Dr. Tom Insel is stirring the pot again!
You might recall that the director of the National Institute of Mental Health upset many in psychiatry when he dismissed the DSM-5, the so-called Psychiatry Bible, in an April 29th blog just weeks before the new edition was scheduled to be published. (In addition to his original blog, you might wish to read the New Yorker’s take on Insel’s words.)
Now Dr. Insel has published a blog that questions the long term value of anti-psychotics. For those of us whose family members have been helped by medication, his comments are troubling. Each time my son has stopped taking his medication, his symptoms have returned and he’s gotten into trouble. I’ve always known there may be adverse side effects. We have discussed them. The question that Dr. Insel didn’t answer is how are we to know beforehand when and if someone can reduce or stop taking their medication?
My friend, Dr. Dinah Miller, one of the author’s of the popular blog, Shrink Rap, raised this question when she reacted to Dr. Insel’s blog.
So perhaps you’ve heard that people with certain mental disorders need to stay on their medications forever. Certainly, some do — they stop their medicines and each time they try that experiment they end up sick — in the hospital, in jail, on the street, or simply festering in the basement. But some people stop their medicines and they don’t get sick, so clearly, not everyone with a given diagnosis must stay on medicines for life, but we don’t have a way of knowing who needs them and who doesn’t. We know risks for populations (maybe, to read Dr. Insel’s blog, we don’t know them as well as we thought), yet we know nothing about a given individual until a doc stops the meds or the patient goes off them on their own. We also know that the medicines have risks. How much risk? Who knows. Here, one figure sticks: of those who remain on an older generation antipsychotic (Haldol, thorazine, prolixin) for 25 years, 68% will get tardive dyskinesia. And that figure doesn’t say anything about dose.
Because medication is such a controversial issue, I’m not going to interpret what Dr. Insel wrote. Instead, you should read it for yourself.
Anti-psychotics: Taking the Long View
By Thomas Insel on
One of the first lessons I received as a psychiatrist-in-training 35 years ago was the value of antipsychotic medications. These medicines have been available for the treatment of psychosis for over half a century, beginning with the prototype first generation drug chlorpromazine (Thorazine) and now extending to some 20 different compounds, including several second-generation medications, often called “atypical antipsychotics.” Symptoms such as hallucinations, delusions, and paranoia are reduced reliably by these drugs. Although these symptoms can be frightening and dangerous for patients, family members, and providers, antipsychotics safely and effectively help people through the crisis of acute psychosis.
I turned sixty-two last Thursday and my wife, Patti, hosted a family party on Sunday. When you have a blended family of seven, there’s always someone having a birthday but this one was different for me. I can’t say that I am going through a mid-life crisis because I already have done that, several times. I am now old enough to collect Social Security so I have to acknowledge that I have walked over the middle age line .
