Brain shrinkage okay for schizophrenia, but not for depression

I follow a blog called Family Dysfunction and Mental Health by Dr. David Allen. I stopped commenting on that blog because the last few times my comments did not appear/were not approved. Dr. Allen’s blog appears to have a healthy number of followers, but few comments. I noticed that the people who tended to comment are opinioned about his views on schizophrenia. They continuously challenge him on his views that schizophrenia is a “true” brain disease.

Since I am blocked from commenting on Dr. Allen’s most recent post, I’m making my comments here. Dr. Allen’s post is about the latest research findings* that antipsychotics shrink the brain. This rather important information was sat on for several years by Dr. Nancy Andreasen, one of the co-authors of this paper. Dr. Andreasen sat on the information because she didn’t want people to go off their antipsychotics, even though her research indicated that these medications damage the brain. (Dr. Andreasen built her career on the pharmaceutical lie that antipyschotics actually “protect the brain.”) The psychiatrists I dealt with as late as 2004/2005 were telling me that if Chris didn’t take these drugs to “protect” his brain, his brain was going to look like a concrete block of Swiss cheese. Thanks, Dr. Andreasen.

Dr. Andreasen’s position is typical of doctors who think they are God and yet have a skewed version of what it means to be God. In this world, the Doctor God forces treatment on psychotic people by withholding the truth, but is a “partner” in decision making with the otherwise sick but so-called mentally healthy. In my world, God empowers us all to make the best choices for ourselves.

Now, back to Dr. Allen. Dr. Allen now realizes that he was taught the wrong thing about brain atrophy. “I had been taught that this phenomenon was first discovered in patients who had never been treated with antipsychotic medication.”  But Dr. Allen then goes on to introduce a spurious choice that treating psychiatrists have no right to make. “Of course, even if it was entirely due to the drugs, one would still have to weigh the risks of cerebral atrophy versus the risk of being chronically tortured by accusatory hallucinations and living out on the street, as was well-portrayed in the movie The Soloist.” (Any doubt what choice Dr. Allen would make for them?)

He interjects a straw man argument of skid rows littered with unmedicated schizophrenics:

Go check out Skid Row in L.A. in person if you don’t believe it. That part of town is actually marked with a sign that says, “Skid Row.” See the folks on street corners loudly preaching incoherent gibberish about the Gospels for hours to an audience of…no one at all.

I despair for psychiatrists who show little understanding for why people are on skid row and the choices they have made to get there, who believe that bad drugs are better than no drugs at all. Why not acknowledge that many people on skid row are there because they don’t like the side effects of the medications they are given, their families refuse to take help them, and psychiatry isn’t interested in what makes them tick in the first place?

Schizophrenia is the bread and butter of the mental health industry, as long as the patients remain patients. Chronic schizophrenia is a goal. Naturally, the psychiatric profession denies this, but here we have it in print: knowing that the drugs aren’t useful but not caring, either. There is outrage about the mess called skid row, but not about the failure of understanding that drove them there in the first place.

Dr. Allen is really worked up about antipychotics being used as antidepressants. Readers of my blog are also concerned about this misuse of dangerous drugs, but why is Dr. Allen saving his outrage for people with depression (a mental health condition that is historically easier to treat than schizophrenia) instead of directing his outrage where outrage is due: that schizophrenia patients continue to be lobotomized with drugs that don’t work except to make them compliant as patients?

Showing favoritism for the depressed, he writes: “Nonetheless, these results should certainly give pause to any doctor treating a non-psychotic patient with anti-psychotic medication – especially since much safer alternative drugs are available. This potential risk is on top of the serious risks that these medications may cause diabetes, high cholesterol, and a chronic untreatable neurological condition called tardive dyskinesia. As all these risks are cumulative, long term treatment of non-psychotic individuals with anti-psychotics before all other measures are tried is particularly reprehensible.”

Well, I can’t get worked up to the same extent as Dr. Allen over depressed people when I know that psychiatry has failed at its bigger challenge with schizophrenia patients and has much less sympathy for their plight. It’s equally, if not more, reprehensible for schizophrenia patients to have diabetes, tardive dyskinisia, etc. since psychiatry has not exhausted all other measures. Exhausting all other measures is tiring work. Rather than do the work, biochemical psychiatry claims there are no other measures.

The title of Dr. Allen’s post is “Antipsychotics are for Psychosis, Not Insomnia.” No, they are not. These drugs don’t cure psychosis and they have horrible side effects and according to current research, they shrink the brain. So, why does the psychiatric profession keep insisting that they are for psychosis? What if doctors had insisted, in the face of important evidence to the contrary, that thalidomide was for pregnant women and only pregnant women? 

On a positive note, is it possible that antipsychotics actually don’t shrink the brain, and we are simply being primed for the next generation of expensive chemicals to be foisted upon us? There’s a name for that practice that eludes me.
Archives of General Psychiatry,“Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia,” Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Ronald Pierson, MS; Vincent Magnotta, PhD, Arch Gen Psychiatry 2011; 68(2):a128-137).

Jumping on the clozapine bandwagon

I am reading more and more media reports extolling the virtues of clozapine as an effective antipsychotic. Clozapine has been around for years, since the 1970s in Europe and the 1990s in North America. It is the first of the second generation of atypical antipsychotics and has been described as the treatment of last resort for people who have not shown improvement on other antipsychotics. The fact that it is off-patent is one reason why it is not more widely used, but only one reason.

Anybody thinking of taking clozapine should think twice before doing so. Begin by resisting the label of “treatment resistant” that is probably being directed at your relative. Treatment resistant simply means that medical science hasn’t found out what your relative’s problem is, but by golly, they are going to get a drug for whatever ails them, anyway. If your relative’s problem is psychospiritual, which I suspect in most cases it is, then no drug is going to fix a mind that is “on strike.” (John Nash’s words, not mine.)

Antipsychotics, whether first or second generation, don’t make anybody well, they simply repress the more outward signs of psychosis, and very often they even fail to do that. In my experience with Chris, clozapine was no more effective than any of the others, it is much harder to withdraw from, and then there is need for regular blood testing to avoid a potentially fatal condition called agranulocytosis, which involves the white blood cell count.

I am always heartened when I hear that people have managed to get off clozapine, even after many years.

A short history of antipsychotics

Dr. Abram Hoffer has much to say on what happened to mental illness after the introduction of atypical antipsychotics in the 1970s. Atypical antipsychotics are the second-generation antipsychotics, which have fewer side effects than the first-generation “typical” antipsychotics introduced in the 1950s. The second-generation antipsychotics are tranquilizers that still produce side effects. With the second-generation drugs, people were fit enough to leave the hospital but not fit enough to hold down jobs. Psychiatric hospitals emptied, but the streets filled up with people unable to manage their medications or who preferred a life unmedicated to a life and and spirit controlled by medication.

Dr. Hoffer writes: “I am pleased with my medical colleagues who are quickly moving into this modern paradigm (megavitamin therapy), and am very frustrated by the massive inertia of my psychiatric colleagues who are still waiting for the Holy Grail, that new tranquilizer which appears every year, which will do for schizophrenia what insulin does for diabetes. The number of homeless chronic schizophrenics in the streets of all large American and Canadian cities is evidence of their inability to do more for them than we could do in 1950 before we had any tranquilizers. But at least then we had hospitals which provided shelter and food and some care. Today the downtown slums have become the surrogate mental hospital beds for the chronic patients whose treatment has been wholly tranquilizers.”

In the United States, a 1951 amendment to the 1938 Food, Drug, and Cosmetic Act meant that all the new drugs produced after World War II, which included second-generation antipsychotics, as well as antidepressants and antibiotics, could only be issued by prescription.When medication became the new Holy Grail, megavitamin therapy was tossed out. It lived on in communities of adherents here and there, but their voices were drowned over the next few decades as the number of antipsychotics on the market proliferated.