The first 1967 one year-after hospital discharge study found that patients who received placebo (non-medicated) “were less likely to be re-hospitalized than those who received any of the three active phenothiazines. See: N. Schooler
3. In two drug withdrawal trials, both of which included patients who weren’t on any drug at the start of the study, relapse rates rose in correlation with drug dosage. The higher the dose the greater the probability of relapse. See: R. Prien
4. There is no good evidence that antipsychotics improve long-term schizophrenia global outcomes. See: Lisa Dixon and Emmanuel Stip
5. There is significance evidence that drugs might worsen long-term outcomes. See: Cole, Bockoven, Rappaport, Carpenter, Mosher, Harding, and the WHO.
6. There is long-term evidence that antipsychotics affect the brain, and why the drug-withdrawal studies have misled psychiatrists into believing that the drugs prevented relapse. See: Chouinard and Jones
7. There is long-term evidence research that randomized placebo studies show that recovery rates are higher for non-medicated patients. See: Rappaport, Carpenter, Mosher
8. There are long-term studies that indicate that drugs induce global brain dysfunction in a high percentage of patients over the long term. See: the tardive dyskinesia studies by
9. There is also evidence that antipsychotics cause morphological changes in the brain and that these changes are associated with a worsening of both positive and negative symptoms, and with functional and cognitive functioning as well. See: Andreasen MRI studies
10. There is long-term evidence showing how schizophrenic patients in the US are faring following their hospitalization. See: Martin Harrow’s NIMH funded 2007 fifteen-year follow-up global outcome study showing that 40 percent of schizophrenic patients off antipsychotics recovered, versus 5 percent of the medicated patients.
At the 2008 APA conference Harrow stated: I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning outcomes than those on antipsychotics.”
(There is long-term evidence-based study that demonstrates that seven patients had to be treated with chlorpromazine to produce a net gain of one “global improvement.” versus a mere symptomatic short-term benefit. See: The 2007 Cockrane Collaboration.)
Chapter 7: The Benzo Trap
When Hoffmann-La Roche brought Valium to the market in 1963, advertising it in particular to women, and from 1968 to 1981, it was the bestselling drug in the Western world. Valium was preceded by Miltown which was often referred to as “mother’s little helper.” During this same period the number of people admitted to mental hospitals, psychiatric emergency rooms, and mental health outpatient clinics soared.
First discovered by George Beard in 1869 he described the condition as ”tired nerves” and defined the symptoms as consisting of worry, fatigue, and insomnia. He later also named the condition “neurasthenia.” Sigmund Freud first began treating neurasthenia in 1895 and soon announced that Beard’s disease of dread and worry were psychological in origin rather than tired nerves. He began to write about anxiety neurosis in women which he theorized arose in a large part form their unconscious repression and sexual desires and fantasies. Until the onset of Benzodiazepines psychiatry was a profession for those who treated mad patients in thee asylum.
Once researches in the United States and the United Kingdom determined that Benzos did not provide any durable relief from anxiety, an obvious question arose: Do these drugs when taken on a continual basis, worsen the very symptoms they are supposed to treat? In 1991 Karl Rickels at the University Pennsylvania School of Medicine reported on a three year follow-up study. Rickels reported on a group of anxious patients and found that those who had successfully gotten off the drugs were doing “significantly” better than those who had failed to so.
A few years later he was back with another study and found that when long-term users withdrew from Benzos, they became more alert, more relaxed, and less anxious, and this change was accompanied by improved psychomotor functions.
Soon Canadian investigators found that benzo usage led to a fourfold increase in depressive symptoms. In England Aston observed that those who stay on the drugs tend to become more ill. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzo use, and panic attack, agoraphobia may also appear for the first time. David Knott, a physician at the University of Tennessee, warned in 1976 that, “I am very convinced that Valium, Librium and other benzo drugs of that class cause damage to the brain. He discovered damage to the cerebral cortex which appeared to become a permanent condition. Other adverse symptoms of Benzos include trouble focusing, rembering things, learning new material and solving problems.
Chapter 8: An Episodic Illness Turns Chronic
Although a handful of European physicians may have sounded the alarm about the changing course of depression in the late 1960s and early 1970s, it wasn’t until 1994 that an Italian psychiatrist, Giovanni Fava, from the University of Bologna, pointedly announced that it was time for psychiatry to confront this issue. Neuroleptics had been found to be problematic over the long term, the benzodiazepines had, too, and now it looked like the antidepressants were producing a similar long-term record. In a 1994 Editorial in Psychotherapy and Psychosomatics, Fava wrote:
“I wonder if the time has come for debating and initiating research into the likelihood that psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat. In several more articles that followed, Fava offered a biological explanation for what was going on with the antidepressants. Like antipsychotics and benzodiazepines, these drugs perturb neurotransmitter systems in the brain. This leads to compensatory processes that oppose the initial acute effects of a drug…” When drug treatment ends, these processes may operate unopposed, resulting in appearance of withdrawal symptoms and increased vulnerability to relapse. A statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse, Fava noted.
Fava also wondered what was the outcome for people who stayed on antidepressants indefinitely. Weren’t they also relapsing with great frequency? He summed up the problem in this way:
“Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression. Use of antidepressants drugs may propel the illness to a more malignant and treatment unresponsive course.”
Finally, Scott Patten, from the University of Calgary, plumbed a large Canadian health database to assess the five-year outcomes of 9,508 depressed patients, and he determined that the medicated patients were depressed on average nineteen weeks each year, versus eleven weeks for those not taking the drugs. These findings, Patten wrote, were consistent with Giovanni Fava’s hypothesis that, “antidepressant treatment may lead to a deterioration in the long-term course of mood disorders.
Returning to someone closer to home, William Coryell and his NIMH-funded colleagues studied the six year “naturalistic” outcomes of 547 people who suffered a bout of depression and they found those who were treated for the illness were three times more likely than the untreated group to suffer a “cessation” of their “principal social role” and nearly seven times more likely to become “incapacitated.”
Whitaker presents several demonological and long-term studies relating to the second generation of antidepressants or SSRIs. Here due to both time and space I will cite just one of the long-term studies by J. Moncrieff. “Trends in sickness benefits in Great Britain and the contribution of mental disorders. Both in the United States and in Great Britain scientists observed that following the arrival of the SSRIs, the number of citizens disabled by depression dramatically increased.
In Britain the number of days on incapacity due to depression and neurotic disorders jumped from 38 million in 1984 to 117 million in 1999, a threefold increased.
Chapter 9: The Bipolar Boom
Do antidepressants worsen the long-term course of bipolar disorder?
Frederick Goodwin and Robert Post’s latest book, Manic Depressive Illness, which is considered the bible in the field of bipolar disorders. At the 2008 APA conference, Goodwin gave this bottom-line summary.
Bipolar outcomes had noticeably worsened in the past twenty years. He went on to tell why. Today, we have a lot more rapid cycling, a lot more lithium resistance, and a lot more lithium treatment failures than there was previously. Regrettably today that most bipolar patients get an antidepressant before they ever get exposed to a mood stabilizer.
Nassir Ghaemi, from Tufs Medical Center agreed that antidepressants can cause manic switches and turn patients into rapid cyclers, and may actually increase the amount of time they spend in depressive episodes. He went on to say that the literature tells us that “the number of episodes is associated with more cognitive deficits. ”We are building more episodes, more treatment resistance, more cognitive dysfunction, and there is data showing that if you have four depressive episodes, unipolar or bipolar, it doubles your late life risk of dementia. Long-term outcomes for bipolar disorder have dramatically worsened in the pharmacotherapy era.
In Robert Whitaker’s segment on, Bipolar Before Lithium, he summarized it best. “Given what the scientific literature revealed about the long-term outcomes of medicated schizophrenia, anxiety, and depression, it stood to reason that the drug cocktails used to treat bipolar illness were not going to produce good long-term results.
The increased chronicity, the functional decline, the cognitive impairment, and the physical illness, all of these can be expected to show up in people treated with a cocktail that often includes an antidepressant, an antipsychotic, a mood stabilizer, a bensodiazepine, and perhaps a stimulant, too.
Chapter 10: An Epidemic Explained
We are now coming to the close of our examination of the long-term outcomes literature for the major psychiatric disorders for adults. I would like to leave with you the fifteen year long-term findings for manic depressive patients conducted by Martin Harrow from 1975 to 1983. Harrow followed four different groups: Schizophrenia on meds, manic-Depressive on meds, schizophrenia off meds, and maniac-depressive off meds. Here briefly were his findings:
Over the long-term, the manic depressive patients who stopped taking psychiatric drugs fared pretty well. At the end of two years, they were still struggling with their illness. Then they began to improve, and by the end of the study their collective scores fell into the “recovered” category on Harrow’s global assessment scale. The recovered patients were working at least part-time, they had acceptable social functioning, and the were largely asymptomatic.
In contrast the manic depressive patients who stayed on their psychiatric medications did not fare so well. At the end of two year they remained quite ill, so much so they were now a little bit worse than the schizophrenia patients off meds. Then, over the next two and one half years, while the manic-depressive and schizophrenia patients who were off meds improved, the manic-depressive patients who kept taking their pills did not, such that by the end of 4.5years, they were doing markedly worse than the other three groups.
We all know that schizophrenia is the worse mental disorder with the worst long-term prognosis. Nevertheless in this long term NIMH-funded study, the manic-depressive group on medications had the worse long-term outcomes. While their counterparts who were off medication fared the best at the end of this fifteen year study.
Chapter 11: The Epidemic Spreads to Children
I would like to conclude this review of the psychiatric literature this morning by now turning our attention to our children. The prescribing of psychiatric drugs to children and adolescents is a recent phenomenon, as relatively few youth were medicated prior to 1980. This will also give us the opportunity to put Robert Whitaker’s thesis to the same test as we have applied to the four previous major disorders. Will we find, in the scientific literature and in societal data, that the medicating of children and teenagers is doing more harm than good? Is it putting many children who initially may be struggling with a relatively minor problem---a disinterest in school, or a bout of sadness – onto a path that leads to lifelong disability?
The diagnosing and medication of mental disorders for our children with depression was nearly nonexistent until Prozac and other SSRIs were brought to market and touted as wonder drugs. The percentage of children so medicated tripled between 1988 and 1994, and by 2002 one in every forty children under nineteen years of age in the US was taking an antidepressant.
Fifty years ago, physicians virtually never saw manic-depressive illnesses in preteens, and they rarely diagnosed it in adolescents. Suddenly pediatricians and psychiatrists began prescribing Ritalin to hyperactive children, and suddenly the medical journals began running case reports of manic children. This problem grew as the prescribing of Ritalin increased, and then it exploded with the introduction of the SSRIs.
Research has since showed that both of these drugs trigger bipolar symptoms in children and adolescent cents on a regular basis. Whitaker concludes that these are the two outside agents fueling the epidemic. It should be remembered that they do perturb normal brain function. The manic children showing up at hospital emergency rooms have dopaminergic and serotonergic pathways that have been altered by the drugs and are now functioning in an “abnormal” manner.
There are no good studies yet on the percentage of “early onset” bipolar patients who, when they reach adulthood, end up on the SSI and SSDI disability rolls. However the astonishing jump in the number of “severely mentally ill” children receiving SSI speaks volumes about the havoc that is being wreaked. There were 16,200 psychiatrically disabled youth under eighteen years old on the SSI roles in 1987, and they comprised less than 6 percent of the total number of disabled children. Twenty years later there were 561,569 disabled mentally ill children on the SSI rolls, and they comprised 50% of the total.
This epidemic is even hitting pre school children . The prescribing of psychotropic drugs to two-year olds and three-year olds began to become more commonplace about a decade ago, and sure enough, the number of severely mentally ill children under six years of age receiving SSI has tripled since the, rising from 22,453 in 2000 to 65,928 in 2007.
Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one of every fifteen Americans enters adulthood with a “serious mental illness.” Continuing to quote Whitaker, “The medicating of children has now become commonplace only a short time ago, and already it has put millions onto a path of lifelong mental illness.”
Now having reviewed the mental health outcome or evidenced-based literature let me conclude by saying a few things that these outcome studies have to say. First we have learned that antipsychotic drugs can help patients better manage their most acute symptoms early in the onset of the disorder.
(The conclusion of this paper will briefly highlight the most significant findings contained in these long term outcome studies for each of the four major disorders and for children. This paper remains a work in progress.)
Introduction
Welcome to this presentation this morning. Much of what I will share with you today can be found in Robert Whitaker’s latest book, Anatomy of an Epidemic – Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America.
Whitaker is an investigative medical reporter and has written one other book on this same topic. It’s called Mad in America. Some of the studies contained in Whitaker’s latest book also appear and are discussed in Mad in America. Maybe some of you have heard of both of these books. How many of you are familiar with either of them?
With respect to Anatomy of an Epidemic, I am convinced that Whitaker makes a strong case that indeed there is an epidemic of chronic disabled mental health patients, actually over four million, who have been diagnosed with a mental disability sufficient to be eligible for government assistance. Every day 1,100 adults and children are added to these rolls because they have become newly disabled by mental illness. Of this number 250 of these citizens are children. Using SSI and SSDI and other epidemiological data he argues that this epidemic is now spreading most rapidly among our nation’s children.
I am not here this morning however to try and persuade you to accept Whitaker’s admitally controversial chronic epidemic thesis --- in part because there is not enough time to do so, and because it would seriously detract from and compromise the larger long-term research studies presented in his book. Many readers of this book will argue that perhaps the greatest contribution to the mental health and medical research literature is Whitaker’s systematic documentation and grouping of the scientific long-term outcome studies by the four major mental disorders and for children.
As noted on my bio my expertise and experience includes thirty years as a clinical and program evaluator. I have conducted and have had published several papers on both clinical and program evaluation studies of my own, including an 18 month follow-up study on emotionally disturbed adolescents who were treated in a Wisconsin residential treatment facility.
During these three decades as a professional mental health clinician and evaluator I have tried to keep up on mental health research of all kinds. In fact it was due to such training and experience that my own interest was piqued when Whitaker’s recent book appeared. I just happened to have the good fortune to hear Whitaker interviewed about his book on Wisconsin Public Radio and I was both dismayed and confused when Whitaker began citing several long-term mental health outcome studies which until then I didn’t know even existed. Needless to say I bought the book and here I am.
Before turning to our very first long-term outcome follow-up study I suggest that we begin by comparing what you will hear today with the story presented by the American Psychiatric Association and large pharma. This latter story is one that we all know. It is a story that begins after WW 2 with the experimentation with certain chemical compounds or substances like dyes and their various reactions on caged rats. These various compounds were soon used on humans as an anesthetic in surgery to calm the patient.
Using rats and mice scientists observed that various compounds produced certain effects or behavior in these animals. Some substances produced less hyperactivity, greater calmness and manageability. By 1955 an antipsychotic drug called Thorazine appeared on the market for humans.
American psychiatry and pharmaceutical companies soon began to credit this drug with ending the suffering of the chronically ill and for making deinstitutionalization possible. The APA touted this drug as our first antidote to a mental disorder. One writer haled Thorazine for initiating a revolution in psychiatry, comparable to the introduction of penicillin in general medicine. This was the start of the psychopharmacological revolution. Now all of us are familiar with the story told by big pharma. It is a story that began with the National Institute of Mental Health’s first drug trials what was later called the magic or silver bullet era that now is regularly stoked with ever newer miracle drugs. About this same time the Diagnostic and Statistical Manual also appeared and drew a line as to what is normal and what is not. Also during this early period there was the need to discover and demonstrate an antibiotic-like pill that would “treat the brain by curing chemical imbalances that causes mental disorders.” Slightly before and during the same time period something called “community psychiatry” which was threatening to redefine American psychiatry and vigorously opposed by a more conservative branch of the AMA.
During this same period there was also pressure on the psychiatric profession to adopt a more rigorous research design in order to increase its scientific credibility. They chose a research design that had been recently used and proven in infectious disease: studies which included placebo-controlled, double-blind, randomized clinical trials. Thorazine came on the market over a half century ago in June of 1951 to treat psychotic disorders.
Whitaker asks the reader to compare this idealized and more sexy version of American psychiatric history with a more realistic and candid story told by the numerous long-term mental health outcome studies that his book has just recently brought into public light, and presented to you here today.
Chapter 6: A Paradox Revealed
This story, told in the narrative of long-term scientific studies, really begins when the National Institute of Mental Health was asked to design and conduct the first Thorazine drug trials and evaluate its safety and effectiveness. Here it would be helpful to first consider briefly the difference between Food and Drug Administration’s approved clinical drug trails versus long-term mental health outcome follow-up studies.
As you know, most clinical drug trials are designed to run for as little as four to six weeks, while long term follow-up studies might run for up to one to ten years or more. Unlike clinical trials which target only clinical symptoms typically observed during the intake or initial office visit, such as anxiety, depression, mental confusion, long-term follow-up studies are more likely to use global rating scales and broader and more concrete social functioning indicators such as employment, family relationships, relapses, physical health and medication status.
And, while clinical trials use more narrow industry-driven rating scales often routinely administered by the treating clinician themselves to rate the patient’s progress, long-term outcome studies tend to use several different broad social functioning measures and are rated by more independent and objective verification sources, who are usually, not involved in the treatment or clinical process per se.
Now, what does the long-term scientific mental health evidence tell us with regard to the treatment of schizophrenia with antipsychotic drugs?
In 1961 the Psychopharmacology Service Center using symptom-based rating scales in short term placebo studies researcher found 75 percent of the drug-treated patients to be “much improved” versus 23 percent of the placebo (non-medicated) patients.
Following this study hundreds of smaller studies have since produced similar results. Sixty-six such short-term studies were reviewed and found that 53 percent of the drug withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medications. These results prompted the researcher to conclude that “The efficacy of these medications in reducing the risk of psychotic relapse has been well documented.” 1995 See: NIMH investigators, and Patricia Gilbert, “Neuroleptics withdrawal in schizophrenic patients.”
Later in 1967 the NIMH’s conducted a one year after discharge follow-up study with 299 schizophrenia patients who had been treated with either neuroleptics or placebo upon their admission to a hospital.
In this landmark study the researchers found that patients who received placebo “were less likely to be re-hospitalized than those who received any of the three active phenothiazines.” See: Schooler, N. American Journal of Psychiatry, 123 (1967):986-995.
After this study the researchers described these results as “ so unexpected” but stated that despite these findings, they “were unprepared to recommend placebo as the treatment of choice.”
This study was soon followed by NIMH’s first two relapse studies.
The first such study investigated whether relapse rates increased in direct relation to dosage. The critical finding of this NIMH funded study was that relapse rates rose in direct relation to dosage—the higher the dosage that patients were on before the drugs were withdrawn, the greater the relapse rates.
At the start of this study, 18 patients were on placebo, and only one got worse over the next six months (6%). Sixty-five patients were on 300 mg. of chlorpromazine at the start of the study, and 54% of these patients got worse after drug withdrawal. One hundred thirteen patients were on more than 300mg. of chlorpromazine at the start of the study, and 66% of these patients got worse after drug withdrawal. See: Relapse in Chronic Schizophrenics following Abrupt Withdrawal of Tranquilizing Medication, Prien, R. British Journal of Psychiatry, 115 (1968) 679-86.
In the second relapse study, the earlier finding that relapse rates rose in correlation with neuroleptics dosage was confirmed. Only 2 of 30 patients who were on placebo at the start of the study relapsed during the next 24 weeks (7%). Twenty-three percent of the 99 patients who were on under 300 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal. Fifty-two percent of the 91 patients who were on 300 to 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal, and sixty-five percent of the 81 patients who were on more than 500 mg. of chlorpromazine at the start of the study relapsed following drug withdrawal.
The researchers concluded: “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo—the higher the dose, the greater the probability of relapse.” See: Discontinuation of Chemotherapy for Chronic Schizophrenics, Prien, R. Hospital and Community Psychiatry, 22 (1971), 20-23.
It seems paradoxical that drugs that ameliorate acute psychotic symptoms over the short term will actually increase the likelihood that a person diagnosed with schizophrenia will become chronically ill. But as we have just seen, that disturbing fact showed up in the very first outcome studies presented here.
In 1997 Ross Baldessarini of Harvard Medical School reviewed 145 of such clinical trials and found that the antipsychotic proved superior to a placebo in 83 % of them. The Brief Psychiatric Rating Scale (BPRS) adopted by the American Psychiatric Association was regularly employed in these trials. The APA eventually decided that a 20 percent reduction in total BPRS score represented a clinically significant response to a drug. Based on this measurement, an estimated 70 percent of all schizophrenia patients suffering from an acute episode of psychosis “respond” over a six week period, to an antipsychotic medication.
Once the NIMH investigators determined that the antipsychotics were efficacious over the short term they naturally wanted to know how long schizophrenia patients should stay on the medication.
To investigate this question, they ran studies that, for the most part, had the following design: Patients who were good responders to the medication were either maintained on the drug or abruptly withdrawn from it.
In 1995, Patricia Gilbert at the University of California at San Diego reviewed sixty-six relapse studies, involving 4,365 patients and found that 53 percent of the drug-withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medication. Gilbert concluded that “The efficacy of these medications in reducing the risk of psychotic relapse has been well documented.” It was later discovered after repeating this study that when the drugs were gradually withdrawn, the relapse rate was only one-third as high as in the abrupt-withdrawal studies.
Based on these relapse studies, in a 2002 John Geddes, a prominent British researcher, wrote in an article in the New England Journal of Medicine, “Anti-psychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.
Nevertheless, in 2007 the Cochrane Collaboration, an international group of scientists that doesn’t take funding from pharmaceutical companies, raised questions about the drug’s short-term efficacy.
They conducted a meta-analysis of all chlorpromazine-versus placebo studies in the scientific literature, and after identifying fifty of decent quality, they came to the following conclusion: (Most briefly, a meta-analysis study is one that combines the results of several studies that address a set of related research hypotheses. In the simplest form, this is normally by identification of a common measure effect size, for which a weighted average might be the output of a meta-analysis.)
They calculated that seven patients had to be treated with chlorpromazine to produce a net gain of one “global improvement” and that even this finding may be an overestimate of the positive and an underestimate of the negative effects of giving chlorpromazine.” These investigators noted that they were startled by their results. This was the first attempt to assess the long-term efficacy of these drugs when a long-term measure was applied.
Even if one accepts the objectivity of this clinical trial procedure many investigators have pointed to the large hole in this evidence base. Joseph Zubin warned that when it came to evaluating a therapy for psychiatric disorder, a six-week study induced a kind of scientific myopia.
“It would be foolhardy to claim a definite advantage for a specified therapy without a two-to five-year follow-up. A two year follow-up would seem to be the very minimum for the long-term effects.
Lisa Dixon, psychiatrists at the University of Maryland School of Medicine in 1995 went still further in her criticism. “Little can be said about the efficacy and effectiveness of conventional antipsychotics on nonclinical outcomes.” Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.
After reviewing a robust number of such clinical trial results, Whitaker noted, “Evidence that the drugs might worsen long-term outcomes showed up in the very first follow-up study conducted by the NIMH, and then it appears again and again in the research literature over the next fifty years. Some of these researchers include: J. Cole, 1977, Bockover 1975, Rappaport 1978, W. Carpenter 1977, L. Mosher 2003, C. Harding 1994, M. Harrow 2007, World Health Organization 1998
Evidence that long-term recovery rates are higher for non-medicated patients appears in studies and investigations of many different types. It shows up in the randomized studies conducted by Rappaport, Carpenter, and Mosher; in the cross-cultural studies conducted by the World Health Organization; and in the naturalistic studies conducted by Harding and Harrow.
Once a new tool for studying brain structures came along called electro-magnetic resonance imagery (MRIs), investigators discovered that antipsychotics fail to maintain or increase the size of the frontal lope and the white matter found there. These morphological changes in the brain reflect a “progressive neurodevelopmental disorder” in the schizophrenic patient which is associated with negative symptoms and both cognitive and functional impairments, which antipsychotics fail to arrest. (See: Nancy Andreason, American Journal of Psychiatry, 2003.
Whitaker makes the point that for the most part, the psychiatric researchers who conducted these studies hoped and expected to find the reverse. They wanted to tell a story of drugs that help schizophrenia patients fare well over
Conclusion - Now to summarize, what does the long-term scientific mental health evidence tell us about the record of antipsychotic medication for the treatment of schizophrenia?
1.Beginning in 1961 using symptom-based rating scales in short term placebo studies researcher found 75 percent of the drug-treated patients to be “much improved” versus 23 percent of the placebo (non-medicated) patients.
Following this study hundreds of smaller studies produced similar results. Sixty-six such short-term studies were reviewed and found that 53 percent of the drug withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medications. See: NIMH investigators, and Patricia Gilbert
2. The first 1967 one year-after hospital discharge study found that patients who received placebo (non-medicated) “were less likely to be re-hospitalized than those who received any of the three active phenothiazines. See: N. Schooler
3. In two drug withdrawal trials, both of which included patients who weren’t on any drug at the start of the study, relapse rates rose in correlation with drug dosage. The higher the dose the greater the probability of relapse. See: R. Prien
4. There is no good evidence that antipsychotics improve long-term schizophrenia global outcomes. See: Lisa Dixon and Emmanuel Stip
5. There is significance evidence that drugs might worsen long-term outcomes. See: Cole, Bockoven, Rappaport, Carpenter, Mosher, Harding, and the WHO.
6. There is long-term evidence that antipsychotics affect the brain, and why the drug-withdrawal studies have misled psychiatrists into believing that the drugs prevented relapse. See: Chouinard and Jones
7. There is long-term evidence research that randomized placebo studies show that recovery rates are higher for non-medicated patients. See: Rappaport, Carpenter, Mosher
8. There are long-term studies that indicate that drugs induce global brain dysfunction in a high percentage of patients over the long term. See: the tardive dyskinesia studies by
9. There is also evidence that antipsychotics cause morphological changes in the brain and that these changes are associated with a worsening of both positive and negative symptoms, and with functional and cognitive functioning as well. See: Andreasen MRI studies
10. There is long-term evidence showing how schizophrenic patients in the US are faring following their hospitalization. See: Martin Harrow’s NIMH funded 2007 fifteen-year follow-up global outcome study showing that 40 percent of schizophrenic patients off antipsychotics recovered, versus 5 percent of the medicated patients.
At the 2008 APA conference Harrow stated: I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning outcomes than those on antipsychotics.”
(There is long-term evidence-based study that demonstrates that seven patients had to be treated with chlorpromazine to produce a net gain of one “global improvement.” versus a mere symptomatic short-term benefit. See: The 2007 Cockrane Collaboration.)
Chapter 7: The Benzo Trap
When Hoffmann-La Roche brought Valium to the market in 1963, advertising it in particular to women, and from 1968 to 1981, it was the bestselling drug in the Western world. Valium was preceded by Miltown which was often referred to as “mother’s little helper.” During this same period the number of people admitted to mental hospitals, psychiatric emergency rooms, and mental health outpatient clinics soared.
First discovered by George Beard in 1869 he described the condition as ”tired nerves” and defined the symptoms as consisting of worry, fatigue, and insomnia. He later also named the condition “neurasthenia.” Sigmund Freud first began treating neurasthenia in 1895 and soon announced that Beard’s disease of dread and worry were psychological in origin rather than tired nerves. He began to write about anxiety neurosis in women which he theorized arose in a large part form their unconscious repression and sexual desires and fantasies. Until the onset of Benzodiazepines psychiatry was a profession for those who treated mad patients in thee asylum.
Once researches in the United States and the United Kingdom determined that Benzos did not provide any durable relief from anxiety, an obvious question arose: Do these drugs when taken on a continual basis, worsen the very symptoms they are supposed to treat? In 1991 Karl Rickels at the University Pennsylvania School of Medicine reported on a three year follow-up study. Rickels reported on a group of anxious patients and found that those who had successfully gotten off the drugs were doing “significantly” better than those who had failed to so.
A few years later he was back with another study and found that when long-term users withdrew from Benzos, they became more alert, more relaxed, and less anxious, and this change was accompanied by improved psychomotor functions.
Soon Canadian investigators found that benzo usage led to a fourfold increase in depressive symptoms. In England Aston observed that those who stay on the drugs tend to become more ill. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzo use, and panic attack, agoraphobia may also appear for the first time. David Knott, a physician at the University of Tennessee, warned in 1976 that, “I am very convinced that Valium, Librium and other benzo drugs of that class cause damage to the brain. He discovered damage to the cerebral cortex which appeared to become a permanent condition. Other adverse symptoms of Benzos include trouble focusing, rembering things, learning new material and solving problems.
Chapter 8: An Episodic Illness Turns Chronic
Although a handful of European physicians may have sounded the alarm about the changing course of depression in the late 1960s and early 1970s, it wasn’t until 1994 that an Italian psychiatrist, Giovanni Fava, from the University of Bologna, pointedly announced that it was time for psychiatry to confront this issue. Neuroleptics had been found to be problematic over the long term, the benzodiazepines had, too, and now it looked like the antidepressants were producing a similar long-term record. In a 1994 Editorial in Psychotherapy and Psychosomatics, Fava wrote:
“I wonder if the time has come for debating and initiating research into the likelihood that psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat. In several more articles that followed, Fava offered a biological explanation for what was going on with the antidepressants. Like antipsychotics and benzodiazepines, these drugs perturb neurotransmitter systems in the brain. This leads to compensatory processes that oppose the initial acute effects of a drug…” When drug treatment ends, these processes may operate unopposed, resulting in appearance of withdrawal symptoms and increased vulnerability to relapse. A statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse, Fava noted.
Fava also wondered what was the outcome for people who stayed on antidepressants indefinitely. Weren’t they also relapsing with great frequency? He summed up the problem in this way:
“Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression. Use of antidepressants drugs may propel the illness to a more malignant and treatment unresponsive course.”
Finally, Scott Patten, from the University of Calgary, plumbed a large Canadian health database to assess the five-year outcomes of 9,508 depressed patients, and he determined that the medicated patients were depressed on average nineteen weeks each year, versus eleven weeks for those not taking the drugs. These findings, Patten wrote, were consistent with Giovanni Fava’s hypothesis that, “antidepressant treatment may lead to a deterioration in the long-term course of mood disorders.
Returning to someone closer to home, William Coryell and his NIMH-funded colleagues studied the six year “naturalistic” outcomes of 547 people who suffered a bout of depression and they found those who were treated for the illness were three times more likely than the untreated group to suffer a “cessation” of their “principal social role” and nearly seven times more likely to become “incapacitated.”
Whitaker presents several demonological and long-term studies relating to the second generation of antidepressants or SSRIs. Here due to both time and space I will cite just one of the long-term studies by J. Moncrieff. “Trends in sickness benefits in Great Britain and the contribution of mental disorders. Both in the United States and in Great Britain scientists observed that following the arrival of the SSRIs, the number of citizens disabled by depression dramatically increased.
In Britain the number of days on incapacity due to depression and neurotic disorders jumped from 38 million in 1984 to 117 million in 1999, a threefold increased.
Chapter 9: The Bipolar Boom
Do antidepressants worsen the long-term course of bipolar disorder?
Frederick Goodwin and Robert Post’s latest book, Manic Depressive Illness, which is considered the bible in the field of bipolar disorders. At the 2008 APA conference, Goodwin gave this bottom-line summary.
Bipolar outcomes had noticeably worsened in the past twenty years. He went on to tell why. Today, we have a lot more rapid cycling, a lot more lithium resistance, and a lot more lithium treatment failures than there was previously. Regrettably today that most bipolar patients get an antidepressant before they ever get exposed to a mood stabilizer.
Nassir Ghaemi, from Tufs Medical Center agreed that antidepressants can cause manic switches and turn patients into rapid cyclers, and may actually increase the amount of time they spend in depressive episodes. He went on to say that the literature tells us that “the number of episodes is associated with more cognitive deficits. ”We are building more episodes, more treatment resistance, more cognitive dysfunction, and there is data showing that if you have four depressive episodes, unipolar or bipolar, it doubles your late life risk of dementia. Long-term outcomes for bipolar disorder have dramatically worsened in the pharmacotherapy era.
In Robert Whitaker’s segment on, Bipolar Before Lithium, he summarized it best. “Given what the scientific literature revealed about the long-term outcomes of medicated schizophrenia, anxiety, and depression, it stood to reason that the drug cocktails used to treat bipolar illness were not going to produce good long-term results.
The increased chronicity, the functional decline, the cognitive impairment, and the physical illness, all of these can be expected to show up in people treated with a cocktail that often includes an antidepressant, an antipsychotic, a mood stabilizer, a bensodiazepine, and perhaps a stimulant, too.
Chapter 10: An Epidemic Explained
We are now coming to the close of our examination of the long-term outcomes literature for the major psychiatric disorders for adults. I would like to leave with you the fifteen year long-term findings for manic depressive patients conducted by Martin Harrow from 1975 to 1983. Harrow followed four different groups: Schizophrenia on meds, manic-Depressive on meds, schizophrenia off meds, and maniac-depressive off meds. Here briefly were his findings:
Over the long-term, the manic depressive patients who stopped taking psychiatric drugs fared pretty well. At the end of two years, they were still struggling with their illness. Then they began to improve, and by the end of the study their collective scores fell into the “recovered” category on Harrow’s global assessment scale. The recovered patients were working at least part-time, they had acceptable social functioning, and the were largely asymptomatic.
In contrast the manic depressive patients who stayed on their psychiatric medications did not fare so well. At the end of two year they remained quite ill, so much so they were now a little bit worse than the schizophrenia patients off meds. Then, over the next two and one half years, while the manic-depressive and schizophrenia patients who were off meds improved, the manic-depressive patients who kept taking their pills did not, such that by the end of 4.5years, they were doing markedly worse than the other three groups.
We all know that schizophrenia is the worse mental disorder with the worst long-term prognosis. Nevertheless in this long term NIMH-funded study, the manic-depressive group on medications had the worse long-term outcomes. While their counterparts who were off medication fared the best at the end of this fifteen year study.
Chapter 11: The Epidemic Spreads to Children
I would like to conclude this review of the psychiatric literature this morning by now turning our attention to our children. The prescribing of psychiatric drugs to children and adolescents is a recent phenomenon, as relatively few youth were medicated prior to 1980. This will also give us the opportunity to put Robert Whitaker’s thesis to the same test as we have applied to the four previous major disorders. Will we find, in the scientific literature and in societal data, that the medicating of children and teenagers is doing more harm than good? Is it putting many children who initially may be struggling with a relatively minor problem---a disinterest in school, or a bout of sadness – onto a path that leads to lifelong disability?
The diagnosing and medication of mental disorders for our children with depression was nearly nonexistent until Prozac and other SSRIs were brought to market and touted as wonder drugs. The percentage of children so medicated tripled between 1988 and 1994, and by 2002 one in every forty children under nineteen years of age in the US was taking an antidepressant.
Fifty years ago, physicians virtually never saw manic-depressive illnesses in preteens, and they rarely diagnosed it in adolescents. Suddenly pediatricians and psychiatrists began prescribing Ritalin to hyperactive children, and suddenly the medical journals began running case reports of manic children. This problem grew as the prescribing of Ritalin increased, and then it exploded with the introduction of the SSRIs.
Research has since showed that both of these drugs trigger bipolar symptoms in children and adolescent cents on a regular basis. Whitaker concludes that these are the two outside agents fueling the epidemic. It should be remembered that they do perturb normal brain function. The manic children showing up at hospital emergency rooms have dopaminergic and serotonergic pathways that have been altered by the drugs and are now functioning in an “abnormal” manner.
There are no good studies yet on the percentage of “early onset” bipolar patients who, when they reach adulthood, end up on the SSI and SSDI disability rolls. However the astonishing jump in the number of “severely mentally ill” children receiving SSI speaks volumes about the havoc that is being wreaked. There were 16,200 psychiatrically disabled youth under eighteen years old on the SSI roles in 1987, and they comprised less than 6 percent of the total number of disabled children. Twenty years later there were 561,569 disabled mentally ill children on the SSI rolls, and they comprised 50% of the total.
This epidemic is even hitting pre school children . The prescribing of psychotropic drugs to two-year olds and three-year olds began to become more commonplace about a decade ago, and sure enough, the number of severely mentally ill children under six years of age receiving SSI has tripled since the, rising from 22,453 in 2000 to 65,928 in 2007.
Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one of every fifteen Americans enters adulthood with a “serious mental illness.” Continuing to quote Whitaker, “The medicating of children has now become commonplace only a short time ago, and already it has put millions onto a path of lifelong mental illness.”
Now having reviewed the mental health outcome or evidenced-based literature let me conclude by saying a few things that these outcome studies have to say. First we have learned that antipsychotic drugs can help patients better manage their most acute symptoms early in the onset of the disorder.
(The conclusion of this paper will briefly highlight the most significant findings contained in these long term outcome studies for each of the four major disorders and for children. This paper remains a work in progress.)
Wednesday, April 13, 2011
Robert Whitaker Book Review Group Meeting Re: Long-term mental health patient outcomes
MEETING MINUTES
Meeting Place: Wisconsin Family Ties
Participants present: Jackie Baldwin, Paula Buege, Mike Bachhuber, Bill Benedict, Lori Krinki and Joann T.Stephens. Donna Wren, was unable to attend, but agreed to share her comments about: Robert Whitaker’s book, Part 3, Chapter 6 soon.
Bill began this meeting by thanking all those present for taking on this assignment and for their attendance. Special thanks were given to Paula for helping to arrange the best date for this meeting and to Lori for providing the meeting location and telephone hookup.
The first forty-five minutes of the meeting went by much too quickly as we each took turns talking about our reading assignment, but it was well worth it. Several points of concern and questions helped us considerably to better clarify this advocacy project’s much narrower mission: To help inform all Wisconsin Council on Mental Health members of the importance of long-term mental health patient outcome findings, and using this knowledge when reviewing policies/grants and best practice service standards. (For those interested, below I have also added a summary of this reading assignment.)
Following the discussion members gave attention to the project’s July 30, 2011 timetable which called for Council action on his request by July 30, 2011. While Bill expressed thanks and appreciation for Council cooperation thus far for what has already been accomplished to date, including both his two Council meeting visits and presentation to both the Adult Quality and Policy and Legislative Committees, however, he expressed concern with the progress made to date.
While the earlier discussion of Whitaker’s book was enthusiastic and compelling, efforts to identify what Council action might be most effective proved to be more challenging. The following member suggestions were considered: 1.) conduct more awareness- raising educational opportunities for Council members. Perhaps a panel discussion and Q&A meeting at a Council meeting; 2.) Ask Bill to present a concise summary of long-term study findings for each of the four major mental disorders and ADHD, 3) Establish a long-term patient outcome sub-committee composed of members from each of the Council Committees to be a resource and advisory group to the Council., 4) Prepare a Council letter supporting greater attention to long-term patient findings to the Department and funding sources.5. The Council would recommend to the Department IT Unit long-term patient functioning indicators to be including in the existing service information system; Finally, 6.) recommend that this project be referred outside the Council to a state-wide patient peer organization.
With respect to the latter suggestion, Bill noted that after again carefully reviewing the Council’s mission and membership make-up that he was more than ever convinced that this patient advocacy project belongs with the Wisconsin Council on Mental Health.
Group members agreed to report back to their respective Committees on this meeting and the suggestion presented: Meeting closed at 3 PM
The following is a summary review of the reading content discussed by group members:
(In order to share the nature of the reading content discussed, please note below the summary contained in Chapter 6, “The Case for Neuroleptics” and their effectiveness in the short-term and long-term. Whitaker states that “Once these anti-psychotic drugs were proven to be effective in the short-term, attention soon turned to determining, how long schizophrenia patients should stay on the medication?
To investigate this question, they ran studies that, for the most part, had this design: Patients who were good responders to the medication were either maintained on the drugs or abruptly withdrawn from them. Many such studies were done and showed good results with 53 percent of the drug-withdrawn patients, relapsed within ten months versus 16 percent of those maintained on the medication.
Based upon this research, an investigator summarized these findings this way: “The efficacy of these medications in reducing the risk of psychotic relapse has now been well documented.” Furthermore, as late as 2002 John Geddes, a prominent British researcher, wrote in the New England Journal of Medicine, “Anti-psychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.”
Whitaker however claimed he saw “a hole in this evidence,” and cites another prominent investigator of the New York State Psychiatric Institute, Joseph Zubin who earlier in a 1956 conference warned that when it came to evaluating a therapy for a psychiatric disorder, a six-week study induced a kind of scientific myopia. It would be foolhardy to claim a definite advantage for a specified therapy without a two to five-year follow-up,” he said. (Please note the attachment which gives the differences between a clinical trials study versus a long-term study.)
Now with respect to the hole in the evidence, an investigator, Liza Dixon, at the University of Maryland School of Medicine in 1995, goes on to add that “Little can be said about the efficacy and effectiveness of conventional antipsychotics on non-clinical outcomes. Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.”
As late as 2002 an editorial in European Psychiatry, a professor of psychiatry at the University de Montreal, Emmanuel Stip had this to say: “After fifty ears of neuroleptics, are we able to answer the following simple question: Are neuroleptics effective in treating schizophrenia/” There was, he said “no compelling evidence on the matter, when ‘long-term’ is considered.”
Out of the following context Whitaker, after reviewing medical and scientific journals going back over fifty years, then goes on to agree that there is no long-term data to be reviewed. Whitaker is not easily satisfied however, and goes on to say that “it is in fact possible to piece together a story of how antipsychotics alter the course of schizophrenia. He suggests that the story to answer this question begins, quite appropriately, with the NIMHs follow-up study of the 344 patients in its initial nine-hospital trial.
Most briefly, this NIMH study found that regardless of what treatment they had received in the hospital, they were not faring so badly. At the end of one year, 254 were living in the community, and 58 percent of those who according to their age and gender, could be expected to work were in fact employed. He then notes, that at this very first moment in the scientific literature, there is the hint of a paradox. “While the drugs were effective over the short term, perhaps they made people more vulnerable to psychosis over the long-term, and thus the higher re-hospitalization rates for drug-treated patients at the end of one year.
Partly as a result of these findings, soon the NIMH investigators were back with another surprising result. In two drug withdrawal trials, both of which included patients who weren’t’ on any drug at the start of the study. Relapse rates rose in correlation with drug dosage. Only 7 percent of those who had been on a placebo at the start of the study relapsed, compared to 65 percent of those taking more than five hundred milligrams of the chlorpromazine before the drug was withdrawn. “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo---the higher the doses the greater the probability of relapse,”)
Out of the above summarized context Lori did however begin our group’s discussion with a question relating to the validity and usefulness of findings derived from a retroactive study by two psychiatrists at Boston Psychopathic Hospital---J. Sanbourne Bockover and Harry Solmon. In their study they found that 45 percent of the patients treated in 1947 at their hospital hadn’t relapsed in the next five years and 76 percent were successfully living in the community at the end of that follow-up period.
In contrast, only 31 percent of the patients treated at the hospital in 1967 with neuroleptics remained relapse-free for five years, and as a group they were much more “socially dependent” on welfare and needing other forms of support. They concluded, that their extended use (neuroleptics) in aftercare may prolong the social dependency of many discharged patients. Part of Lori’s concern had to do with the two comparison groups used and the appropriateness of the two very different follow-up dates.
(Why do we need more and better long-term mental health patient follow-up studies: They may help us to more objectively and better determine what forms of care are strongly associated with fewer relapses, or with higher global functioning scale results. Or they may provide us with more and better information about what is the optimum dosage and duration of care for different diagnostic mental health populations? How do long-term continuous medication regimens compare with more episodic or as-needed medication practices?
Finally, we may be able to better determine what kinds of mental health outcomes are correlated with economic independence, physical health, quality of life satisfaction, family and community engagement, and mortality rates.)
Respectively submitted,
William R. Benedict
Mental Health Patient Advocate
Meeting Place: Wisconsin Family Ties
Participants present: Jackie Baldwin, Paula Buege, Mike Bachhuber, Bill Benedict, Lori Krinki and Joann T.Stephens. Donna Wren, was unable to attend, but agreed to share her comments about: Robert Whitaker’s book, Part 3, Chapter 6 soon.
Bill began this meeting by thanking all those present for taking on this assignment and for their attendance. Special thanks were given to Paula for helping to arrange the best date for this meeting and to Lori for providing the meeting location and telephone hookup.
The first forty-five minutes of the meeting went by much too quickly as we each took turns talking about our reading assignment, but it was well worth it. Several points of concern and questions helped us considerably to better clarify this advocacy project’s much narrower mission: To help inform all Wisconsin Council on Mental Health members of the importance of long-term mental health patient outcome findings, and using this knowledge when reviewing policies/grants and best practice service standards. (For those interested, below I have also added a summary of this reading assignment.)
Following the discussion members gave attention to the project’s July 30, 2011 timetable which called for Council action on his request by July 30, 2011. While Bill expressed thanks and appreciation for Council cooperation thus far for what has already been accomplished to date, including both his two Council meeting visits and presentation to both the Adult Quality and Policy and Legislative Committees, however, he expressed concern with the progress made to date.
While the earlier discussion of Whitaker’s book was enthusiastic and compelling, efforts to identify what Council action might be most effective proved to be more challenging. The following member suggestions were considered: 1.) conduct more awareness- raising educational opportunities for Council members. Perhaps a panel discussion and Q&A meeting at a Council meeting; 2.) Ask Bill to present a concise summary of long-term study findings for each of the four major mental disorders and ADHD, 3) Establish a long-term patient outcome sub-committee composed of members from each of the Council Committees to be a resource and advisory group to the Council., 4) Prepare a Council letter supporting greater attention to long-term patient findings to the Department and funding sources.5. The Council would recommend to the Department IT Unit long-term patient functioning indicators to be including in the existing service information system; Finally, 6.) recommend that this project be referred outside the Council to a state-wide patient peer organization.
With respect to the latter suggestion, Bill noted that after again carefully reviewing the Council’s mission and membership make-up that he was more than ever convinced that this patient advocacy project belongs with the Wisconsin Council on Mental Health.
Group members agreed to report back to their respective Committees on this meeting and the suggestion presented: Meeting closed at 3 PM
The following is a summary review of the reading content discussed by group members:
(In order to share the nature of the reading content discussed, please note below the summary contained in Chapter 6, “The Case for Neuroleptics” and their effectiveness in the short-term and long-term. Whitaker states that “Once these anti-psychotic drugs were proven to be effective in the short-term, attention soon turned to determining, how long schizophrenia patients should stay on the medication?
To investigate this question, they ran studies that, for the most part, had this design: Patients who were good responders to the medication were either maintained on the drugs or abruptly withdrawn from them. Many such studies were done and showed good results with 53 percent of the drug-withdrawn patients, relapsed within ten months versus 16 percent of those maintained on the medication.
Based upon this research, an investigator summarized these findings this way: “The efficacy of these medications in reducing the risk of psychotic relapse has now been well documented.” Furthermore, as late as 2002 John Geddes, a prominent British researcher, wrote in the New England Journal of Medicine, “Anti-psychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.”
Whitaker however claimed he saw “a hole in this evidence,” and cites another prominent investigator of the New York State Psychiatric Institute, Joseph Zubin who earlier in a 1956 conference warned that when it came to evaluating a therapy for a psychiatric disorder, a six-week study induced a kind of scientific myopia. It would be foolhardy to claim a definite advantage for a specified therapy without a two to five-year follow-up,” he said. (Please note the attachment which gives the differences between a clinical trials study versus a long-term study.)
Now with respect to the hole in the evidence, an investigator, Liza Dixon, at the University of Maryland School of Medicine in 1995, goes on to add that “Little can be said about the efficacy and effectiveness of conventional antipsychotics on non-clinical outcomes. Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.”
As late as 2002 an editorial in European Psychiatry, a professor of psychiatry at the University de Montreal, Emmanuel Stip had this to say: “After fifty ears of neuroleptics, are we able to answer the following simple question: Are neuroleptics effective in treating schizophrenia/” There was, he said “no compelling evidence on the matter, when ‘long-term’ is considered.”
Out of the following context Whitaker, after reviewing medical and scientific journals going back over fifty years, then goes on to agree that there is no long-term data to be reviewed. Whitaker is not easily satisfied however, and goes on to say that “it is in fact possible to piece together a story of how antipsychotics alter the course of schizophrenia. He suggests that the story to answer this question begins, quite appropriately, with the NIMHs follow-up study of the 344 patients in its initial nine-hospital trial.
Most briefly, this NIMH study found that regardless of what treatment they had received in the hospital, they were not faring so badly. At the end of one year, 254 were living in the community, and 58 percent of those who according to their age and gender, could be expected to work were in fact employed. He then notes, that at this very first moment in the scientific literature, there is the hint of a paradox. “While the drugs were effective over the short term, perhaps they made people more vulnerable to psychosis over the long-term, and thus the higher re-hospitalization rates for drug-treated patients at the end of one year.
Partly as a result of these findings, soon the NIMH investigators were back with another surprising result. In two drug withdrawal trials, both of which included patients who weren’t’ on any drug at the start of the study. Relapse rates rose in correlation with drug dosage. Only 7 percent of those who had been on a placebo at the start of the study relapsed, compared to 65 percent of those taking more than five hundred milligrams of the chlorpromazine before the drug was withdrawn. “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo---the higher the doses the greater the probability of relapse,”)
Out of the above summarized context Lori did however begin our group’s discussion with a question relating to the validity and usefulness of findings derived from a retroactive study by two psychiatrists at Boston Psychopathic Hospital---J. Sanbourne Bockover and Harry Solmon. In their study they found that 45 percent of the patients treated in 1947 at their hospital hadn’t relapsed in the next five years and 76 percent were successfully living in the community at the end of that follow-up period.
In contrast, only 31 percent of the patients treated at the hospital in 1967 with neuroleptics remained relapse-free for five years, and as a group they were much more “socially dependent” on welfare and needing other forms of support. They concluded, that their extended use (neuroleptics) in aftercare may prolong the social dependency of many discharged patients. Part of Lori’s concern had to do with the two comparison groups used and the appropriateness of the two very different follow-up dates.
(Why do we need more and better long-term mental health patient follow-up studies: They may help us to more objectively and better determine what forms of care are strongly associated with fewer relapses, or with higher global functioning scale results. Or they may provide us with more and better information about what is the optimum dosage and duration of care for different diagnostic mental health populations? How do long-term continuous medication regimens compare with more episodic or as-needed medication practices?
Finally, we may be able to better determine what kinds of mental health outcomes are correlated with economic independence, physical health, quality of life satisfaction, family and community engagement, and mortality rates.)
Respectively submitted,
William R. Benedict
Mental Health Patient Advocate
Monday, February 14, 2011
Reply From WI DHS
State of Wisconsin
Department of Health Services
February 14, 2011
Mr. William R. Benedict
Madison, WI 53704-5107
Dear Mr. Benedict:
Thanks you for your letter and your interest in informing the Wisconsin on Mental Health about Robert Whitaker’s book, “Anatomy of an Epidemic.” You noted that the book outlined the research regarding the long-term impact, cost and repercussion of reliance on prescription drugs to treat mental illness.
You note in your letter that you believe that the Council members, who include patients and family members, would be the best to review the findings of Mr. Whitaker’s book because they have the fewest conflicts of interest. At this point, the Council has not yet recommended to the Department further action or additional consideration of the book’s findings.
I agree with you that our Department should use every means possible to become more efficient and effective and use the latest data and research to promote the most cost-effective treatment approaches that will improve outcomes for people who have a mental illness. I appreciate the information that you have provided and thank you for binging this to my attention.
Sincerely,
Dennis G. Smith
Secretary
Department of Health Services
February 14, 2011
Mr. William R. Benedict
Madison, WI 53704-5107
Dear Mr. Benedict:
Thanks you for your letter and your interest in informing the Wisconsin on Mental Health about Robert Whitaker’s book, “Anatomy of an Epidemic.” You noted that the book outlined the research regarding the long-term impact, cost and repercussion of reliance on prescription drugs to treat mental illness.
You note in your letter that you believe that the Council members, who include patients and family members, would be the best to review the findings of Mr. Whitaker’s book because they have the fewest conflicts of interest. At this point, the Council has not yet recommended to the Department further action or additional consideration of the book’s findings.
I agree with you that our Department should use every means possible to become more efficient and effective and use the latest data and research to promote the most cost-effective treatment approaches that will improve outcomes for people who have a mental illness. I appreciate the information that you have provided and thank you for binging this to my attention.
Sincerely,
Dennis G. Smith
Secretary
Wednesday, February 2, 2011
Project Update - Letter to new Secretary of the Wisconsin Department of Health Services
Secretary Dennis Smith
Department of Health Services
1 West Wilson Street
P.O. Box 7850
Madison, WI 53707
February 2, 2011
Re: Wisconsin Council on Mental Health Action Recommendation
Dear Mr. Smith:
Congratulations and the best of luck in your new position. What follows is my effort to maintain the continuity and support for a modest project that is now in process. I hope it will accomplish much and at the lowest possible cost to Wisconsin taxpayers.
I am a retired social worker and worked for many years as the program evaluation specialist for Lutheran Social Services of Wisconsin and Upper Michigan.
In July of last year I wrote a letter to the then Sec. Karen Timberlake and alerted her to the recent book by Robert Whitaker called Anatomy of an Epidemic. I informed her that in spite of my many years in mental health research, only after reading Whitaker’s book did I become aware of the fifty or more evidenced-based long-term mental health outcome studies and their findings therein.
Most briefly, these long-term study findings ---several funded totally or in part by the NIMH ---consistently showed that mental health patients treated continuously on a strong drug regimen usually did less well than those treated primarily with fewer drugs and with a range of psychosocial therapies.
My recommendation to Ms. Timberlake simply called for members of Wisconsin’s Council on Mental Health to become as knowledgeable as possible of these latest evidenced-based long-term study findings, and in light of their own findings, consider there implications for the for the Division’s current mental health policies and practices. Presently my proposed recommendation to the Wisconsin Council on Mental Health has been assigned to the Council’s Legislative and Policy Committee.
Considering the challenges that all Wisconsin taxpayers now face along with a staggering deficit and an ever faltering economy I believe our health department should use every means possible to become more efficient and effective.
One way to do this is to simply take look at the latest scientific mental health long-term research study findings contained in Whitaker’s book but largely kept from the public’s eye until now.
My recommendation to the Wisconsin Council on Mental Health envisions a completion date by July of this year and a small volunteer committee of interested Council members to read and review at least a sample of the most significant long-term studies, and then weigh these findings in the context of one or more programs within the Division.
Who better than patients or family members of patients to compare these new long-term outcomes findings with Wisconsin’s existing mental health policy and practices? Who could serve with the fewest conflicts of interests or be any fairer than Council members whose primary mission and commitment is to monitor Wisconsin’s mental health program performance and make recommendations for improvements
To help contain both the members’ time and resources I hope the July deadline will be met. As an incentive for organizational representatives to purchase this book I have allocated $300.00 out of my own budgeted resources to help organizations defray their expenses for the cost of the book.
I hope this update will be useful. Your comments would be most welcome and appreciated. For more information about this advocacy project see my blog:
danecountyalmanac.blogspot.com.
Most respectfully yours,
William R. Benedict, MSW
See: Gov. Scott Walker, Sen. Scott Fitzgerald, Rep. Jeff Fitzgerald, Sen. Mark Miller, Rep. Joe Parisi, John Easterday, Jackie Baldwin, Judy Wilcox, Geoff Greiveldinger, Lania Syren, Marc Herstand, Jan Greenberg, Diane Greenly, Marc Herstand, Michael J. Fitzpatrick
Department of Health Services
1 West Wilson Street
P.O. Box 7850
Madison, WI 53707
February 2, 2011
Re: Wisconsin Council on Mental Health Action Recommendation
Dear Mr. Smith:
Congratulations and the best of luck in your new position. What follows is my effort to maintain the continuity and support for a modest project that is now in process. I hope it will accomplish much and at the lowest possible cost to Wisconsin taxpayers.
I am a retired social worker and worked for many years as the program evaluation specialist for Lutheran Social Services of Wisconsin and Upper Michigan.
In July of last year I wrote a letter to the then Sec. Karen Timberlake and alerted her to the recent book by Robert Whitaker called Anatomy of an Epidemic. I informed her that in spite of my many years in mental health research, only after reading Whitaker’s book did I become aware of the fifty or more evidenced-based long-term mental health outcome studies and their findings therein.
Most briefly, these long-term study findings ---several funded totally or in part by the NIMH ---consistently showed that mental health patients treated continuously on a strong drug regimen usually did less well than those treated primarily with fewer drugs and with a range of psychosocial therapies.
My recommendation to Ms. Timberlake simply called for members of Wisconsin’s Council on Mental Health to become as knowledgeable as possible of these latest evidenced-based long-term study findings, and in light of their own findings, consider there implications for the for the Division’s current mental health policies and practices. Presently my proposed recommendation to the Wisconsin Council on Mental Health has been assigned to the Council’s Legislative and Policy Committee.
Considering the challenges that all Wisconsin taxpayers now face along with a staggering deficit and an ever faltering economy I believe our health department should use every means possible to become more efficient and effective.
One way to do this is to simply take look at the latest scientific mental health long-term research study findings contained in Whitaker’s book but largely kept from the public’s eye until now.
My recommendation to the Wisconsin Council on Mental Health envisions a completion date by July of this year and a small volunteer committee of interested Council members to read and review at least a sample of the most significant long-term studies, and then weigh these findings in the context of one or more programs within the Division.
Who better than patients or family members of patients to compare these new long-term outcomes findings with Wisconsin’s existing mental health policy and practices? Who could serve with the fewest conflicts of interests or be any fairer than Council members whose primary mission and commitment is to monitor Wisconsin’s mental health program performance and make recommendations for improvements
To help contain both the members’ time and resources I hope the July deadline will be met. As an incentive for organizational representatives to purchase this book I have allocated $300.00 out of my own budgeted resources to help organizations defray their expenses for the cost of the book.
I hope this update will be useful. Your comments would be most welcome and appreciated. For more information about this advocacy project see my blog:
danecountyalmanac.blogspot.com.
Most respectfully yours,
William R. Benedict, MSW
See: Gov. Scott Walker, Sen. Scott Fitzgerald, Rep. Jeff Fitzgerald, Sen. Mark Miller, Rep. Joe Parisi, John Easterday, Jackie Baldwin, Judy Wilcox, Geoff Greiveldinger, Lania Syren, Marc Herstand, Jan Greenberg, Diane Greenly, Marc Herstand, Michael J. Fitzpatrick
Friday, January 28, 2011
Presentation to the Wisconsin Council Mental Health’s Legislative and Policy Committee
January 13, 2011
First, a brief update re my letter to the Secretary of the Department of Health
First, let me begin by saying how pleased I was to learn that your Committee was chosen to consider my recommendation and to report back your findings to the Council. I thank you and I am so pleased to be here this afternoon.
On July 23, 2010 I wrote a letter to the Secretary of the Wisconsin Department Health, Ms. Karen E. Timberlake. In this letter I briefly shared my professional qualifications and experience relating to evidenced-based, long-term mental health outcome studies. I noted that in spite of this professional training and some thirty years of experience, Robert Whitaker’s latest book, Anatomy of An Epidemic, shocked and surprised me (For the full text of the letter, including my recommendation for action, to the Secretary, please see my blog: Danecountyalmanac.blogspot.com).
In this book, for the first time, Whitaker brings into public view over fifty evidenced-based and scientific long-term mental health outcome studies about what actually occurs to those treated for mental illness in the United States. This story is quite different than what the public media has given us until now. This story is framed from dozens of archival scientific mental health research studies beginning in the 1950s to the present. They are cogently summarized and documented (See Chapter 6: A Paradox Revealed).
Because Whitaker tells his story through the prism of evidenced based scientific long-term mental health outcome results, this Legislative and Policy Committee can draw its own conclusions about these studies, including your recommendations regarding their implication for Wisconsin’s mental health program. Based upon these scientific studies Whitaker asked and chose to write about some of the following questions:
“During the past fifty years when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? And, are long-term recovery rates higher for medicated or un-medicated patients with serious mental health disorders?
I am convinced that Robert Whitaker’s book will be this century’s definitive
evidenced-based repository and source when people gather to discuss long-term outcome evaluation studies.
I believe that with your help, that hereafter mental health researchers and other stakeholders will use and refer to this text whenever they turn their attention to the latest scientific findings having to do with long-term mental health outcome study findings. Hereafter when ever questions of long-term treatment efficacy are raised in mental health care, researchers and administrators, and all stakeholders, the world over, will turn to Whitaker’s book. Certainly most of us are aware that Wisconsin has led the country in timely patient-centered mental health reform in the past.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this long-term evidenced-based information and reconcile them with existing practice and funding policies and with their future long-range planning for this state’s mental health system.
To continue as usual in the face of the overwhelming evidenced contained in these scientific long-term outcome studies would be ethically and professionally irresponsible. These evidenced-based outcome study findings demand that all mental health stakeholders, but especially this citizen council, our Governor’s oversight body, carefully consider these findings and document their own findings and recommendations in response to their own study of these study findings.
Most of all, each day that mental health stakeholders delay in informing themselves regarding these latest scientific findings is another day wasted before we reexamine our present care and treatment practices and funding policies against these latest research findings.
As a patient advocate what also concerns me most is that we can no longer continue to follow treatment practices as usual if we find this evidence to be compelling and actionable.
Finally what are we going to say to our youngest mentally ill patients, when and if, they discover down the road that this long-term information existed, and that we should have acted on it on their behalf but failed to do so, way back in year 2011?
What are we going to tell patients and suffering families with mental illness who depend on us and trust us to be aware, informed, honest, upfront and transparent about these latest scientific long-term research findings, if they later prove to be fundamentally true?
I am optimistic however that here in Wisconsin, we will not be too busy, too proud or complacent or too invested in the status quo to consider alternatives, if in deed, we find these long-term evidence-based findings should point in that direction.
Thank you again so much for allowing me to talk with you today. I hope we still have a few minutes for your questions or comments.
Respectfully, William R. Benedict
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81-104 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
To access all the documents to date regarding this mental health reform project,
see this writer’s blog: danecountyalmanac.blogspot.com
First, a brief update re my letter to the Secretary of the Department of Health
First, let me begin by saying how pleased I was to learn that your Committee was chosen to consider my recommendation and to report back your findings to the Council. I thank you and I am so pleased to be here this afternoon.
On July 23, 2010 I wrote a letter to the Secretary of the Wisconsin Department Health, Ms. Karen E. Timberlake. In this letter I briefly shared my professional qualifications and experience relating to evidenced-based, long-term mental health outcome studies. I noted that in spite of this professional training and some thirty years of experience, Robert Whitaker’s latest book, Anatomy of An Epidemic, shocked and surprised me (For the full text of the letter, including my recommendation for action, to the Secretary, please see my blog: Danecountyalmanac.blogspot.com).
In this book, for the first time, Whitaker brings into public view over fifty evidenced-based and scientific long-term mental health outcome studies about what actually occurs to those treated for mental illness in the United States. This story is quite different than what the public media has given us until now. This story is framed from dozens of archival scientific mental health research studies beginning in the 1950s to the present. They are cogently summarized and documented (See Chapter 6: A Paradox Revealed).
Because Whitaker tells his story through the prism of evidenced based scientific long-term mental health outcome results, this Legislative and Policy Committee can draw its own conclusions about these studies, including your recommendations regarding their implication for Wisconsin’s mental health program. Based upon these scientific studies Whitaker asked and chose to write about some of the following questions:
“During the past fifty years when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? And, are long-term recovery rates higher for medicated or un-medicated patients with serious mental health disorders?
I am convinced that Robert Whitaker’s book will be this century’s definitive
evidenced-based repository and source when people gather to discuss long-term outcome evaluation studies.
I believe that with your help, that hereafter mental health researchers and other stakeholders will use and refer to this text whenever they turn their attention to the latest scientific findings having to do with long-term mental health outcome study findings. Hereafter when ever questions of long-term treatment efficacy are raised in mental health care, researchers and administrators, and all stakeholders, the world over, will turn to Whitaker’s book. Certainly most of us are aware that Wisconsin has led the country in timely patient-centered mental health reform in the past.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this long-term evidenced-based information and reconcile them with existing practice and funding policies and with their future long-range planning for this state’s mental health system.
To continue as usual in the face of the overwhelming evidenced contained in these scientific long-term outcome studies would be ethically and professionally irresponsible. These evidenced-based outcome study findings demand that all mental health stakeholders, but especially this citizen council, our Governor’s oversight body, carefully consider these findings and document their own findings and recommendations in response to their own study of these study findings.
Most of all, each day that mental health stakeholders delay in informing themselves regarding these latest scientific findings is another day wasted before we reexamine our present care and treatment practices and funding policies against these latest research findings.
As a patient advocate what also concerns me most is that we can no longer continue to follow treatment practices as usual if we find this evidence to be compelling and actionable.
Finally what are we going to say to our youngest mentally ill patients, when and if, they discover down the road that this long-term information existed, and that we should have acted on it on their behalf but failed to do so, way back in year 2011?
What are we going to tell patients and suffering families with mental illness who depend on us and trust us to be aware, informed, honest, upfront and transparent about these latest scientific long-term research findings, if they later prove to be fundamentally true?
I am optimistic however that here in Wisconsin, we will not be too busy, too proud or complacent or too invested in the status quo to consider alternatives, if in deed, we find these long-term evidence-based findings should point in that direction.
Thank you again so much for allowing me to talk with you today. I hope we still have a few minutes for your questions or comments.
Respectfully, William R. Benedict
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81-104 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
To access all the documents to date regarding this mental health reform project,
see this writer’s blog: danecountyalmanac.blogspot.com
Handout at WC’s Leg & Policy Committee presentation
(January 13, 2011)
Some thoughts prior to my meeting with the Legislative and Policy Committee regarding their likely response to Robert Whitaker’s book and to my action recommendation to the Council.
1. To what extent are Council members already aware of evidenced-based
long-term scientific studies and the significance of their findings?
2. Are Council members aware that such long-term outcome studies exist
for all the major mental health maladies, including schizophrenia,
depression, bipolar, anxiety, ADHD?
3. How many Council members have read either both or perhaps one of
Whitaker’s books on these long-term studies – Anatomy of an Epidemic,
Mad in America? If, so how many were already aware of these findings?
4. What do Council members know about Robert Whitaker? His education,
training, work before becoming a journalist, etc, and his reputation
as a science investigator reporter or writer? Awards?
5. If a member has read the book what level of credibility, scholarship and
respect do they have for Whitaker’s investigative and research style?
Did they find the book easy to read and interesting and appropriate for
most lay people and informed citizens?
6. Who do Council members believe would be the most objective and fair
group to evaluate these long-term mental health findings if not the
Council members themselves?
7. What understanding do members already have about how psychiatric
drugs affect long-term patient community adjustment and health?
8. Are Council members aware that mental illness has tripled over the
past two decades 1990 – 2010?
9. How many Council members are aware that due to mental illness every
day 1,100 adults and children are added to the government
disability rolls?
10. Where on “the most important scale” for Council members should
information of this kind be treated?
Some thoughts prior to my meeting with the Legislative and Policy Committee regarding their likely response to Robert Whitaker’s book and to my action recommendation to the Council.
1. To what extent are Council members already aware of evidenced-based
long-term scientific studies and the significance of their findings?
2. Are Council members aware that such long-term outcome studies exist
for all the major mental health maladies, including schizophrenia,
depression, bipolar, anxiety, ADHD?
3. How many Council members have read either both or perhaps one of
Whitaker’s books on these long-term studies – Anatomy of an Epidemic,
Mad in America? If, so how many were already aware of these findings?
4. What do Council members know about Robert Whitaker? His education,
training, work before becoming a journalist, etc, and his reputation
as a science investigator reporter or writer? Awards?
5. If a member has read the book what level of credibility, scholarship and
respect do they have for Whitaker’s investigative and research style?
Did they find the book easy to read and interesting and appropriate for
most lay people and informed citizens?
6. Who do Council members believe would be the most objective and fair
group to evaluate these long-term mental health findings if not the
Council members themselves?
7. What understanding do members already have about how psychiatric
drugs affect long-term patient community adjustment and health?
8. Are Council members aware that mental illness has tripled over the
past two decades 1990 – 2010?
9. How many Council members are aware that due to mental illness every
day 1,100 adults and children are added to the government
disability rolls?
10. Where on “the most important scale” for Council members should
information of this kind be treated?
Robert Whitaker’s Anatomy of an Epidemic, and Mad in America
Chapter 16
Pages 331 - 359
Blueprints for Reform
Examples of some of the possible policy/practice implications found in Whitaker’s two books: (This list is not in any special order with respect to importance or presumed
significance.)
New practice policies/practice formulations relating to psychiatric medications.
Solutions – When and how should they be used for health and safety.
Acknowledge the possibility that the biological causes of mental disorders continue to remain unknown. Present certainty leaves no room for error and causes providers to have too little humility with patients.
Why not consider the real possibility that psychiatric drugs, rather than fixing chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways?
Acknowledge the possibility that current medications actually worsening long-term outcomes for a significant number of patients.
Prescribers still need to learn better ways to use the drugs more judiciously and wisely, and respect the need for some patients to be given alternative therapies, that don’t rely on medications or at least minimize their use.
To produce best results USE PSYCHIATRIC MEDICATIONS IN A SELECTIVE, limited and CAUTIOUS MANNER (OR NOT AT ALL) Dr. David Healy writes on the history of psychiatry.
Acknowledge the possibility that some patients can recover naturally.
Many patients will improve with low doses.
Focus on the patients past successes, 337
Patients are more interactive without medications 338
Long term use of drugs increase the likelihood of chronicity and a shorter life span.
Lower initial dosages
Consider practice policies that relate to the gradual medication withdrawal during the early medication phase of treatment. Establish best practice temporal standards to
Ensure that the long range medication regimens have regular patient-centered stop/go assessments specifically relating to the pro and cons of drug continuation.
Develop and require greater patient education about the pros and cons of medication versus other therapeutic alternatives
Consider doing a longitudinal budget analysis of the comparative proportionality of the cost of medication and other forms of therapy.
Longitudinally tract to percent of those on medications vs. social and more natural therapies.
Consider the implications of Whitaker’s study findings in the context greater consumer rights relative to their informed consent, safety and welfare.
Consider implications for existing long-term treatment and care for those who are placed an on-going drug regimen/
Evaluate and perhaps stop the ever expansion of psychiatric boundaries. Mental Health Advocacy Project
Pages 331 - 359
Blueprints for Reform
Examples of some of the possible policy/practice implications found in Whitaker’s two books: (This list is not in any special order with respect to importance or presumed
significance.)
New practice policies/practice formulations relating to psychiatric medications.
Solutions – When and how should they be used for health and safety.
Acknowledge the possibility that the biological causes of mental disorders continue to remain unknown. Present certainty leaves no room for error and causes providers to have too little humility with patients.
Why not consider the real possibility that psychiatric drugs, rather than fixing chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways?
Acknowledge the possibility that current medications actually worsening long-term outcomes for a significant number of patients.
Prescribers still need to learn better ways to use the drugs more judiciously and wisely, and respect the need for some patients to be given alternative therapies, that don’t rely on medications or at least minimize their use.
To produce best results USE PSYCHIATRIC MEDICATIONS IN A SELECTIVE, limited and CAUTIOUS MANNER (OR NOT AT ALL) Dr. David Healy writes on the history of psychiatry.
Acknowledge the possibility that some patients can recover naturally.
Many patients will improve with low doses.
Focus on the patients past successes, 337
Patients are more interactive without medications 338
Long term use of drugs increase the likelihood of chronicity and a shorter life span.
Lower initial dosages
Consider practice policies that relate to the gradual medication withdrawal during the early medication phase of treatment. Establish best practice temporal standards to
Ensure that the long range medication regimens have regular patient-centered stop/go assessments specifically relating to the pro and cons of drug continuation.
Develop and require greater patient education about the pros and cons of medication versus other therapeutic alternatives
Consider doing a longitudinal budget analysis of the comparative proportionality of the cost of medication and other forms of therapy.
Longitudinally tract to percent of those on medications vs. social and more natural therapies.
Consider the implications of Whitaker’s study findings in the context greater consumer rights relative to their informed consent, safety and welfare.
Consider implications for existing long-term treatment and care for those who are placed an on-going drug regimen/
Evaluate and perhaps stop the ever expansion of psychiatric boundaries. Mental Health Advocacy Project
Brief Excerpts from Anatomy of an Epidemic
Sixteen outcome studies
November 12, 2010
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from
medical archives by Robert Whitaker:
A brief summary of the following 16 long-term mental health outcome studies
appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent) . NIMH Go to page 374; citation number 35.
1992 - Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on anti-psychotics, than in the United States and other rich countries where continual drug use is the standard of care.
World Health Organization Go to page 370, citation number 45.
1995 - In a six-year study of 537 depressed patients those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.” NIMH Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
1998 - In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse---in terms of their depressive symptoms and their general health---over a one-year period than those who weren’t exposed to the drugs.
WHO depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
2000 - Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics.
Eli Lilly; Harvard Medical School Long-term bipolar outcomes. Page 379, citation number 53
2001 - In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication.
Canadian Investigation bipolar depression study, See page 373, citation on page 167
2001 - In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up almost as cognitively impaired as schizophrenia patients.
Sheppard Pratt Health System in Baltimore bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude Australian scientists’ benzo study. Seepage 372, citation 43.
2005 - Angel dust, amphetamines, and other drugs that induce psychosis all increase D2 HIGH receptors in the brain; antipsychotics cause this same change in the brain.
Angel dust reference. See page 370, citation 53
University of Toronto
2005 - In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medications.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
French Scientists
2007 - In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.” The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too.
Study of ADHD. See page 381, citation 36 & 39.
NIMH
2008 - In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome.
Bipolar study. See page 378, citation 46 &47
NIMH
November 12, 2010
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from
medical archives by Robert Whitaker:
A brief summary of the following 16 long-term mental health outcome studies
appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent) . NIMH Go to page 374; citation number 35.
1992 - Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on anti-psychotics, than in the United States and other rich countries where continual drug use is the standard of care.
World Health Organization Go to page 370, citation number 45.
1995 - In a six-year study of 537 depressed patients those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.” NIMH Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
1998 - In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse---in terms of their depressive symptoms and their general health---over a one-year period than those who weren’t exposed to the drugs.
WHO depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
2000 - Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics.
Eli Lilly; Harvard Medical School Long-term bipolar outcomes. Page 379, citation number 53
2001 - In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication.
Canadian Investigation bipolar depression study, See page 373, citation on page 167
2001 - In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up almost as cognitively impaired as schizophrenia patients.
Sheppard Pratt Health System in Baltimore bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude Australian scientists’ benzo study. Seepage 372, citation 43.
2005 - Angel dust, amphetamines, and other drugs that induce psychosis all increase D2 HIGH receptors in the brain; antipsychotics cause this same change in the brain.
Angel dust reference. See page 370, citation 53
University of Toronto
2005 - In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medications.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
French Scientists
2007 - In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.” The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too.
Study of ADHD. See page 381, citation 36 & 39.
NIMH
2008 - In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome.
Bipolar study. See page 378, citation 46 &47
NIMH
Sunday, January 2, 2011
Letter on stem cells didn’t tell whole story
Wisconsin State Journal, Letter to the editor
To support his argument that non-embryonic stem cell research is the stem cell of choice when measured by the percent of allocated funding grants, a recent writer referred to the California Institute of Regenerative Medicine, and noted that it recently approved funding for 19 grants worth $67 million with only five going to human embryonic stem cell research.
We were not told, however what proportion of the total funding went to non-embryonic or embryonic funding. Nor did the reader indicate that CIRM was conceived in 2005 by an overwhelming majority of California taxpayers in their opposition to President George Bush’s restriction on embryonic stem cell research.
Also CIRM has already allocated one of its $3 billion loan initiatives for embryonic stem cell research, much of which has already come back to California in private matching funds.
A study authored by Aaron Levine of Georgia Institute of Technology provides detailed information about stem cell research grants handed out by six states including California between December 2005 and December 2009. His findings detail that most human embryonic stem cell research conducted in the United States is funded by states, not the federal government. The share of stem cell funding given for embryonic stem cell research varied widely, from 97 percent in Connecticut to only 21 percent in New York, for example.
For more info go to stemcellaction.org.
-William R. Benedict, Madison
To support his argument that non-embryonic stem cell research is the stem cell of choice when measured by the percent of allocated funding grants, a recent writer referred to the California Institute of Regenerative Medicine, and noted that it recently approved funding for 19 grants worth $67 million with only five going to human embryonic stem cell research.
We were not told, however what proportion of the total funding went to non-embryonic or embryonic funding. Nor did the reader indicate that CIRM was conceived in 2005 by an overwhelming majority of California taxpayers in their opposition to President George Bush’s restriction on embryonic stem cell research.
Also CIRM has already allocated one of its $3 billion loan initiatives for embryonic stem cell research, much of which has already come back to California in private matching funds.
A study authored by Aaron Levine of Georgia Institute of Technology provides detailed information about stem cell research grants handed out by six states including California between December 2005 and December 2009. His findings detail that most human embryonic stem cell research conducted in the United States is funded by states, not the federal government. The share of stem cell funding given for embryonic stem cell research varied widely, from 97 percent in Connecticut to only 21 percent in New York, for example.
For more info go to stemcellaction.org.
-William R. Benedict, Madison
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