Re: More reasons why to avoid antipsychotic drugs if possible

August 13, 2010

Having worked with alot of people who suffer from Schizophrenia - both inside

psychiatric hospitals and out, one thing to consider is that for someone with

such a severe illness, sometimes the long-term effects of the medication are

better than the alternative of not being on it at all. Schizophrenia is a

devastating illness, and living in a psychotic or delusional state is very

uncomfortable to say the least, and can devastate a person's life - and

sometimes shorten or end it prematurely. People with Schizophrenia are also at

greater risk for attempting suicide that the regular population.

I do agree that using antipsychotic medication in children should not be a first

or second alternative. It is an option gone to only when the benefits outweigh

the risks - Like people who struggle with Schizophrenia. Another example:

Dilantin - an anticonvulsant that people take for seizure disorder - drops some

people's IQ by 1-2 points a year (according to psychiatrists I have worked

with), but the torture and possible damage of repeated seizures and the

possibility of dying from a seizure makes it an option for people that other

alternatives have not worked for.

If any adults reading this site struggle with Schizophrenia or Bipolar Disorder,

PLEASE don't stop your meds based on this information. Talk with your

Psychiatrist first! They know you best.

I can't tell you how many people I've met in the hospital very ill because they

abruptly stopped their medication. It can lead to long periods of instability.

If you don't like your psychiatrist, get with one you can trust. If you dont'

have insurance/can't afford one, then locate a medical school with sliding scale

fee or access public services. It may not be perfect, but it's possible to get

what you need.

Blessings to all!

Diane

>

> I am posting this since so many " loving " doctors are exploring off label adult

medications for our children with autism. Caveat emptor!!

>

> Published on Psychology Today (http://www.psychologytoday.com)

>

> Charlie Rose and the Mentally Ill Brain

> By Whitaker

> Created Aug 12 2010 - 1:51pm

>

> On a recent PBS television show hosted by Charlie Rose on the " mentally ill

brain, " Columbia University's Lieberman presented a series of brain

scans of a person with schizophrenia, which showed enlarged ventricles and thus,

as Lieberman told the audience, " loss of brain gray matter. "

>

> (See minute 29:30 of video.) The idea being presented by Lieberman was that

schizophrenia is a neurodegenerative disease, characterized by brain tissue

loss.

>

> In the discussion, Lieberman also implied that antipsychotic medications, in

some way, protect against this neurodegenerative process. The drugs " stabilize

the illness, " he said. But when people " stop taking the medicines, they get sick

again, and when this happens, they have repeated insults to the brain . . . and

this leads to a progression, and the progression, like somebody who has multiple

little strokes, can lead to some decline in which people are not able to recover

to the same level. And if you actually take brain scans over time, you can see

the subtle, perceptible loss of brain grey matter. "

>

> To the public, this is a new paradigm for understanding why antipsychotics are

an essential treatment for schizophrenia. Schizophrenia is a neurodegenerative

illness, characterized by brain tissue loss, and antipsychotics are

" neuroprotective " agents that thwart that pathological process in some way.

>

> Given that this idea is taking hold, it seems worthwhile to check the

literature to see if it is well grounded in science.

>

> MRI Scans

>

> Making sense of MRI studies of schizophrenia patients can be a difficult task,

partly because the results can be so inconsistent, and partly because the

results are confounded by exposure to antipsychotics. However, earlier this

year, Joanna Moncrieff and Leo brought new clarity to this topic by

analyzing the studies based on the patients' exposure to antipsychotics.

>

> Here is a summary of their findings, which they published in Psychological

Medicine.

>

> Studies of chronic patients never exposed to antipsychotics

>

> They identified three studies of schizophrenia patients who were ill for

extended periods of time and were never exposed to antipsychotic medications. In

comparison to the " controls " in the studies, these never-exposed patients showed

" no major differences in global cerebral, grey-matter, ventricular, or CSF

(cerebrospinal fluid) volumes. "

>

> Studies of first-episode patients with limited exposure to antipsychotics

>

> A number of studies have found brain abnormalities in first-episode

schizophrenia patients, and these findings have been seen as proof that the

abnormalities must be due to the disease and not the treatment. But as Moncrieff

and Leo noted in their paper, many of the patients in the first-episode studies

had been on antipsychotics for months, and there is evidence that antipsychotics

may induce changes in brain structures in a short period of time. As such, the

results from first-admission studies -- as a group -- are confounded by drug

exposure.

>

> To counter this problem, Moncrieff and Leo analyzed the results from studies

of schizophrenia patients who were either drug naïve or had limited exposure to

antipsychotics (on average less than four weeks.) They found 18 such studies (in

addition to the three studies discussed above.)

>

> In 13 of them, researchers did not find any differences between the patients

and controls in whole-brain volumes, total grey matter, and CSF volumes. Of the

five studies that did show differences in brain volumes, one included a subset

of patients that had taken antipsychotics for up to 24 weeks, which could have

confounded the results. A second study reported differences in an initial sample

of 18 patients, but then, in a larger sample of 51 patients, no global

differences were found. The remaining three studies found a difference in the

size of the " third ventricle only; " a " trend level reduction in whole-brain

volume; " and " smaller cerebellar volumes. "

>

> Longitudinal studies of patients treated with antipsychotics

>

> In 14 of 26 MRI studies of schizophrenia patients treated with antipsychotics

for periods ranging from eight months to 10 years, the patients " showed a

greater reduction in whole-brain, cortical or grey-matter volumes, or a greater

increase in CSF or ventricular volumes, compared with controls. "

>

> Several of the 14 studies quantified the brain-volume loss. In adult patients,

" grey matter, whole-brain or cerebral volume showed a decline of 1.2% to 2.9%

per year. "

>

> Summing Up The MRI Studies

>

> With the MRI literature parsed in this way, it's easy to see that the studies

do not provide convincing evidence that schizophrenia patients, if they were not

treated with antipsychotics, would regularly suffer " a loss of brain gray

matter. " A reduction in whole brain volumes is not regularly seen in

first-episode patients with limited exposure to neuroleptics, and it was not

seen in the three longitudinal studies of never-exposed patients. The fact that

it shows up in the majority of studies of drug-treated patients simply leads to

this possibility: It could be due to a disease process, or it could be due to

the medication, or it could be due to a combination of the two.

>

> The Effect of Antipsychotics on Brain Volumes

>

> To best assess the long-term effects of antipsychotics on brain volumes and to

distinguish drug effects from disease processes, you would need to run a

long-term study that compared brain volumes in four groups: healthy people on

the medications, healthy people off the drugs, schizophrenia patients on the

drugs, and schizophrenia patients off the drugs. But you can't put healthy

people on antipsychotics and it is considered unethical to withhold

antipsychotics from schizophrenia patients for long periods, and so you can't

run studies of that type. However, animal research and MRI studies of medicated

schizophrenia patients do provide evidence that antipsychotics may cause " brain

gray matter loss. "

>

> In animal studies, typical antipsychotics have been found to cause neuronal

loss and gliosis in the striatum, hypothalamus, brain stem, limbic system and

cortex. In a study of non-human primates (macaque monkeys), a daily dose of

haloperidol or olanzapine for 18 months led to an 8% to 11% reduction " in mean

fresh brain weight compared to controls. "

>

> Next, as Moncrieff and Leo reported, a majority of studies of schizophrenia

patients on the drugs for longer periods found that they had reduced brain

volumes, while in the three longer studies of never-exposed patients, there was

no such finding. Furthermore, researchers have found that gray matter loss

varies according to whether a typical or atypical antipsychotic is prescribed,

and if the drugs did not affect brain volumes, there shouldn't be this

variability. Lieberman and others recently conducted a study of this type,

mapping the cortical changes seen in 36 first-episode schizophrenia patients

treated with either haloperidol or olanzapine for one year.

>

> Here are their results, which they published in 2009:

>

> • In the haloperidol patients, " a dynamically spreading wave of significant

gray matter loss was detected . . . progressive gray matter reduction began in

lateral parietal-temporal cortices by three months, spreading into the

dorsolateral, medial frontal and prefrontal cortices by six months, and

involving most of the frontal cortex by one year after the first psychotic

episode. " The " total loss is severe by 12 months. "

>

> • In the olanzapine patients, " regions of significant progressive gray matter

loss were found at all time points, but these were less intense and widespread.

These changes also evolved in a distinct antatomical trajectory " compared to the

haloperidol-treated patients.

>

> So how should these results be interpreted? Given the effects of haloperidol

and olanzapine in macaque monkeys, you might conclude that both drugs cause

brain gray matter loss in schizophrenia patients, with olanzapine perhaps less

toxic than haloperidol. However, since there was no control group in this study

and thus no mapping of gray matter loss in unmedicated schizophrenia patients,

the researchers concluded that it was also possible that olanzapine was

" neuroprotective, " i.e. that it slowed down the loss seen in the haloperidol

patients (which presumably was due mostly to the disease.) But, they wrote,

without a control group " it is difficult to be sure that the effect is either

due to toxic effects of one drug versus protective effects of another (among

other interpretations), and it cannot be determined what the normal trajectory

of such change is in schizophrenia. "

>

> The Bottom Line

>

> While the public may be hearing that schizophrenia is a neurodegenerative

disease characterized by a loss of brain gray matter, with atypical

antipsychotics neuroprotective against that process, even a quick review of the

scientific literature reveals that it is unclear whether the gray matter loss is

due to the disease, or to the drug, or to a combination of both.

>

> Here's what Moncrieff and Leo wrote in their conclusion : " Overall, there

seems to be enough evidence to suggest that antipsychotic drug treatment may

play a role in reducing brain volume and increasing CSF or ventricular spaces .

.. . although it remains possible that the underlying disease process also causes

brain volume changes, we suggest that antipsychotic drug treatment may be

responsible for some of the changes that are usually attributed to

schizophrenia. "

>

> Source URL: http://www.psychologytoday.com/node/46526

>

August 13, 2010

Oh Diane I hope you didn't think I was sharing this because I was suggesting

people go off medications -I was sharing because I know there is a dramatic

increase in exploratory off label medications to " treat " autism which is why I

shared this. As you can read in this link the use of antipsychotic drugs

http://www.medscape.com/viewarticle/460481_2 is pretty common in treating autism

-so let's just as parents make sure that this doesn't end up in the same boat as

antidepressant medications.

From recent news tells us through the Cochrane review which Cherab is a part of

" (SSRIs) cannot be recommended for treating autism in children or adults, the

results of a new Cochrane review of the literature show.

The analysis found no evidence that SSRIs are effective in children with autism

and may even be harmful, and although there is limited evidence that SSRIs are

effective in adults, the sample size of the trials is small and there is a risk

of bias. "

http://www.medscape.com/viewarticle/726850

I was trying to let parents know to question -to dig -to explore side effects

and seek second opinions prior to putting their child on any type of medication

that is off label or not proven effective for their child's diagnosis. I am NOT

talking about medications that are clinically validated for a specific

diagnosis. That is why I say " if possible "

Trust me I am right there with you Diane!!! I have a neighbor from a very

wealthy family within my community who lives alone who has diagnosed bipolor

with " psychotic episodes " who my husband just saw spray painting a huge rock

with a sad face prior to picking it up and throwing it -and that's not even the

least of his bizarre-o-world stories...he's awesome when he's on his meds and

he's like a creepy scary horror movie when he's not on his meds -he's clearly

off of them again and in my opinion should not be living alone- but when someone

has money they sometimes get to break the rules out of the norm anyway. (and

yes we call the police all the time and he has been taken away for months at a

time)

So again -let me make it clear that if anyone has a diagnosis that needs any of

these medications -PLEASE take them -as much as prescribed!!!! Listen to

Diane!!!!

....my message was again just a head's up to parents who explore off label

medications with their doctors to try to " treat " autism or like disorders-

exploring options with little or no proof - and in my opinion exposing the

innocent children to being real life guinepigs. This article is very

interesting in that it clearly shows there are possible strong neuro side

effects we don't yet even fully understand the extent of -and why put children

at risk when certain drugs are again being used in some cases as off label real

world experiments? Enough anyway to try to get money raised for actual clinical

research...in other words the children are real life experiments without the

safety of an actual clinical trial -my opinion anyway.

=====

August 14, 2010

Hey ,

No, I understand that you weren't encouraging people to stop their medications.

Sometimes news like that can have unintended consequences. I totally agree with

you that parents have to think long and hard about what they give to their

children and really research and explore all the options. I too would be very

leery of giving my child Antipsychotic medications - even the atypical ones.

There would have to be a really good reason, and I personally don't see based on

what I know about that class of medication how it would help someone with

Autism, but I haven't read the research. Sometimes it means tough choices when

it comes to our kids, and as it often is with life, no option is perfect. It's

always a measure of risks versus benefits. I don't about anyone else, but it's a

constant balancing act for me! :-).

Blessings,

Diane

>

> Oh Diane I hope you didn't think I was sharing this because I was suggesting

people go off medications -I was sharing because I know there is a dramatic

increase in exploratory off label medications to " treat " autism which is why I

shared this. As you can read in this link the use of antipsychotic drugs

http://www.medscape.com/viewarticle/460481_2 is pretty common in treating autism

-so let's just as parents make sure that this doesn't end up in the same boat as

antidepressant medications.

>

> From recent news tells us through the Cochrane review which Cherab is a part

of

>

> " (SSRIs) cannot be recommended for treating autism in children or adults, the

results of a new Cochrane review of the literature show.

>

> The analysis found no evidence that SSRIs are effective in children with

autism and may even be harmful, and although there is limited evidence that

SSRIs are effective in adults, the sample size of the trials is small and there

is a risk of bias. "

> http://www.medscape.com/viewarticle/726850

>

> I was trying to let parents know to question -to dig -to explore side effects

and seek second opinions prior to putting their child on any type of medication

that is off label or not proven effective for their child's diagnosis. I am NOT

talking about medications that are clinically validated for a specific

diagnosis. That is why I say " if possible "

>

> Trust me I am right there with you Diane!!! I have a neighbor from a very