I am reprinting an interesting comment to Dr. Sandra Steingard’s Mad in America blog post entitled Why I Prescribe. The writer of the comment demontrates how fickle scientific “truth” can be. The option she refers to in her opening paragraph is the option to accept or decline meds.
Marianne on March 5, 2012 at 6:24 pm said:
I wish I had been given an option when I was 18 and heard voices. I am 62 now, and still hear them from time to time, but I have figured out what they are. I took “anti-psychotics” for years. They made me eat more and didn’t change the voices.
I had to go along with the doctors to get out of hospital, that is lie to them.
For several years, their theory was that schizophrenics had “too much dopamine”. In 1968, when I was started on phenothiazines, there was something called the Thorazine Shuffle, or “pseudo-Parkinsonism”.
One never hears that term now, even though the side effects still include Parkinson-like rigidity. I also found out that phenothiazines are actually pesticides and Parkinson’s didn’t exist before pesticides were used for killing pests. (Insecticides, herbicides, rodenticides).
Now there are so-called professionals telling people that Dopamine is the “feel good” chemical in the brain! I still have journal articles from the 1960′s and 1970′s with the theory that was the opposite, and also about when L-dopa was being used for Parkinson’s patients, with short-term effects.
Can you explain how dopamine went from causing schizophrenia to being the “feel good chemical” without some major tampering by scientists?
I also cannot find a doctor who will work with me to get off of drugs. A long history of a label has caused me extreme misery over the years.
If only someone had told me those voices were from inside of me, instead of ECT and meds, and counseled me that things would be ok…I was only 18. If only there had been some compassion.
Reply ↓
Sandy Steingard
on March 5, 2012 at 7:48 pm said:
Marianne-
Thanks for your comments. Dopamine is the neurotransmitter in the so-called pleasure and reward center of the brain. As Whitaker and others point out, there is no evidence that there is an abnormality of dopamine in the brains of people who hear voices or experience other psychotic symptoms. The dopamine hypothesis of schizophrenia – that there is too much dopamine in the brains of people who experienced psychosis -was proposed because the neuroleptic drugs are known to block dopamine. Over many years, scientists never found any evidence to support the dopamine hypothesis of schizophrenia.
Perhaps you could copy some of the articles from this website so you could discuss it with your doctor. Philip Thomas, MD posted an excellent blog on this topic today.
Sandy
As painful as the truth may be, Marianne hits the nail on the head with her reference to antipsychotics being used to kill pests.
According to Robert Whitaker’s research, this is precisely how the antipsychotics came into use… as pesticides in the 1930s and 1940s, and the newer ones are no better than the older ones –
http://www.madinamerica.com/2011/11/%ef%bb%bftimeline/
Also, I have heard Peter Breggin, M.D. refer to antipsychotics as pesticides, specifically rodent poison on a radio show.
Dialogue.
Everyone wants a dialogue.
But I wonder how many people really want to know the truth, the facts.
They’re painful.
Very painful.
In fact, maybe too painful for some to address.
My best,
Duane
Rossa,
I have strong feelings about the risk of psychiatric drugs, but the last thing I want to do is take away hope from any of your readers.
There are lots of options to consider besides drugs, and many ways people recovery from “mental illness”…. I hope any of your readers who are searching for answers find them!
Duane
discoverandrecover.wordpress.com
I agree, Duane. There are many ways to recover.
Some of the things in this article are patently false. Pesticides of dopamine nature interfere with the electron transport chain in the mitochondria of dopamine producing cells in the substanta nigra which controls motor function. they do induce parkinsons by killing these cells by inhibiting cellular respiration.
Now, neuroleptics only block dopaminergic action everywhere in the brain and thus the dopamine cells are not destroyed but just shut down. The goal of antipsychotics is to block dopamine in the striatum, however most drugs are not very selective for that part of the brain although you never see the same kind of twitching with olanzapine as you would with thorazine. All around the symptoms are no where near as bad as parkinsons and the mode of action of these drugs is not even close to that of pesticides.
Striatal dopamine activation causes pleasure in the substantia nigra it controls movement
Parkinsons was also described by the ancient Greeks and it is not a new development following the introduction of pesticides.
The dopamine hypothesis is one part of the puzzle. It is not understood the problem is dysfunctional AMPA and NMDA receptor signaling (NMDA antagonists like PCP induce schizophrenia) The thing is that Over overactivation of Dopamine D2 receptors in the striatum causes some phosphatase emzyne activity to increase and internalize NMDA receptors, making them nonfunctional. To make things worse low NMDA activation causes dopamine release so it is a vicious cycle. This is why it is good to block dopamine receptors and stimulate things that cause proper NMDA function like the glycine system and certain serotonin pathways.
Drugs do not work for everyone, and they are over marketed at times, but without them we would still be in the days of lobotomies and exclusion wards. I do not think it is fair to say that drugs are this ultimate evil, because they work very well for some people. I sympathize with your positions on SSRI’s and ADD/ADHD medications are quite frankly rubbish but having seen the good anti psychotics can do I believe that they are a valid treatment option.
Thanks for taking the time to write. I was amazed to see that I had seven comments waiting for me when I logged on today. You know of course, that antipsychotics are basically sedatives, so when you say you’ve seen the good they can do, I assume you are referring to the sedation of the patient when he/she gets out of control. The problem is, these “sedatives” are given to people way past the point of needing sedation and are pushed as permanent solutions to life’s problems. You say they are a valid treatment “option.” I could agree with you if the patient was actually given a choice, i.e. full information about what the drugs does and a valid list of its side effects, and of course the option of not taking them at all, taking high dose niacin combos, or finding a therapy that appeals to them. If you practice medicine or are hoping to practice medicine, I would sincerely hope that you are not hiding the treatment options available from your current or future patients and that you would respect their treatment choices, even if it means no drugs. But, in reality, both you and I know that no such treatment choices are offered to people suffering from psychosis. They have to find out about their “options” by doing their own research.
I am sorry if I came off as militant in my ideals. I do agree with some of your positions, that the pharma industry is aweful and will do whatever it takes to make money however I am more skeptical and concerned about some things and I worry that such things could cause some patient who could benefit from a drug to believe there is a conspiracy etc which is also not letting them make your own choice.
I want to be a research scientist. I come from a family with 3 generations of Schizophrenics and have some minor afflictions myself although they are now manifested as something closer to Bipolar disorder. I was on anti psychotics for a while but found the benefits minimal, so I got off them and have been ok, so I whole heartedly agree with you that they are not the end all and be all. It took the longest time to be prescribed the mood stabilizer that I am reliant on now. And I would love to see other treatment options offered like therapy etc but quite frankly many of these treatments are on shaky ground at best. But then again who said the placebo effect isn’t good, if it works it works eh?
This is not true for my mother and several other family members who become incredibly paranoid of the ones they love when not on medications. My life was hell prior to risperidone. She considers it the best decision she ever made despite the sleepiness. Another was saved from dropping out of school by them.
Now I look back to my family history, my grandmother and aunt were institutionalized most of their life and endured high dose lithium, thorazine, and ECT. (yes kiddies that is unilateral ECT, the really bad kind)If things had been a bit worse lobotomies might have been possible. Thorazine was regarded as a chemical lobotomy because of the sedation but new drugs are not anywhere near as bad. (I have taken them) And in the long run thorazine was SO much better than a lobotomy. I would say that if you look at the state of the mentally ill now and before the advent of these drugs it is better in whole.
Again, I do not want to seem as if I merely want to make your life difficult but I am concerned that you go a bit to far. Alternative treatments should be an option but I still believe that Anti psychotics should be the first line treatment, and after a patient has shown to not show benefit after a good run (a few months) alternatives should be considered.
Thanks again for writing. Really! I would respond by saying that people are not statistics. People should pursue whatever gets them better, and by better, I mean working, pursuing higher education, etc. etc. Very few people with schizophrenia diagnoses in the past have been able to support themselves. But, what happened in the past is not what is happening now. I would wonder what you would consider a benefit of antipsychotic treatment?
That the person is no longer scaring the relatives? While what I wrote sounds facetious, I am actually puzzled by what people refer to as benefits, beyond the sedation. Many people continue to take their drugs, put up with the side effects, yet still land back in the emergency room. Then there is the benefit in the eye of the beholder. It seems to me that anybody with a family history of schizophrenia may be inclined to support drug treatment because of the fall-out from the person’s behaviour, but could one say that this belief in drugs is the family member wanting anything for a peaceful life? The drugs are major tranquillizers and to that end, are successful, but they don’t help people face the problems in their lives that have brought them to the point of psychosis.
The term major tranquilizer is not really used now because most modern atypical antipsychotics are not anywhere near as sedating as the older typical class. And of course the original draw to them clinically was to shut the patient up and make them tired but having been on atypicals I can say that they are not terribly sedating compared to something even as mild as over the counter diphenhydramine. I do share your belief that the risk and benefits need to be closely examined and that the treatment that works is best, but I still believe that the first line should be neuroleptics vs something like magnet therapy for which there is no accepted scientific explanation. (I am not saying it doesn’t work, but I would prefer to try the tested solution first) And for many people the drugs work. My personal fear is that your stance on these drugs is a bit harsh, while not unreasonable given your personal experience, and could adversely affect someone who is beginning to undergo drug therapy to prematurely quit it due to paranoia etc. I believe a more healthy message is “follow what your prescribing doctor says and give medications paired with therapy a chance, but if it doesn’t work out for you be firm with your doctor that you would like to seek an alternative”
Haha I know you were not intending to sound facetious, after all you are in a similar spot I was. I notice that those on the medications my mother can speak coherently and form complex thoughts where there used to be only rambling, she is nowhere near as suggestible and paranoid as she used to be. Other family members who seemed quite cognitively impaired demonstrate above average intelligence and human understanding after drug therapy. I believe that these are benefits you would not see with mere sedation like that of Valium. And as you said, drugs without therapy is a failed philosophy. A multi-pronged approach is needed.
Just to make it clear I am not just standing up for the drug companies/acting like a sheep. I know very well that these medications are dangerous and the minute that something better is found they should be discarded. If you weren’t aware of it already they cause some pretty scary grey matter loss over a few decades of use.
http://www.themindinstitute.org/pubs/bustillo.pdf
Regardless, If I had a psychotic break I would take the drugs.