QJM Advance Access originally published online on July 22, 2006
QJM 2006 99(8):561; doi:10.1093/qjmed/hcl078
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Correspondence |
Neuroleptics revisited
Sir,Contrary to Dr Daniels' dismissal of my suggestion that neuroleptics cause dependence,1 this phenomenon was established throughout the 1950s and 60s in numerous studies, which included non-psychiatric controls as well as psychotic patients.2 It was established that people are more likely to suffer psychotic breakdowns and dyskinesias after withdrawal from neuroleptics than if they had never taken the drug. Indeed, some people were forced to take neuroleptics permanently, due to the severity of withdrawal symptoms.
Chronic neuroleptic treatment probably causes lasting brain changes which may, paradoxically, aggravate psychotic symptoms.3 A combination of chronic Parkinsonism, withdrawal-induced exacerbations and cumulative CNS damage probably accounts for the fact that patients diagnosed with schizophrenia have a much better prognosis in under-developed countries that cannot afford neuroleptics, than they do in technologically-advanced Western societies.3,4
My criticism of neuroleptics means that I am in favour of looking for better alternatives. For example, acutely disturbed psychotic patients (with diagnoses such as schizophrenia and mania) may be more quickly, effectively and safely be calmed by one or two treatments of electroconvulsive therapy (ECT).5,6 This is because acute psychosis is probably a delirious state, and ECT has powerful anti-delirium actions.7 And chronically-psychotic patients may best be maintained neuroleptic-free, with early treatment of symptom exacerbations using minor tranquillizers such as diazepam.8
The short-term effectiveness of neuroleptics in suppressing agitated behaviour (albeit at the cost of extremely unpleasant subjective symptoms) is not in doubt. But over the long-term, neuroleptics usually cause more problems than they solve. Most patients would be much better off if they were never exposed to these neurotoxic agents.
School of Biology and Psychology,
University of Newcastle upon Tyne,
Newcastle upon Tyne NE1 7RU
email: bruce.charlton{at}ncl.ac.uk
References
1. Daniels A. Neuroleptics reconsidered. Q J Med 2006; 99:421–3 (Response to preceding Commentary by BG Charlton, pp 417–20 of same issue.).
2. Healy D. The creation of psychopharmacology 2002;Harvard MA Harvard University Press.
3. Whitaker R. The case against antipsychotic drugs. Med Hypoth 2004; 62:5–13.[CrossRef][ISI][Medline]
4. Whitaker R. Mad in America 2002;Cambridge MA Perseus Publishing.
5. Fink M and Sackeim S. Convulsive therapy in schizophrenia? Schizophren Bull 1996; 22:27–39.[ISI][Medline]
6. Small JG, Klapper MH, Kellams JJ, Miller MJ, Milstein V, Sharpley PH, Small IF. ECT compared with lithium in the management of manic states. Arch Gen Psychiat 1988; 45:727–32.[Abstract]
7. Charlton BG and Kavanau JL. Delirium and psychotic symptoms—an integrative model. Med Hypoth 2002; 58:24–7.[CrossRef][ISI][Medline]
8. Carpenter WT, Buchanan RW, Kirkpatrick B, Brier AF. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiat 1999; 156:299–303.
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