Welcome to From Insults To Respect.
Back in 2019, I criticized the use of “antipsychotics” and on Facebook someone criticized what I had written saying, “all of the research clearly indicates that the “antipsychotics,” when used by people diagnosed as having schizophrenia, decrease the risk of dying.” I then, very respectfully, asked that he supply me with the references that he is relying on to make his assertion, and within a very brief period, he did just that.
In looking at his list, I noticed immediately that he left out every one of the studies that provided strong evidence published in peer reviewed articles that suggest this class of drugs actually reduces longevity. For example, a 2007 study was published in the Archives of General Psychiatry titled “A Systematic Review of Mortality in Schizophrenia: The Differential Mortality Gap Worsening Over Time.” The authors wrote:
Mental health services have advanced in many parts of the world during the past few decades. Apart from a different mix of community-based care, the introduction of the second-generation antipsychotic medications [also referred to as atypical antipsychotics] in the early 1990s was initially found to be associated with better quality of life and reduced risk of relapse.77–79 More recent trials have questioned the clinical superiority of second-generation antipsychotic medication,80,81 and concern is now widespread about the adverse effects associated with these medications.82 In particular, compared with typical antipsychotics, several of the second-generation antipsychotics are more likely to cause weight gain and metabolic syndrome.83 Because the metabolic syndrome is associated with a 2- to 3-fold increase in cardiovascular mortality and a 2-fold increase in all-cause mortality,84 these adverse effects would be expected to contribute to even higher SMRs [Standard Mortality Ratio] in the next few decades.85,86
After summarizing the many studies revealing these types of troubling findings, I then took a look at the studies that were cited by the person who criticized my position, and wrote up my findings (see HERE).
I don’t know where this person obtained his list, but it appeared to me, as I began to study it, that it was probably made by a pharmaceutical industry salesperson who goes to doctors’ offices to convince them to prescribe their drugs. I say this because there are articles on the list that had titles that sounded like they were relevant, but when reading them, they were not. For example, the first study on my critic’s list was published in The Lancet in 2018, and titled “Second-generation Antipsychotic Drugs and Short-term Mortality: A Systematic Review and Meta-analysis of Placebo-controlled Randomized Controlled Trials.” It looked at 596 studies, all of which looked at patients that were randomly assigned to either an “antipsychotic” or a placebo for 13 weeks or less. For the patients in this analysis that had been labeled as having schizophrenia, there was no statistically significant difference in mortality between the two comparison groups.
Upon reading this article, I was left puzzled. Why was this article included in my critic’s list. As I have said, his contention was that every research paper published demonstrated “antipsychotics” decrease mortality for schizophrenia labeled individuals, which was not supported in this study. 
In another study on the list, “Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of Patients in Community Care After First Hospitalisation Due to Schizophrenia and Schizoaffective Disorder: Observational Follow-up Study,” published in 2006 in the British Medical Journal, the most important finding is that patients that were on “antipsychotics” for less than 6 months had a lower rate of dying than those who were on the drug for longer periods. The authors note this in the results section of their article with a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.”
However, if you read just the abstract of the article, as many practitioners do because time reading research studies is not billable, you would find no mention of this statistically significant finding, a finding that could have life saving implications.
After completing my review of the various studies on my critic’s list, I concluded that the studies claiming support for the notion that “antipsychotics” increase longevity are seriously flawed and the weight of the evidence indicates they do just the opposite.
Since my analysis, Robert Whitaker, to my mind the premier science writer on psychiatric drugs, published an article in the peer reviewed research journal Psychological Medicine. The article is titled “Do Antipsychotics Protect Against Early Death? A Critical View” (see HERE). The journal is published by Cambridge University Press, and to read it you have to have a subscription to the journal. Fortunately, Whitaker has made his findings available for free HERE.
Whitaker’s article covers much of the same territory as my own, but he adds some insightful additional analyses so worth considering that I want my readers to become aware of its existence. After all, the information addresses life and death issues.
As I have said, Whitaker’s analysis is freely available. However, because he so thoroughly covers the relevant research it is rather long. Therefore, to make his analysis more accessible to a wider audience, below I provide a few of his summary statements.
Whitaker’s Summary Statements
As can be seen in the research summarized to this point, there are compelling reasons to conclude that these drugs contribute to early death. To wit:
- Both first-generation and second-generation antipsychotics cause adverse effects that are known to increase the risk of dying from cardiac, respiratory, and endocrine diseases.
- Psychiatric users of antipsychotics die at high rates from these somatic illnesses.
- Non-psychiatric patients who use these drugs also die at elevated rates from these illnesses.
- In both psychiatric and non-psychiatric patients, the use of antipsychotics doubles the risk of death in comparison to matched cohorts of patients who do not take the medications.
- Studies of smaller cohorts of schizophrenia patients have found that antipsychotic use is associated with elevated rates of death, with this risk rising with higher doses and polypharmacy.
- Suicide rates for patients diagnosed with schizophrenia are dramatically higher in the antipsychotic era than in the pre-antipsychotic era, and this risk soars during the first year after initial treatment with an antipsychotic in the hospital.
…A number of longer-term studies have found higher recovery rates for those off medication. Add in research findings that antipsychotics shrink brain volumes, with this shrinkage associated with cognitive decline and a worsening of negative symptoms, and psychiatry is confronted with an “evidence-based” crisis.
The “antipsychotics lengthen lives” research gave the field a new claim to hang onto and to promote. A treatment for a disease that increases survival…can lay claim to being effective. During a time of doubt, that is a conclusion that provides a sigh of relief—and comfort—for the field.
But as can be seen in this review, that belief arises from research that is flawed in so many ways. There is evidence, time and again, of a process that was designed to justify the long-term use of antipsychotics, rather than honestly assess their impact on mortality.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Today we once again take up the controversial topic of the usefulness of the group of drugs referred to by psychiatrists and the pharmaceutical industry as “antipsychotics.” In most of the articles that I have read that have been written by psychiatrists, “antipsychotic” drugs are the first line of treatment for schizophrenia. And yet, a growing number of mental health advocates have been fiercely critical of this. As someone who has given considerable thought to helping people resolve challenging conflicts, I set myself on trying to find out what is going on here. 
After a review of the scientific research and participating in several debates, I then wrote three blog posts that reported to my readers what I have found.
Upon publishing the first two posts, several defenders of the use of these drugs claimed these drugs are worth using because they reduce the risk of early mortality. I, therefore, published a third 
The cost for the drug approach is not just confined to the cost of the “antipsychotic” drugs which has been estimated to be in the range of several billions of dollars. Doctors often prescribe a whole cocktail of drugs for these patients, dramatically adding to the cost of the drug approach, while evidence indicates the combination of “antipsychotics” with these other drugs often leads to additional adverse effects. The cost of the doctors’ time for prescribing and monitoring the treatment must be added, as well, as the cost of the revolving door of placement in a hospital, releasing from the hospital, and readmitting to the hospital, which has been the frequent pattern with this drugging approach. Finally, we must add the cost of treating patients for all of the adverse effects of these drugs.
There are several very promising alternatives, but in most regions they are not yet available. Articles like mine are designed to expand the general population’s knowledge of just how ineffective, harmful, and financially wasteful the drug treatments are, and that there are safer alternatives. This increased awareness campaign has been a major reason for the slow rising tide of advocates demanding that these more healthy alternatives become readily accessible in every community.
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The central features of this treatment for this group of patients involve normalization and evaluation of the appraisals that people make, helping them to test such appraisals with use of behavioral experiments, and helping them to identify and modify unhelpful cognitive and behavioral responses. Additionally, it aimed to provide warm, empathic, and non-judgmental face-to-face contact, supportive listening, signposting to appropriate local services for unmet needs, and crisis management when needed.
Relationships developed naturally, and we all got to know one another to various degrees, no different than how we develop friendships. This was not a therapist-patient relationship but rather a sort of social relationship. As a staff member I had some responsibilities—going to the market and preparing dinner. Everyone was on their own for breakfast and lunch and could help themselves to whatever they might like. Grocery shopping was often an outing to the market. Usually, one or two residents would accompany me to the store. When we returned, I would ask for help prepping the meal. It was quite informal. The house was often a bit of a mess, but then, we’d all get together and decide it was time for a quick house cleaning and again, whoever wanted to join would do so.”
Another approach well described in the JHP special issue is written by Charles Knapp. The Windhorse therapeutic perspective has a Tibetan Buddhist orientation that offers meditation, and spiritual teachings, along with a supportive, empathetic staff. Unlike the Soteria House approach, which aims to support people through a recovery process over a few months, the Windhorse approach recognizes that individual recovery periods are highly variable, and it is not uncommon for people to stay in their programs for eighteen months and even longer.
There are several other approaches described in the JHP special issue, all worth while to think about. All have had their share of success in helping to provide support for people experiencing extreme states.