Has Mad in America Changed its View of Medication for Schizophrenia?

newer meBy Marvin Ross

For those of you not familiar with Mad in America (MIA), it is a US organization begun by journalist Robert Whitaker. He is the author of books that are highly critical of modern psychiatry and its reliance on medication particularly for schizophrenia. As they say on their website they “investigate the problems and deficiencies with the current drug-based paradigm of care.”

I happened to come across this announcement on their site: “In World Psychiatry, two Canadian psychiatrists argue that the body of scientific evidence about schizophrenia shows that it is not a progressive illness and therefore we should have much higher expectations of full recoveries than we do.” I was intrigued because one of the authors of this study is Dr Robert Zipurski of McMaster University in Hamilton, Ontario.

Once before, MIA cited a study by him that used quotes selectively. They implied that Dr Zipurski provided proof of the evils of antipsychotic medication. Their website stated “decreases in brain tissue volumes are attributable to antipsychotic medication, substance abuse, and other secondary factors.” But, a careful reading of that paper found that when people discontinue medication early, the relapse rate is up to 78 per cent compared to 0-12 per cent for those who remain on medication.

MIA did not provide its own interpretation of this current paper which Dr Zipurski wrote with Dr Ofer Agid of the Centre for Addiction and Mental Health in Toronto. The two authors continue from the previous paper mentioned above and point out that:

Relapse of psychotic symptoms following a remission from a first episode of schizophrenia is also observed to occur in over 80% of individuals when studied naturalistically. This is largely attributable to discontinuation of antipsychotic medication rather than to the effects of an unrelenting disease process. The risk of symptom recurrence in remitted first episode patients receiving maintenance antipsychotic treatment is estimated to be in the range 0-5% in the first year of follow-up, compared to 78% in the first year off medication and close to 100% after three years off medication.

The authors then go on to wonder why outcomes are so poor if people have the ability to remain in remission. The reasons, they say, are numerous including the lack of services for these people or that they refuse treatment. Then, of those who are treated, about 20-30% are treatment resistant to the available antipsychotic medications. Others are non compliant with medication and so have relapses and re-hospitalizations. For others, their concurrent problems with alcohol, drugs, and other mental illnesses mitigate against retained recovery.

They conclude that while “there is room for debate about how recovery should be defined, it should be clear that most individuals with schizophrenia have the potential to achieve a stable remission of symptoms and substantial levels of satisfaction and happiness.”

That stability, they say, can be achieved with antipsychotic medication. Physicians/scientists/psychiatrists who observed that this dementia praecox or group of schizophrenias appeared to be a progressive disease were observing people with this illness pre 1960 before anti-psychotics were available – they were not wrong or overly pessimistic as there were no effective treatments at the time.

And it does take time for science to recognize that if someone begins antipsychotics at about age 19 and remains on them along with good medical care, that they can get to old age and remain stable or even improve.

It is encouraging to see MIA recognizing the importance of drug treatment by their promotion of this paper.

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7 thoughts on “Has Mad in America Changed its View of Medication for Schizophrenia?

  1. I would like to hear more about exactly how the researchers define recovery and happiness?? Although the authors define their own interpretation of recovery, but truth be told there is no evidence of the patient’s return to the healthy brains they would have had without the damage of neurological diseases like schizophrenia.

    We seek a complete cure for other chronic diseases. We must do the same for serious mental illnesses. This means that scientific research must destroy the agents in the brain that create dementias–not just decrease their virulence.

    We want to offer more than a half-life to those unfortunate enough to develop these human scourges by offering only amelioration. We owe them complete freedom from the disabilities SMI brings to their brains..

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    1. I am not sure what you are saying here June re: infectious agents . Other serious chronic diseases are often poorly understood and they do not have cures, but we strive to deliver treatment that works and try to persuade people to stay on that treatment for optimal outcome.

      With regard to Schizophrenia and allied conditions there were no effective treatments prior to the fifties. The trouble with the mad in America crowd they influence those who would benefit from treatment and constantly state that brain damage comes from antipsychotic which we know is not true. They would have them stay in a state of misery and serious unhappiness.

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  2. Marvin, I am a parent with an adult son with a schizophrenia diagnosis. We tried the antipsychotic “traditional” medication … and my son would abruptly stop his medication, then start it again…he complained from the onset that he did not like how the medication made him feel and started suffering from the debilitating side affects. I saw my son’s symptoms get worse with this coarse of treatment. He was further damaging his brain. We are currently exploring alternative treatments… a holistic approach, diet high in B6, magnesium, Vit D, rest, exercise and a high CBD, low THC medical cannabis strain and for the first time, I see improvement. We have only just started this approach but am hopeful. Medication is not for everyone and treatment should be between the patient and his doctor NOT the pharmaceutical companies who hold too much power. Thank you, Lynn Baldin Date: Wed, 4 Mar 2015 14:04:24 +0000 To: baldino.lynn@hotmail.com

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    1. Thanks for your comments Lynn. Not everyone responds to medication and it can be a long process to find the right combination of meds but some people are treatment resistant (about 20-30%). I too have an adult son with schizophrenia and I’ve seen the very positive effects of medication as the research suggests.

      I agree that treatment is between a patient and his doctor but I don’t understand what you mean by saying it should not between the pharmaceutical company and the patient. The doctor prescribes not big pharma. It is very unfortunate that our society leaves it to private industry to take medications through the clinical trial phases to market but no one else is doing that. Government regulatory bodies like Health Canada, the FDA in the US and a European regulatory agency will only license a drug if they see proof that is is effective and safe. And even after a drug is licensed, its safety is monitored and those that prove not to be safe are withdrawn.

      Best of luck with your attempts at a solution.

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    2. Hi Lynn,
      Has your son heard of pharmacogenetic testing for psychiatric drugs ?
      If I had my wish, the saliva test determining the best drug with the least side effects should be used before a drug is recommended.
      He could check the web for saliva test for psychiatric drugs.
      CAMH has a video on the subject.
      Wishing your son better health soon

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    3. It seems to me tha t you are treating him. THC and CBD are drugs. The others are dietary supplements.
      S chizophrenia is episodic ANF if the first episode is at 21 the the next may be many years after. Many get better with little treatment but the damage is not worth the risk.

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      1. I agree with John and dietary supplements are a risky way to go in my experience and I would not trust the alternative medicine people to come up with a solution.

        It is a very hard thing to press on and find the antipsychotic that the person might eventually respond to. It is not for the timid. The treating physician needs to have lots of experience.

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