Thanks to Beyond Meds for posting this very interesting story. And I say interesting for a number of reasons. One, whenever a doctor would deny the side effects I was experiencing from Seroquel or Abilify, I wanted to say, “Have you tried it?” Two, after my swain learned of my horrible experiences with Seroquel he took 1/4 of the dose I used to take (100mg) to see what would happen. He took 25 mg one time and was knocked out for nearly 24 hours. After he woke he could barely form a sentence, he was extremely sluggish and it took him a few days for him to recover from that one small dosage. He simply could not imagine what it must have been like for me, taking a stronger dosage for a much longer time. And thirdly, anytime I’ve ever seen a pharma rep selling (marketing, pimping or whatever you choose to call it) these horrific drugs, I have always wanted to ask, “Would you take this? Would you have your child take this?” I did ask a former friend and Wyeth rep the last question and his answer was no. Of course it was. So, here we have the story of a doctor who voluntarily took an antipsychotic drug:
In 1993 Richard Bentall went a bit mad.
He voluntarily took an antipsychotic drug and at first thought he’d get through unscathed.
“For the first hour I didn’t feel too bad. I thought maybe this is okay. I can get away with this. I felt a bit light-headed.”
Then somebody asked him to fill in a form. “I looked at this test and I couldn’t have filled it in to save my life. It would have been easier to climb Mt Everest.”
That was the least of his troubles. Bentall, an expert on psychosis from the University of Bangor in Wales who is in New Zealand under the University of Auckland Hood Fellowship programme, developed akathisia - unpleasant sensations of inner restlessness and an inability to sit still.
“It was accompanied by a feeling that I couldn’t do anything, which is really distressing. I felt profoundly depressed. They tried to persuade me to do these cognitive tests on the computer and I just started crying.”
Bentall had volunteered to be in a study run by Irish psychiatrist Dr David Healy. Volunteers were given either 5mg of the antipsychotic droperidol, 1mg of lorazepam, a type of tranquillizer, or a placebo.
“The experiment completely failed,” says Bentall. “Because first, it’s absolutely mind-bogglingly obvious to anybody after an hour whether or not they are taking an antipsychotic or a placebo - the side effects are so marked. There is no such thing as a placebo antipsychotic in that sense.”
But it was the fact that most of the healthy volunteers who took the antipsychotic became so unwell, let alone do the cognitive tests, that meant the study couldn’t continue. One psychiatrist became suicidal and had to be put under observation.
In his controversial book Let Them Eat Prozac Healy wrote about what the volunteers experienced. “It was not like anything that had happened to them before… Highly personal memories of previous unhappy times - broken relationships or loneliness - seemed to be flooding back. And if they previously held themselves responsible for these unhappy times, they seemed to hold themselves responsible for feeling the way they did now as well.”
The antipsychotic experiment, which gave him a hangover for a week, typifies Bentall’s approach to mental illness - rigorous scientific research coupled with a clinical psychologist’s perspective.
He has a doctorate in experimental psychology. “Most of my arguments are research-based,” says Bentall. “I’m just interested in what the evidence says about the nature of mental illness and how best to treat it. I’m a scientist at heart.”
What worries Bentall is how many mental health services seem to ignore what the research says and when an antipsychotic medicine doesn’t work, simply up the dose.
Once again Bentall refers to the science - that about a third of recipients don’t get any benefit whatsoever from the drugs. And research that shows if patients don’t respond at a relatively low dose, they’re not going to respond to a high dose. And are very likely not going to respond to any other anti-psychotic.
The optimum dose of antipsychotics is about 350mg per day (measured as chlorpromazine equivalents). Yet a recent study in the north of England found the median dose of antipsychotic drugs was about 600mg and about a quarter of those reviewed were on a gram or more a day.
“The average dose was about twice the optimum. How does that happen? It doesn’t make any sense.” Bentall suggests the reason such “unethical doses” occur is because mental health services have come to rely on these drugs as if they are the only treatment available. “When a patient doesn’t respond, they just up the dose in some magical belief that hopefully something will happen.”
But while promoting alternatives like cognitive behavioral therapy - the Government-sanctioned treatment of choice for depression and anxiety disorders in England - Bentall also points to research that shows all psychotherapies work, and that no type is more effective than any other. It’s a finding that surprised many, including Bentall.
Closer analysis highlights a common theme. “The quality of the relationship between therapist and patient explained most of the result.”
It seems blindingly obvious that having a good quality, empathetic therapist is likely to get good results, so why doesn’t it happen? “Establishing good relationships with patients shouldn’t be that difficult, but most psychiatric services seem to find it very difficult indeed,” says Bentall.
He says many services operate from a coercive model: “We know best. We’ve got the treatment. Better take these no matter what the side effects. Do what we say and if you don’t, we’ll put you on a community treatment order and you’ll be legally obliged to do what we say.”