Wunderink and The Bitterest Pills*

A study on the longer-term effects of “antipsychotics” by the awesomely named Lex Wunderink was published back in July that deserves some attention. Since Robert Whitaker and Joanna Moncrieff at Mad in America have summarized its findings and talked about its context and implications, I’ll just link to their posts.

• Robert Whitaker, “Harrow + Wunderink + Open Dialogue = An Evidence-based Mandate for A New Standard of Care”

• Joanna Moncrieff, “Long-Term Antipsychotics: Making Sense of the Evidence in the Light of the Dutch Follow-Up Study”

I will say that Whitaker is being extraordinarily generous with psychiatry, though, when he writes:

In my opinion, this represents a defining moment for the profession. If it changes its protocols for prescribing antipsychotics, in the manner set forth in the JAMA Psychiatry editorial, then “hats off” to the profession. It will have responded to evidence that didn’t show up in shorter withdrawal studies, and changed its ways in response to new evidence, even though that will surely be a difficult thing to do. This would be a beautiful—and inspiring—change to watch.

But, if psychiatry doesn’t amend its protocols, and if psychiatry doesn’t sponsor new research to best reach these goals, then—and I know no other way to say this—then I think psychiatry will have to be seen, by mainstream society, as a failed medical discipline. Psychiatry will no longer be able to claim that its practices are evidence-based and driven by a desire to achieve the best possible outcomes for its patients. Instead, the lack of change will be evidence that its prescribing practices are, in fact, driven by an ideology, which is to maintain a societal belief that antipsychotics are a necessary long-term treatment for psychotic disorders, and that it is more important for the profession to maintain that belief than it is to help those it treats to have the best chance possible to achieve a good functional outcome, which is the outcome that counts.

He acknowledges that his “realistic self expects the latter,” but, really, it’s far too late for a scientific or ethical hats off for psychiatry. It’s far too late for any of their actions in this regard to be seen as beautiful or inspiring, far too late for them to demonstrate that their practices are evidence-based. The fact that this is being discussed as a gold-standard RCT studying the effects of drugs on the “symptoms,” “relapse,” and “remission” of a disease that hasn’t even been shown to exist is an indication of just how far out at sea they are.

In related news, as mentioned in her post, Joanna Moncrieff has a new book coming out: The Bitterest Pills: The Troubling Story of Antipsychotic Drugs.

Antipsychotic (neuroleptic) drugs have become some of the biggest blockbusters of the early 21st century, increasingly prescribed not just to people with 'schizophrenia' or other severe forms of mental disturbance but for a range of more common psychological complaints. This book challenges the accepted account that portrays antipsychotics as specific treatments that target an underlying brain disease and explores early views that suggested, in contrast, that antipsychotics achieve their effects by inducing a state of neurological suppression. Professional enthusiasm for antipsychotics eclipsed this understanding, exaggerated the benefits of antipsychotics and minimized or ignored evidence of their toxic effects. The pharmaceutical industry has been involved in expanding the use of antipsychotics into territory where it is likely that their dangers far outweigh their advantages.

I don’t understand why even this new one isn’t available for Kindle, but it looks good.

*Sounds like a scary fairy tale about biopsychiatry.