Criticism of anti-psychotic meds sound.

Byline: Ron Unger

According to the March 25 guest viewpoint by psychiatrist Richard Staggenborg, we should ignore alarms about the hazards of anti-psychotic medications sounded by mental health worker Chuck Areford in an earlier column.

These alarms, he assures us, are "egregiously false," anti-psychotic use is based on "sound clinical research" and people such as Areford are simply "misinformed" - which isn't surprising, given their "nonmedical" background.

It is Staggenborg's assertions, however, that fall flat when confronted with the facts.

Mental health consumers are typically told that anti-psychotics are required to prevent relapse, as is insulin for diabetes. (This is ironic, given that many of these medications frequently cause diabetes.) A more accurate comparison would be with the use of alcohol for social anxiety.

Alcohol is effective in providing short-term relief of social anxiety. But when people rely on it long-term, they find their need for it does not diminish, both because they develop few coping skills during their period of use and because withdrawal typically causes relapse into higher levels of anxiety than when drinking began.

To the alcoholic, this seems a good argument to keep on drinking. But most objective observers would disagree, based on observations of the negative effects of extensive alcohol use and the gradually more successful coping shown by those who face their anxiety instead of drinking it away.

While Staggenborg correctly refers to a "vast literature of studies" indicating the effectiveness of anti--psychotics, he fails to notice that they all use the same faulty logic used by alcoholics. That is, these studies assume long-term effectiveness based only on short-term outcomes or evidence of relapse problems in the first year after they are discontinued. To get a real idea of the long-term effectiveness of anti--psychotics, we need comparisons between people treated long-term with and without the medications.

Perfect comparisons of this sort are difficult to find. But John Bola, in a peer-reviewed article, analyzed all existing studies with good internal validity that compared programs initially using and not using anti-psychotics, with follow-up of at least a year, and found that outcomes slightly favored programs that started treatment without anti-psychotics.

Other studies point to even stronger conclusions. Two World Health Organization studies comparing "schizophrenia" outcomes between developed and developing countries found much better outcomes in the developing countries where anti-psychotics were used much less. A comparison of the era before anti-psychotics and the modern era in the United States found modern outcomes were worse. And long-term outcome studies in general (not just the one Areford referenced) find the best recovery rates among those who have stopped medications.

While some might argue that this is not rigorous proof of the long-term ineffectiveness of anti-psychotics, the burden of proof really should be on those claiming effectiveness, especially given the evidence that anti-psychotics are doing serious long-term harm. And despite Straggenborg's denials, this evidence is overwhelming.

Straggenborg appeared to challenge Areford's report that the life expectancy of those treated in mental health centers is now 25 years below average. But this horrifying statistic is quite sound, and can be found in a report prepared by the National Association of State Mental Health Program Directors' Medical Directors Council. Areford's claim that the mortality rate has jumped since atypical anti-psychotics were introduced is also noncontroversial to those familiar with the data.

Straggenborg went on to attack Areford's credibility by implying he had claimed that the atypicals were fully responsible for the death rates, but Areford's actual assertion was only that they make an unacceptable contribution to death rates, "like adding gasoline to a fire." And while Straggenborg suggests anti-psychotic use may actually lower death rates in one respect by reducing suicide, he ignores evidence that anti-psychotics actually increase suicide rates.

Straggenborg goes on to call animal and human studies showing brain damage "speculative" and questions their "clinical significance," but common sense argues against ignoring this evidence.

Some of the brain-altering effects, while possibly temporary, appear to make it more difficult for people to withdraw from these medications without psychotic reactions. This may explain why slow withdrawal, over at least a number of months, has been shown to be about three times as successful as more rapid withdrawal.

Mental health problems are complex, and some people may find that long-term use of anti-psychotics continues to be their best option. But given the hazards, along with new data showing that long-term problems such as "schizophrenia" can often be prevented by timely nondrug psychosocial approaches and data showing the best mental health outcomes among those who have somehow safely gotten off anti-psychotics, it is clear a new approach is needed.

People should be helped to face and resolve mental health problems as much as possible, rather than being asked to accept a lifetime of anti--psychotics as the best outcome.

The Web site www.mindfreedom .org/rg has references for this and for Areford's column, and information on alternatives.

Ron Unger, a licensed clinic social worker, is a mental health counselor in Eugene.