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.
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.”
Consequently, some of my readers showered me with praise for having the courage to stand up to the powerful pharmaceutical-psychiatric institutions, while others showered me with the most disrespectful insults known to the human race. 
And then there were those who disagreed with me but did so in a respectful manner. I believe it is my responsibility to now provide them a respectful response.
Any pill prescribed by a doctor will lead many to experience a placebo effect, which can be, for a period of time, helpful. I hasten to point out that a person can get a placebo effect with non-drug treatment approaches as well, and this would avoid the various harms associated with this type of drug.
These drugs are not only known as “antipsychotics,” but also “major tranquilizers,” because they sometimes do appear to calm someone in distress.
Unfortunately, once someone begins to take these drugs to help with agitation, when they try to come off of the drug, they are left with drug withdrawal experiences that have been described as awful. I hasten to point out that there are other ways to help someone to calm down that need not rely on these types of drugs. I have worked on many occasions with people who are agitated, and without the aid of a drug prescription I listened in a caring way, and in time the person eventually calmed down. If, however, you give someone a drug that calms the person down, it is sometimes much easier, and less time consuming. For people who witness someone they care about in high distress drift into a calmer state upon taking an “antipsychotic,” this can seem enormously helpful.
Some of them would have recovered in a fairly short period without the drug, but because they recovered while taking the drug, they, and their loved ones, attribute the improvement to the effectiveness of the drug. If the person tries to see whether the improvement was due to the drug or the natural recovery process, he or she may try to stop ingesting the drug.
However, the withdrawal from the drug, as I mentioned above, often causes a nasty physiological reaction which, in some ways, is similar to someone who is a coffee drinker who suddenly decides to stop, cold turkey. However, the “antipsychotic” physiological withdrawal reaction can be experienced as much worse. When people who care about this person see the downward spiral that occurs from the physiological withdrawal reactions, they may come to attribute it to the person’s “mental illness” returning, and thus, the illusion of long term effectiveness is now deeply entrenched.
Another way in which the illusion of the long term effectiveness of the drugs can occur has to do with the fact that even when the “diagnosed” person is not functioning well on a drug treatment regimen, human beings can always imagine that the patient would be doing even worse without taking the drug. And of course, when the patient does try to go off the drug, the raging physiological withdrawal process occurs. So, in this way, the combination of the belief that the patient could be doing worse, and upon becoming worse when trying to do without the drug, it convinces people that the drug treatment is helpful.
Once they take that position, and tell others what they had done, information that comes their way in the form of the distressed person having bad side-effects, or hearing from people who take the position that the drugs may be more harmful than helpful, a psychological phenomenon known as cognitive dissonance occurs. The principle of cognitive dissonance states that human beings strive for internal psychological consistency. When they experience internal inconsistency they become psychologically uncomfortable and a major way that they try to reduce the discomfort is by avoiding circumstances and contradictory information likely to increase the magnitude of the cognitive dissonance.
I have publicly supported the argument that these drugs cause more harm than good. Therefore it can be argued, it is I who suffer from cognitive dissonance whenever evidence comes my way that might support the idea that these drugs are helpful in the long run.
By the late 1990s, investigators had reported that antipsychotics caused basal ganglion structures and the thalamus to swell, and the frontal lobes to shrink, with these changes in brain volumes “dose related.” Then, in 1998, Raquel Gur, from the University of Pennsylvania, reported that the swelling of the basal ganglia and thalamus was “associated with greater severity of symptoms.”
The MRI studies provide objective evidence that antipsychotics cause changes in brain volumes that are associated with a worsening of symptoms, and a worsening of functional impairment.
Recently I provided a post titled, “
Whitaker was a medical writer at the 
In 2002, 
As Stip noted in his 2002 paper, there is no compelling evidence in the literature that antipsychotics improve long-term outcomes. The relapse studies do not provide such evidence, and there is no other body of research that does. However, as can be seen in this paper, there is a history of science, stretching across six decades, that consistently tells of a medical treatment that, in the aggregate, does more harm than good.
The first long-term study reveals a higher rehospitalization rate for patients treated initially with antipsychotics.
Guy Chouinard and Barry Jones, drawing on an emerging understanding of how antipsychotics change the brain, provide a biological explanation of why that would be so. They then test their hypothesis and find that a significant percentage of medicated patients suffer from drug-induced tardive psychosis. 
MRI studies reveal that antipsychotics induce changes in brain volumes that are associated with a worsening of positive and negative symptoms, and adverse cognitive effects. 
In order to argue that antipsychotics do not worsen long-term outcomes in the aggregate, all of this evidence would have to be explained away. This entire history of science would need to be discounted. In addition, this review has focused on the benefit side of the risk-benefit equation for antipsychotics. The drugs are supposed to provide the benefit of reducing psychotic symptoms. 
But the research reveals that, over the long term, this benefit turns into a negative, and so, over the long-term, there are only negatives to be chalked up: the increased chronicity of psychotic symptoms, the impaired functional outcomes, the worse cognitive functioning, and, of course, a broad range of “side effects,” such as tardive dyskinesia, metabolic problems, sexual dysfunction, and so forth. Such is the bottom-line arithmetic that makes the case against antipsychotics.
