Should we be afraid of Medication?

To me, this exchange encapsulates the tension and prejudice surrounding the topic of medication for mental illness. Those influenced by the anti-psychiatry movement as well as some frightened people grappling with mental illness, see all medication as a bad thing.

To them, all medication is a means of mind control or a money spinner cynically produced by greedy drug companies. But the vast majority of mental health workers such as psychiatrists and nurses see that  medication sometimes helps to give people back their lives.

Both sides can point to extreme examples. ‘Anti-psychiatrists’ point to people - even children - who have been forcibly given high doses of medication to sedate, rather than treat them. Or they point to people given high doses of medication which does not help their mental illness but which leads to awful side-effects or death.

On the other hand, psychiatrists like me remember patients who did terrible things to themselves or others while in the grip of delusional ideas and felt intense regret once they had accepted medication and their delusions melted away. If only they had taken their medication all along.

For my own part, I think that the majority of mental health workers go into the profession with good intentions - to help people carry the burden of mental illness and achieve satisfaction in their lives. We use our training to help people choose what will ultimately help them the most and seeing someone express a new enjoyment in life is deeply rewarding. Of course, we depend on accurate facts and figures from Drug Companies, and, yes, they are sometimes guilty of misleading us, but that does not mean that "all medication is bad". Far from it.

The subject of medication has come up recently in a couple of different areas. One of my fellow Rethink Mental Illness trustees recently asked me what I thought about the article Bitter Pills  by self-confessed ‘anti-psychiatrist’, Robert Whitaker in which he argues psychiatric drugs have actually increased the burden of mental illness in westernised societies

Whitaker points to figures from the USA, Europe and Britain showing that government spending on mental disability has increased since the 1980s as has annual spending on psychiatric drugs. Whitaker asks whether these increases been the result of drug therapy. 

Of course, there are a lot of reasons why mental illness might appear to be increasing such as better recognition, or better statistics. However, Whitaker goes on to suggest that psychotropic drugs, taken long-term, actually make patients more vulnerable to psychosis and antidepressants make patients more vulnerable to mania.

Some of the evidence Whitaker points to is deeply flawed. For example he suggests that before the introduction of chlorpromazine in 1956 - which is widely credited for emptying the large mental asylums - the majority of people with schizophrenia recovered and did well.

That simply is not true. However, the diagnosis of schizophrenia in the early years of the 20th century was a hit and miss affair. People were diagnosed with this illness who today we would merely see as stressed or unusual, so it’s not surprising they ‘recovered’.

Whitaker also points to a recent article by Nancy Andreasen's schizophrenia research group in America,  which suggests that antipsychotics are responsible for decreases in brain volume.

Further criticism of medication and psychiatry in general is found in an article by Marcia Angell in the New York Review of Books in June this year.  She asks why psychoactive drugs, which she calls ‘worse than useless’, are so widely prescribed and argues that the fault lies with drug companies.

Angell echoes Whitaker's suggestion that in the past, before drugs came on the scene, conditions such as schizophrenia and depression were self-limited or episodic. She suggests that although drugs may relieve symptoms in the short-term, they cause long-term mental harm.

This is nonsense. These arguments are best refuted in research by John Kane et al.  Kane points to the enormous research investment in better understanding and treating schizophrenia.

He argues that the introduction of antipsychotic medication has enabled many people to lead meaningful lives, while at the same time acknowledging medication does not treat all symptoms and is not without side-effects.

Kane admits that the cause of schizophrenia is still not understood, but points out that the same is true for many other illnesses. As for reductions in brain volume, Kane points to research that showing similar brain changes in individuals never treated with medication.

So, what are supporters and members of Rethink Mental Illness to make of all this? Should we be frightened by medication? Personally, I do not think we should be frightened, but I do think we should be careful, and choose the right medication, in the right dose, and also be sure that medication is actually necessary.

Current evidence suggests, overwhelmingly, that the best treatment for psychosis, including schizophrenia and bipolar disorder, is to offer appropriate medication, as early as possible, supplemented with psychotherapy.

Medication is not a panacea and it has side-effects, these facts must not be ignored. All medication should be carefully prescribed at the lowest effective dose. We should campaign for transparency from drug companies, so that all the facts are known. We should aim for a balanced approach which uses a cost-benefit exercise to ensure the best possible outcomes for people with a mental illness while minimising adverse effects.

This exercise takes time and money, so it’s important Rethink Mental Illness continues to push the government to fund research and treatment for mental illness. Let’s hope the recently launched independent Schizophrenia Commission, delivers a wake-up call.