silverwheel
Bluelighter
Hilary, the NIH article you linked to does not at all support the idea that antipsychotics damage one's brain. It merely suggests that medication is not always necessary long-term.
They describe the following pattern across these studies: (a) within the first 6-10 months after discontinuation, 25-55 percent of patients relapse; (b) for those who do not relapse during this period, subsequent relapses are much less frequent even after prolonged periods off medication.
This fits with what is already well-known about mental illness - that the severity of the illness is unique to each patient. Quite a few patients only experience one severe episode in their lifetime. Others will relapse consistently regardless of variables in one's life, and the article accounts for this. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous ... Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills. The article acknowledges that antipsychotics are quite useful in the short-term for most patients, and that they are not a cure-all for the other factors that can inhibit lasting recovery. And it also acknowledges that patients with severe cases need to stay on their medication long-term.
The "less is more" approach that this article suggests is also true for other areas of medicine as well - take chronic pain illnesses, for example. It's not wise to rely solely on script opioids to manage pain, because of both long-term side effects and essentially training the mind that the drug is the only method of getting relief. I've dealt with a number of pain management doctors over the last several years, and all of them follow this protocol. They want the illness to prove that strong opioids are necessary for the patient to find relief, and the want the patient to try other methods as well (acupuncture, dietary changes, exercise, physical therapy, etc.) But there are still numerous cases where the patient is doing all they can, and strong drugs are still necessary for them to have a decent quality of life. It's a trade-off between long-term risks and current relief, and the medications should periodically be re-evaluated to determine their necessity. This all applies to mental illness - medication should never be the only thing used, and nobody on this board argues for that. But there are plenty of us who have dealt with severe, recurring illness, who have done plenty of other therapy, and still need long-term medication to function well in their life. When you make such broad, blanket statements about medications, you're offering shit advice to a large percentage of the people who come here. The best person to evaluate the usefulness and necessity of medication is the patient's doctor, and I am consistently offended when you implicitly encourage people to distrust their doctors.
We realize that for too many people, today’s treatments are not good enough. New, better treatments are essential if we are to improve outcomes for all – that is the promise of research. But in the meantime, we need to be thoughtful about the treatments we have. Clearly, some individuals need to be on medication continually to avoid relapse. At the same time, we need to ask whether in the long-term, some individuals with a history of psychosis may do better off medication. This is a tough call, where known risks need to be balanced against potential benefits.
They describe the following pattern across these studies: (a) within the first 6-10 months after discontinuation, 25-55 percent of patients relapse; (b) for those who do not relapse during this period, subsequent relapses are much less frequent even after prolonged periods off medication.
This fits with what is already well-known about mental illness - that the severity of the illness is unique to each patient. Quite a few patients only experience one severe episode in their lifetime. Others will relapse consistently regardless of variables in one's life, and the article accounts for this. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous ... Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills. The article acknowledges that antipsychotics are quite useful in the short-term for most patients, and that they are not a cure-all for the other factors that can inhibit lasting recovery. And it also acknowledges that patients with severe cases need to stay on their medication long-term.
The "less is more" approach that this article suggests is also true for other areas of medicine as well - take chronic pain illnesses, for example. It's not wise to rely solely on script opioids to manage pain, because of both long-term side effects and essentially training the mind that the drug is the only method of getting relief. I've dealt with a number of pain management doctors over the last several years, and all of them follow this protocol. They want the illness to prove that strong opioids are necessary for the patient to find relief, and the want the patient to try other methods as well (acupuncture, dietary changes, exercise, physical therapy, etc.) But there are still numerous cases where the patient is doing all they can, and strong drugs are still necessary for them to have a decent quality of life. It's a trade-off between long-term risks and current relief, and the medications should periodically be re-evaluated to determine their necessity. This all applies to mental illness - medication should never be the only thing used, and nobody on this board argues for that. But there are plenty of us who have dealt with severe, recurring illness, who have done plenty of other therapy, and still need long-term medication to function well in their life. When you make such broad, blanket statements about medications, you're offering shit advice to a large percentage of the people who come here. The best person to evaluate the usefulness and necessity of medication is the patient's doctor, and I am consistently offended when you implicitly encourage people to distrust their doctors.
We realize that for too many people, today’s treatments are not good enough. New, better treatments are essential if we are to improve outcomes for all – that is the promise of research. But in the meantime, we need to be thoughtful about the treatments we have. Clearly, some individuals need to be on medication continually to avoid relapse. At the same time, we need to ask whether in the long-term, some individuals with a history of psychosis may do better off medication. This is a tough call, where known risks need to be balanced against potential benefits.
