|
Review: Your Drug May Be Your Problem
November 17, 2004
by Byron Fraser
- First published in the Fall 2000 In A Nutshell
- Your Drug May Be Your Problem:
- How and Why to Stop Taking Psychiatric Medications
- (Persus Books/Harper Collins Publishers, 1999. 272 pages)
- by Peter Breggin, M.D. and David Cohen, Ph.D.
- Review commentary and select quotes compiled by Byron Fraser
- Introduction
- This is the best selling book first published late last year
(and now due to come out in a large paperback edition as of Nov.,
2000) which numerous people I ve met in the local mental health
community have been vigorously recommending, promoting, and/or
disputatiously talking up, seemingly non-stop, of late; it is having
a major impact. The thing is that, for years, people “in
the system” wanting to access alternatives to what passed for
“treatment” (i.e., essentially drugging) have had no
ready guide to either the risks entailed in taking their prescribed
medications or the often extremely debilitating withdrawal
syndromes associated with going off of their medications; there
simply has been nothing like informed consent, full disclosure, or
any sort of succinct informational source we could direct people to
which covers all of this. Now, thankfully, we have this factually
power-packed, up-to-date, authoritative and definitive capsule
summary, grounded in solid medical research, of everything anyone
considering taking -- or wondering about stopping taking --
psychiatric drugs really needs to know. Intended for patients,
laymen and professionals alike, it is also a must-read for all
health care service providers and advocates working in general
fields related to psychiatry. Adverse effects of all categories of
psychiatric drugs currently in use -- including minor and major
tranquilizers, antidepressants, stimulants, sleeping pills,
neuroleptics/antipsychotics, and “mood stabilizers” --
are listed in detail along with the most comprehensive summary of
psychiatric drug withdrawal reactions (e.g., “relapse”
and “rebound” effects) available anywhere. Of course,
the authors -- world-famous psychiatrist/ author and Director of
the International Center for the Study of Psychiatry and Psychology,
Dr. Peter Breggin, and expert psychiatric drug researcher, Professor
David Cohen, of the University of Montreal -- have a point of view,
but their intent is not to preach or proselytize. Rather, it is to
aid in harm reduction via contributing what they can to maximally
efficacious decision-making processes -- at all levels. This
review is limited to just highlighting a few of the very relevant
and timely issues treated of at length in the book. Its major
premise, briefly, is:
- “...we believe that the benefits of psychiatric drugs are
vastly exaggerated, that their disadvantages are too often
minimized, and that there is far too little information about how to
stop taking them. This book is, in fact, the first and only
one to focus on the overall problem of why and how to stop taking
psychiatric medication.” (--p. 28)
Quotes and Quick Facts
-
- 1) The Current Situation
- “...all psychiatric drugs have well-documented, serious
hazards.” (--p. 12)
- “Evidence suggests that all psychiatric drugs can produce
withdrawal reactions.” (--p. 26)
- “...all psychiatric drugs are drugs of dependence
[according to accepted medical definitions of physical
dependence; see same page --B.F.].” (--p. 145)
- “The longer you take a tranquilizer, the higher the doses,
and the more abrupt the withdrawal -- the more serious your
withdrawal reactions are likely to be.” (--p. 148)
- “Overconfidence in clinical judgment concerning the
long-term safety of drugs has led to an even more tragic outcome.
Millions of patients have been afflicted with gross neurological
disorders from taking antipsychotic drugs. This class of drugs --
... -- was used for two decades before it was generally recognized
that the entire group frequently causes tardive dyskinesia and
neuroleptic malignant syndrome [and they are prescribed more
frequently than ever, in spite of this, to this day --B.F.].”
(--p. 49)
- “FDA records contain thousands of reports of severe and
life-threatening reactions to almost every psychiatric drug in
current use....Hence FDA approval should not be interpreted as
indicating that a given drug is without serious and potentially
fatal adverse reactions. On the contrary, all psychiatric drugs
approved by the FDA can pose enormous risks even in routine use.”
(--pp. 102-03)
- “More than 50 percent of patients drop out of psychiatric
drug treatment 'due to side effects,' including drug-induced
'sleep problems, anxiety and agitation, and sexual dysfunction'.”
(--p. 31)
- “Although there is some variation among medications in
this class [neuroleptics --B.F.], all of them can cause toxic
psychoses with delirium, confusion, disorientation, hallucinations,
and delusions. Probably all of them also cause depression....Most of
them can cause sedation and fatigue, seizures, weight gain,
dangerous cardiac problems, hypotension..., a variety of
gastrointestinal problems such as paralysis of the bowels, hormonal
abnormalities..., sexual dysfunctions..., skin rashes and
sensitivity to sunlight, eye disorders, allergic reactions...and
disorders of body temperature regulation....” (--pp. 80-81)
- 2) Are Biochemical Imbalances and Brain Diseases Treated by
Psychiatric Drugs?
- The simple scientific answer is an emphatic “No”--:
no underlying causal pathology for any psychiatric disorder has ever
been identified to be so “treated” or “cured”.
What psychiatric drugs do is to treat symptoms of mental
disorders temporarily without affecting their causes. This is
admitted by all. Hence: “In the field of mental health, not a
single physical explanation has been confirmed for any of the
hundreds of psychiatric 'disorders' listed in the DSM-4. A recent
editorial in the American Journal of Psychiatry (Tucker, G.J.
1997. 'Editorial: Putting DSM-4 in perspective.' No. 155, pp.
159-61) states the case plainly: 'As yet, we have no identified
etiological agents for psychiatric disorders'.” (--p. 112)
-
- “The concept of biochemical imbalances in people diagnosed
with depression, anxiety and other 'disorders' remains highly
speculative and even suspect...there is at present no way to prove
its validity. Specifically, we lack the technical capacity to
measure biochemical concentrations in the synapses between nerve
cells....
-
...all psychiatric drugs directly affect the brain s normal
chemistry by disrupting it....
-
It is important to keep this in mind: the brain is always
impaired by psychiatric drugs....this conclusion...is supported
by...an enormous amount of scientific research detailing the
biochemical imbalances in the brain created by psychiatric
medication. These drug-induced biochemical imbalances commonly cause
psychiatric disorders in routine psychiatric practice.
- Even if some emotional problem turned out to be caused by
subtle, as-yet-undetected biochemical imbalances, this finding would
not be a rational justification for using any of the psychiatric
drugs that are currently available. Because they impair normal brain
function, such drugs only add to any existing brain malfunction....
- If psychiatric drugs could correct specific biochemical
imbalances, specific types of drugs for specific disorders would be
available. But this is not the case....
- No psychiatric drug has ever been tailored to a known
biochemical derangement.... At the same time, no biochemical
imbalances have ever been documented with certainty in association
with any psychiatric diagnosis. The hunt goes on for these illusive
imbalances; but their existence is pure speculation, inspired by
those who advocate drugs. (Footnote 7, Ch. 2: Within the privacy of
professional writings, various experts in the field agree that no
biochemical abnormalities have been demonstrated in psychiatric
disorders. Textbooks are filled with speculations, often specifying
several potential biochemical mechanisms, but in no case can they
claim that such speculations have been proven. Indeed, the textbook
chapters usually conclude with an admission that nothing has been
proven but that 'breakthroughs' are anticipated. [See also,
especially, in this regard, the recent very scholarly summary by Al
Siebert, Ph.D., in the Ethical Human Sciences and Services
journal, Vol. 1, No. 2, 1999 from the International Center for the
Study of Psychiatry and Psychology: 'Brain Disease Hypothesis for
Schizophrenia Disconfirmed by All Evidence.' Also in the same issue
focusing on the theories about and identification of -- as well as
current treatments for -- 'schizophrenia', is the important article
by Jay Joseph, Ph.D., 'The Genetic Theory of Schizophrenia: A
Critical Overview.' It can be ordered from Support Coalition
International -- toll free: 1-877-623-7743/ Fax: 1-541-345-3737 --
or from Springer Publishing Company: 1-212-941-7842 --B.F.]).”
(--p. 33-35)
- 3) If Psychiatric Drugs Don t Cure Physically Caused
Organic Brain Diseases Or Mental Illnesses , What Do They Do?
- “Psychiatric drugs do not work by correcting anything
wrong in the brain. We can be sure of this....There are no known
biochemical imbalances and no tests for them. That s why
psychiatrists do not draw blood or perform spinal taps to determine
the presence of a biochemical imbalance in patients. They merely
observe the patients and announce the existence of the
imbalances....
- Ironically, psychiatric drugs cause rather than cure
biochemical imbalances in the brain. In fact, the only known
biochemical imbalances in the brains of patients routinely seen by
psychiatrists are brought about by the psychiatrists themselves
through the prescription of mind-altering drugs.
- Psychiatric drugs 'work' precisely by causing imbalances in
the brain -- by producing enough brain malfunction to dull the
emotions and judgment or produce an artificial high....”
(--p. 41)
- “...few, if any, psychiatric drugs have been proven to
bring about long-term beneficial effects, even
-
by standards of researchers who favor drugs.
- There are no lifetime studies of drug efficacy....most
studies of psychiatric drugs last four to six weeks and often have
to be statistically juggled to make them look positive. Even when
researched over the longer term, these drugs tend to be associated
with increasingly adverse effects and no evidence of
efficacy....There is simply no justification whatsoever for the
commonly made claim that some people need to take psychiatric drugs
for the rest of their lives.
- In fact, most of the problems involved in 'doing without
drugs' are the result of drug withdrawal. Patients most often have
trouble stopping drugs not because they are useful but because they
create dependency.” (--p. 193)
- “Contrary to claims, neuroleptics have no specific effects
on irrational ideas (delusions) or perceptions (hallucinations).”
(--p. 77)
- 4) Do Psychiatric Drugs Prevent Suicide and Violence?
- “...the FDA has never approved a drug specifically for the
prevention or control of suicide or violence.
-
More generally, there is no convincing evidence that any
psychiatric medication can reduce the suicide rate or curtail
violence. But there is substantial evidence that many classes of
psychiatric drugs -- including neuroleptics (antipsychotics),
antidepressants, stimulants, and minor tranquilizers -- can cause or
exacerbate depression, suicide, paranoia, and violence.”
(--p. 38)
- (While this is true, the main argument used by
institutional/corporate, political and media proponents of the
expansion of forced treatment/compulsory outpatient committal/
involves deliberate perpetuation and exacerbation of the false
public stereotype of people with mental disabilities as innately
more violent than the general public. For definitive studies
refuting this commonplace myth, see Mental Illness and Violence:
Proof or Stereotype [National Clearing House On Family Violence,
1996. Ph.: 1-800-267-1291] and, in the U.S., The MacArthur
Violence Risk Assessment Study [1998] --B.F.)
- “Numerous suicide and murder cases have involved patients
who have taken SSRIs [serotonin reuptake inhibitors -- such as
Prozac, Zoloft, Paxil, Luvox, etc. --B.F.] for a few days or
longer.” (--p. 69)
- (Luvox was being taken by Eric Harris at the time he committed
the murders at Columbine High School in Littleton, Colorado on April
20, 1999, for example. And the now-accepted -- legally -- “Prozac
Defense” has become quite commonplace due to the numerous
serious violent offences committed by people having reactions to
that particular drug. --B.F.)
- 5) What Are The Dangers? Tardive
Dyskinesia/Dystonia/Akathisia, Neuroleptic Malignant Syndrome, and
other “side effects”.
- “For the neuroleptics that have been extensively
studied...the rates of tardive dyskinesia and neuroleptic malignant
syndrome are very high.” (--p. 47)
- “Tardive dyskinesia (TD) is a common and yet potentially
disastrous adverse reaction to all of the neuroleptic drugs. TD
involves irreversible abnormal movements of any of the voluntary
muscles of the body. It commonly afflicts the face, eyes, mouth, and
tongue, as well as the hands and arms, feet, and legs, and torso. It
can also affect breathing, swallowing, and speech. In some cases,
spasms of the eyes are so severe that the person cannot see.
- One variant of TD is tardive dystonia, which involves painful
spasms, often of the face and neck. Tardive dystonia can be
disfiguring and disabling, potentially impairing even the ability to
walk.
- Another variant of TD is tardive akathisia. The individual is
virtually tortured from inside his or her own body as feelings of
irritability and anxiety compel the person into constant motion,
sometimes to the point of continuous suffering....
- Another disastrous reaction caused by neuroleptic drugs is
neuroleptic malignant syndrome (NMS). Similar to viral brain
inflammation (encephalitis), NMS is characterized by severe abnormal
movements, fever, sweating, unstable blood pressure and pulse, and
impaired mental functioning. Delirium and coma can also develop. NMS
can be fatal....Patients who recover may be left with varying
defrees of irreversible mental impairment as well as permanent
abnormal movements....
- The rates of TD are extremely high. Many standard textbooks
estimate a rate of 5%-7% 5 per year in healthy young adults. The
rate is cumulative so that 25%-35% of patients will develop the
disorder in 5 years of treatment. Among the elderly, rates of TD
reach 20% or more per year. (Footnote No. 35, Ch. 4:
Bezchlibnyk-Butler and Jeffries [Clinical Handbook of
Psychotropic Drugs, 1996], estimate that 37% of patients will
develop TD in the first 5 years and 56% after 10 years. )”
(--pp. 78-79)
- “Mania, depression, and other abnormalities of emotional
control commonly result from taking psychiatric drugs. These
drug-induced 'mood disorders ' are mentioned many times in
the...(DSM-4), which is the source of all official diagnoses in
psychiatry. The manual makes clear that a number of psychiatric
drugs, including antidepressants, can cause mania. As well,
Patients often become more depressed on antidepressants....Almost
all psychiatric drugs -- from the minor tranquilizers to
stimulants... -- can cause depression.” (--pp. 54- 56)
- 6) Is Drug Treatment Superior to Non-Drug Treatment or
Psychotherapy?
- “...the effectiveness of most or all psychiatric drugs
remains difficult to demonstrate. The drugs often prove no more
effective than sugar pills, or placebos....
- ...Studies show that at least 75 per cent of the
antidepressant effect is a placebo effect....” (--p. 37)
-
- “Claims are usually made for the superiority of
medication; it is supposedly faster, more economical, and more
effective. In reality, however, the comparable or superior efficacy
of psychotherapeutic interventions, even for severely disturbed
people, is much better documented than most therapists or the public
realize. [Numerous source references cited --B.F.]....
-
Therapy has also been shown to be more effective than drugs in
helping patients diagnosed with their first 'schizophrenic' break.
Nowadays it is argued that these people must have drugs and that
psychotherapy is futile; yet nothing could be further from the
truth. In controlled studies, untrained therapists in a home-like
setting have proven more successful than drugs and mental hospitals
in treating patients diagnosed with their first episode of
schizophrenia. A key factor was the caring, non-coercive approach of
these therapists.” (--p. 40)
- (See especially also, in this regard, the report on recent
longitudinal studies in Sweden comparing outcomes of first time
psychotic patients treated with neuroleptic drugs vs. those not so
treated in the essay collection, edited by Dr. Lars Martensson,
Deprived of Our Humanity: The Case Against Neuroleptic Drugs
[1998]. This 224 page paperback -- which is one of the best
introductory volumes to current issues in psychiatry for giving to
laymen, family members, and mental health professionals -- is
available from Support Coalition International or from: The
VOICELESS, Movement for Patient s Rights, P.O. Box 235, CH-1211
GENEVA 17, Switzerland. [It also has excellent sections on
“Withdrawal Symptoms Connected with Cessation of Psychiatric
Drugs”, “How to Come Off Psychiatric Drugs”,
“Psychiatric Living Wills” and much else. Highly
recommended!] Also very relevant is the work of Dr. Loren Mosher,
former Chief of the National Institute for Mental Health s [NIMH s]
Center for Studies of Schizophrenia, documented in “Soteria: a
therapeutic community for psychotic persons” in Psychosocial
Approaches to Deeply Disturbed Patients [1996], edited by P.
Breggin and E.M. Stern, as well as Community Mental Health:
Principles and Practice [1994], by L.R. Mosher and L. Burti.
Finally, there is a very recent superb brief treatment of this
subject-area titled “Prepsychotic Treatment for
Schizophrenia: Preventative Medicine, Social Control, or Drug
Marketing Strategy?” by Richard Gosden in the above-mentioned
Vol. 1, No. 2, issue of the Ethical Human Sciences and Services
journal. --B.F.)
- “According to an international study by the World Health
Organization [see: 'WHO studies of schizophrenia: An overview of the
results and their implications for an understanding of the
disorder', 1996, by G de Girolano in Psychosocial Approaches to
Deeply Disturbed Patients --B.F.], less industrialized cultures
characterized by extended families have a very positive effect on
the recovery of individuals who are diagnosed as schizophrenic -- in
contrast to their counterparts in Western cultures, where isolated
families are more common....a large proportion of very disturbed
individuals labeled schizophrenic had complete recoveries.
Tragically, this study also showed that the availability of modern
psychiatric treatment with drugs has a negative effect on the
outcome for people diagnosed as schizophrenic....” (--p. 41)
- 7) Basic Guidelines for Drug Withdrawal
- “We can sum up the most prudent and sensible way to stop
taking psychiatric drugs in one short sentence: Plan it well and go
slowly. Regardless of the drug you are using and the problems it may
have created in your life, a well-planned, gradual withdrawal
has the best chance to succeed.” (--p. 111)
-
- “Beware! It s not a good idea to abruptly stop taking
drugs without first making sure that there s no danger involved in
doing so. In our opinion, it is almost always better to err in the
direction of going too slowly rather than too quickly.” (--p.
133)
-
- “The...best approach is to plan a slow, gradual withdrawal
involving close monitoring and a systematic, ongoing program of
information, counseling, and reassurance. Unfortunately, however,
abrupt withdrawal remains very common in clinical practice. Abrupt
withdrawal is imprudent and may result in additional distress and
disability.” (--p. 172)
- “All psychiatric drugs can produce unpleasant, disturbing
reactions upon withdrawal or discontinuation....However, doctors are
too often unfamiliar with withdrawal problems associated with many
of the...psychiatric drugs they routinely prescribe.
- ...even when doctors do know about the dangers of withdrawal
problems from drugs, they often fail to warn their patients.
(Footnote 1, Ch. 9: Young ... Currie, 1997. 'Physicians knowledge
of antidepressant withdrawal effects: A survey.' Journal of
Clinical Psychiatry. Even with respect to tardive dyskinesia, an
often irreversible movement disorder frequently produced by
neuroleptic drugs and mentioned in all information sources about
these drugs, surveys show that psychiatrists admit that they
routinely fail even to mention this effect to patients before
prescribing [see further: Cohen, D. 1997. 'A Critique of the Use of
Neuroleptic Drugs in Psychiatry.' In From Placebo to Panacea:
Putting Psychiatric Drugs To The Test, Fisher & Greenberg,
eds.]) , medical ethics and sound practice require that physicians
advise patients about withdrawal problems. There is no legitimate
excuse for not doing so.” (--p. 142)
- 8) Rebound and Relapse Effects (Does continued use of
psychiatric drugs actually prevent relapse?)
- “In terms of relapse rates,prolonged drug treatment
appears to be no better than [complete cessation and withdrawal
with] a gradual tapering [vis-à-vis prevention].”
(--p. 165)
- “Psychotic withdrawal symptoms are variously called
tardive psychosis, super sensitivity psychosis, or withdrawal
psychosis. Frequently accompanied by abnormal movements, they
include hallucinations, delusions, confusion, and disorientation.
- After years of suppression of the dopamine system by these
drugs, the brain compensates for their effects. When the drugs are
discontinued, the hyper-aroused dopamine system takes over.
Psychotic reactions [which then often occur] upon abrupt withdrawal
have been observed [even] in individuals with no history of
psychotic symptoms, such as patients taking neuroleptics for tic
disorders.” (--p. 163)
-
- “In cases where patients are withdrawn from extended
neuroleptic use, much of what gets called 'schizophrenic' or
'psychotic' relapse may actually be unrecognized withdrawal
reactions. Withdrawal symptoms such as agitation, restlessness, and
insomnia are also likely to be mistakenly attributed to the patients
mental condition.
- Indeed, because of the resemblance between many withdrawal
symptoms and patients' prior emotional problems, clinicians not only
blame the reaction on the 'underlying disorder' but also recommend
continued treatment with the offending agent.” (--p. 165)
- “We...suggest that a sound attempt be made to answer two
important questions: Do 'discontinuation' or 'withdrawal' effects
drive people to remain on their drugs indefinitely? And do these
effects mistakenly convince doctors that patients 'need' their
drugs?” (--p. 147)
- 9) Conclusion: There Are Humane, Realistic Alternatives (Or
Should Be)
- There is a great, great deal more in Your Drug May Be Your
Problem about why things are the way they currently are, many
more details about planning your or your child's withdrawal, and
non-drug therapy options, etc., but the above excerpts will
hopefully have given the interested reader an essential grasp of the
important issues dealt with in plain English and “in a
nutshell”, as we like to say around here. The book s
concluding Chapter 13, outlining 12 “Psychological Principles
for Helping Yourself and Others Without Resort to Psychiatric
Medications” (page 203), was also found to be an especial
inspiration by this reviewer. We can move beyond this stage
of suffering and harm that many of us have personally witnessed and
lived through.
| |