October 16, 2007

Schizophrenia Drugs: Failure All Around

Forest Labs--makers of Celexa and Lexapro--today announced that a new antipsychotic compound designed to treat schizophrenia failed to outperform placebo in a recent clinical trial. Known as RGH-188, the drug targets D3 receptors instead of D2 receptors, as do most atypicals.

Janssen/J&J recently released a study showing that Invega outperforms Seroquel in treating schizophrenia. CL Psych dubs Invega "Son of Risperdal" and tosses cold water on the study.

In response to a recent post in which I beat up on atypicals for not doing a thing to improve mortality rates among schizophrenics, a reader commented:

"Exactly what would you prescribe for schizophrenics? The older drugs had a host of side effects and long term problems that were horrific. Are you suggesting that there are no treatment options that are acceptable for people with schizophrenia? You are at war with the entire class of atypicals but what is your answer? There are people who have been helped by these drugs. I have been."

Since I'm not in charge of a mental health system and am not a doctor, I'm not sure it's incumbent upon me to provide an option. That's one of the frustrations of being a critic--it's also one of the benefits.

But the question is one I wrestle with.

Of course, the first generation antipsychotics are awful, worse in some respects than the second generation antipsychotics. But the sad truth here is that we are spending tens of billions of dollars a year on SGAs--and allowing them to be used for a host of ailments that have nothing to do with schizophrenia--that don't have a clinically superior profile, costs 10 to 20 times as much as FGAs and are in fact killing people. All while pharma companies, the FDA and researchers stand by and call them good. And taxpayers foot much of the bill.

Current treatment paradigms for schizophrenia and bipolar disorder are built upon a house of lies. My answer is that it is time for the mental health industry to stop lying about these drugs and their ill effects in long-term use.

Also, I think that it's high time this country--if not the world--starting spending research money on examining alternative treatments for schizophrenia. There is a reason that long-term outcomes for schizophrenics in countries like India is much better than it is for their brothers and sisters in the US. We should be very interested in whatever answers we can glean from other cultures.

Sadly, I don't have a thorough answer for what should be used to treat schizophrenia in light of the flaws of the SGAs. What I hear through the grapevine is that some clinicians have reverted to treating schizophrenics with FGAs but at lower doses than in the past. I have no idea how that's working out clinically. It's far too early to say.

But I do know that it's time for this country to stop allowing researchers and pharma companies to apply a failed technology to long-term use in bipolar disorder in adults and children where, classically, there is no indication whatsoever for the long-term use of antipsychotics. It's become a disaster for patients. People have died as a result where, in my opinion, they wouldn't have died in the past.

Posted by Philip Dawdy at October 16, 2007 11:29 AM
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We had an answer to this question in the results of a rigorous research study at the then NIMH, comparing people with early episode schizophrenia sent to a regular hospital and getting drugs and people sent to Soteria House where they had company at all times and sometime to talk to and minimal use of drugs if any. The people who went to Soteria House had much, much better outcomes than those sent for standard treatment. But the study was not listened to in the onslaught of big pharma and the biological model of mental illness.

I would say to the person who asked you this question, you don't have to use drugs to treat schizophrenia. There may be a minority of folks who will end up not doing well with alternatives and taking the neuroleptics, but that is no reason not to try alternatives first with everyone before drugs.

Posted by: Alison Hymes at October 16, 2007 02:58 PM

Soteria House, in my opinion, should exist in each state, at the minimum, in the United States, and then go from there. It must be [in my opinion],an alternative option for housing for mental health patients.Until the mental health system looks beyond the current paradigm, we are going to be frustrated and treading water for many years to come, and people will lead 1/2 lives, or less-- than what their true potential can be and should be.

Posted by: Stephany at October 16, 2007 04:18 PM

I suspect that love, and tenderness, and working in a garden all end up with better effects than harsh, lethal atypicals. I suspect this is what one might find in India. I also suspect that careful analysis followed by supplements can have a clear and positive effect. And, don't forget, there are other medications available for manic depression. Most state Medicaids seem to have forgotten about these because they are not on patent and no one bothers to bribe state officials for these. The power of the industry and its bottom line has suppressed these alternatives, much to the sadness or death of people with mental illness.

Posted by: Soteria at October 16, 2007 05:35 PM

I keep thinking about Soteria House and how much cheaper that model is than the drug and warehouse model we are using today, also, how much more effective. And then there's the real estate crisis. Here in Atlanta we have both lots of homeless and lots of vacant residential housing. Surely eventually someone will make the connection.

Posted by: Sally at October 16, 2007 06:23 PM

The "problem" is that a Soteria House in every state would completely contradict the darwinist-capitalist paradigm that prevails in the United States. What would these Communists think of next: that society do something to effectively help America's many homeless?

A question that many Americans ask when visiting Europe is why they don't see homeless people as they do in the US.

Posted by: Ralph at October 17, 2007 04:21 AM

Ralph, The mainstream approach the homeless is this: America's many homeless are only homeless because they are selfish, dangerous, crazy, firebug, drug addicted, severely mentally ill people who blatantly refuse to take their medication. Oh, and all homelessness was caused by psychiatric survivor human rights groups who dared to suggest that people should be let out of the snakepits (oh excuse me) hospitals.

Homelessness has nothing to do with the fact that in the 20th century, and now the 21st, real wages are decreasing and the price of housing increasing. Hopefully as housing prices fall, homelessness will decrease and some of this horror will abate, but only if we can find jobs for homeless people.

Posted by: Sally at October 17, 2007 09:56 AM

Hi Philip,

I can't speak for the reader who posted the original question, but speaking for myself I find myself terrified and confused as to what to think about my treatment. Answers are few and far between. But I have a job and a family to support, the job expects me to do something, and I have no idea whether I'm doing the right thing.

Currently I'm on Abilify, Wellbutrin, Klonopin, and am being weaned off of Seroquel. The Abilify seems to be helping with mental acuity and mood much better than the Seroquel did. But I find I'm constantly waiting for the other shoe to drop. Every drug I've ever taken, and I've taken a bunch, show promise for a while and then lose their efficacy.

I don't think it's incumbent upon you to provide options, but perspective would be appreciated. I value the information you provide, but it often leaves me wondering if there's any light at the end of the tunnel. At the end of the day, I use the information you provide to talk to my doctor. How he answers my concerns goes a long way towards establishing the trust. Do I take some of the vilified medications? Yes. But I'd like to think I'm taking them with my eyes open.

Thanks!

Posted by: Craig at October 17, 2007 04:47 PM

I met an Invega sales rep at the psych, and asked him if he was representing the "Son of Risperdal", as he sat with the enormous orange coffee/latte' mugs stuffed with Invega samples, in the psych waiting room. It wasn't hard to miss the suit with his badge and goodie bag. He actually answered "Yes" when I called Invega "The Son of Risperdal". I asked for his business card in case I had other questions, and as he reached for his pocket, I think he finally came to his senses and realized I was a consumer, and told me he didnt have a card, but to call the company. I asked him how he stored Invega samples. He had his smooth correct answer ready to go "In a climate controlled environment." I don't think he understood the significance of a consumer asking him questions, or basically making fun of his product.

Posted by: Stephany at October 19, 2007 09:21 AM
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