Treating Madness With Drugs

Vincent Van Gogh

In a previous post I explained that current categorisations of mental illness find it hard to predict the course of the illness. Here I move onto the conventional pharmaceutical treatments associated with these categories.

There are two major pharmaceutical treatments for serious mental illness. For psychotic symptoms there are antipsychotics – also called neuroleptics. For mood disorders there are mood stabilisers, lithium being the most widespread. Many clinical trials on antipsychotics have shown that psychotic patients suffer fewer symptoms and later relapses when taking them. Indeed there are many people for whom medication provides their only effective lifeline.

But this is far from the whole story.

  • There is little evidence that the drugs available, such as chlorpromazine, an antipsychotic and lithium carbonate, are actually specific to the categories of mental illness described in an earlier post.
  • Despite advances in medication, studies into long-term outcomes of those with serious mental illness suggests that patients are not better off now than they were a century ago. (Recovery from Schizophrenia: Psychiatry and Political Economy)
  • Many of the drugs used to treat psychosis and mania have very considerable side-effects. The physical side-effects include: about 50% suffer pronounced weight gain, about 33% have sexual dysfunction and 25% have uncontrollable tremors. The psychological side-effect include feeling restless, agitated and depressed.
  • Finn, Bailey, Schultz & Faber (1990) looked at the subjective utility of antipsychotics in treating schizophrenia. They found that 41 patients experienced the side-effects of antipsychotics as just as bad as the symptoms they were supposed to be treating. Even more surprising, 34 psychiatrists making parallel judgements of utility agreed with them. That was until they were asked to consider the benefits of antipsychotics to society. Then the psychiatrists agreed that, for society, it was better to administer antipsychotics.
  • Some evidence claims that a new generation anti-psychotics – called ‘atypical antipsychotics’ – show reduced side-effects but there is criticism of the studies that have been carried out.
  • Geddes, Freemantle, Harrison & Bebbington (2000) analysed the data from 52 separate studies into the new ‘atypical’ antipsychotics. They found that their apparently reduced side-effects and increased effectiveness had been significantly exaggerated.
  • New ‘atypical’ antipsychotic medications are considerably more expensive than their ‘typical’ counterparts. This is because the old drugs have passed out of patent and so can be manufactured generically and hence cheaply. The new drugs are much more profitable for their manufacturers.
  • In the treatment of serious mental illness, the influence of large pharmaceutical companies, ‘Big Pharma’, cannot be ignored. The investments made in new drugs, especially in the new ‘atypical’ antipsychotics is often huge. Only one study into the effectiveness of clozapine is estimated to have cost the pharmaceutical company Sandos $5 million.
  • Bentall claims that many psychiatrists are continuing to prescribe much higher levels of antipsychotics than is actually necessary, thereby causing many unnecessary side-effects.

Acknowledgement: This post is based, to a large degree, on ideas put forward by Richard P. Bentall in his book, ‘Madness Explained‘.



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Dr Jeremy Dean is a psychologist and the author of PsyBlog. His latest book is "Making Habits, Breaking Habits: How to Make Changes That Stick". You can follow PsyBlog by email, by RSS feed, on Twitter and Google+.

Published: 23 January 2006

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