Treating Madness With Drugs

Vincent Van Gogh

In a previous post I explained
that current categorisations of mental illness find it hard to predict the
course of the illness. Here I move onto the conventional pharmaceutical
treatments associated with these categories.
There are two major
pharmaceutical treatments for serious mental illness. For psychotic symptoms
there are antipsychotics – also called neuroleptics. For mood disorders there
are mood stabilisers, lithium being the most widespread. Many clinical trials
on antipsychotics have shown that psychotic patients suffer fewer symptoms and
later relapses when taking them. Indeed there are many people for whom medication
provides their only effective lifeline.
But this is far from the whole

  • There is little evidence that
    the drugs available, such as chlorpromazine, an antipsychotic and lithium
    carbonate, are actually specific to the categories of mental illness described
    in an earlier post.
  • Despite advances in
    medication, studies into long-term outcomes of those with serious mental
    illness suggests that patients are not better off now than they were a century
    ago. (Recovery from Schizophrenia: Psychiatry and Political Economy)
  • Many of the drugs used to
    treat psychosis and mania have very considerable side-effects. The physical
    side-effects include: about 50% suffer pronounced weight gain, about 33% have
    sexual dysfunction and 25% have uncontrollable tremors. The psychological
    side-effect include feeling restless, agitated and depressed.
  • Finn, Bailey, Schultz &
    Faber (1990) looked at the subjective utility of antipsychotics in treating
    schizophrenia. They found that 41 patients experienced the side-effects of
    antipsychotics as just as bad as the symptoms they were supposed to be
    treating. Even more surprising, 34 psychiatrists making parallel judgements of
    utility agreed with them. That was until they were asked to consider the
    benefits of antipsychotics to society. Then the psychiatrists agreed that, for
    society, it was better to administer antipsychotics.
  • Some evidence claims that a
    new generation anti-psychotics – called ‘atypical antipsychotics’ – show
    reduced side-effects but there is criticism of the studies that have been
    carried out.
  • Geddes, Freemantle, Harrison
    & Bebbington (2000) analysed the data from 52 separate studies into the new
    ‘atypical’ antipsychotics. They found that their apparently reduced
    side-effects and increased effectiveness had been significantly exaggerated.
  • New ‘atypical’ antipsychotic
    medications are considerably more expensive than their ‘typical’ counterparts.
    This is because the old drugs have passed out of patent and so can be
    manufactured generically and hence cheaply. The new drugs are much more
    profitable for their manufacturers.
  • In the treatment of serious
    mental illness, the influence of large pharmaceutical companies, ‘Big Pharma’,
    cannot be ignored. The investments made in new drugs, especially in the new
    ‘atypical’ antipsychotics is often huge. Only one study into the effectiveness
    of clozapine is estimated to have cost the pharmaceutical company Sandos $5
  • Bentall claims that many
    psychiatrists are continuing to prescribe much higher levels of antipsychotics
    than is actually necessary, thereby causing many unnecessary side-effects.
About the author

Psychologist, Jeremy Dean, PhD
is the founder and author of PsyBlog. He holds a doctorate in psychology from
University College London and two other advanced degrees in psychology.
He has been writing about
scientific research on PsyBlog since 2004. He is also the author of the book
“Making Habits, Breaking Habits” (Da Capo, 2003) and several ebooks.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.