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Letters to the Editor: Response to “Better Off Without Antipsychotic Drugs?”: Page 2 of 3

Letters to the Editor: Response to “Better Off Without Antipsychotic Drugs?”: Page 2 of 3

At 2 years, 74% of individuals in group 1 had psychotic symptoms, as did 60% of those in group 3. Although these differences are not statistically significant, the lines diverge at year 4.5 and continue to diverge over the next 15 years. At 4.5 years, 86% of group 1 have psychotic symptoms compared with 21% of group 3. By year 20, the difference is 68% compared with 8%.

If the group who stopped taking drugs did so because they were better, one would have expected to see that difference at 2 years, when medications had already stopped being taken. That is, if recovery led to drug discontinuation, then recovery should precede drug discontinuation; however, recovery began a few years after the drugs had been stopped.

This raises troubling questions for psychiatry. Psychosis can be dramatic, frightening, and disruptive. Dr Torrey understandably bemoans the poor outcomes for so many who suffer from psychosis. However, psychiatrists are assigned a powerful role in our society; we can force patients into treatment, and this sometimes includes forcing them to take these drugs. Dr Torrey has been one of the strongest proponents for this. In taking on this task, it seems that psychiatry should be assiduous in assessing risk and utterly transparent in our disclosures. This risk includes not only the failure to treat but also the consequences of our treatments. Yet, this has not been our history. Our profession has been slow to address the limitations of our drugs. We were slow to acknowledge tardive dyskinesia and slow to address the metabolic impacts of the newer antipsychotics. Will we be equally slow in addressing their impact on long-term recovery?

Sandra Steingard, MD
Medical Director
HowardCenter; Burlington, Vt

References

1. Torrey EF. Better off without antipsychotic drugs? Psychiatr Times. June 18, 2014. http://www.psychiatrictimes.com/psychopharmacology/better-without-antipsychotic-drugs. Accessed July 17, 2014.

2. Steingard S. A psychiatrist thinks some patients are better off without antipsychotic drugs. Washington Post. December 9, 2013. http://www.washingtonpost.com/national/health-science/a-psychiatrist-thinks-some-patients-are-better-off-without-antipsychotic-drugs/2013/12/06/547f5680-48aa-11e3-a196-3544a03c2351_story.html. Accessed July 17, 2014.

3. Wunderink L, Nieboer RM, Wiersma D, et al. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry. 2013;70:913-920.

4. Wunderink L, Nienhuis FJ, Sytema S, et al. Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. J Clin Psychiatry. 2007;68:654-661.

5. Johnstone EC, Macmillan JF, Frith CD, et al. Further investigation of the predictors of outcome following first schizophrenic episodes. Br J Psychiatry. 1990;157:182-189.

6. Gleeson JF, Cotton SM, Alvarez-Jimenez M, et al. A randomized controlled trial of relapse prevention therapy for first-episode psychosis patients. J Clin Psychiatry. 2009;70:477-486.

7. Harrow M, Jobe TH, Faull, RN. Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study. Psychol Med. 2014. http://www.mentalhealthexcellence.org/wp-content/uploads/2013/08/HarrowJobePsychMedMarch2014.pdf. Accessed July 17, 2014.

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