New approach to schizophrenia? I don’t think so.

At first, the article about schizophrenia in today’s New York Times seems promising. It raises the question: Are we overmedicating people with the disease? Are doctors prescribing too much medication and too quickly?

These are valid questions, especially because schizophrenia remains clinically mysterious.

The party line is that schizophrenia is a severe illness that requires aggressive medical treatment. I agree with that, yet I’m open to the idea that there might be alternative ways to address the illness, particularly as science advances and we better understand its etiology.

But coverage of this particular study, I think, is misleading.

The conclusion that some schizophrenics do better without meds is based on Dr. John Bola’s review of six long-term studies involving 623 people. Two studies said patients did better with the meds. Four suggested patients without did better. But, writes the NYT’s Benedict Carey: “Over all, the findings of the studies were a wash, showing no significant advantage for either group.”

If indeed the findings were a wash, with no statistical significance, why am I reading about it in the New York Times? “A wash” should not prompt a conversation that could lead to seriously ill people giving up their medications.

In addition, the studies only included people taking older antipsychotics like Haldol. The new drugs, like Risperdal, Zyprexa, Seroquel, etc., were not included. This is ridiculous. The newer drugs are now the first line of defense against the illness. It’s misleading to demand a new look at treatment based on outdated treatment modalities. We might as well have a conversation about treating pneumonia with leeches.

From the piece:

“‘My hypothesis is that there is a subgroup of patients who are drug-free responders, probably because they have a mild form the disorder,’ Dr. Bola, who has argued against aggressive drug treatment in the past, said in an interview. ‘I think the implications of this are that we need to be additionally careful about medicating people after their first psychotic episode if there’s reason to think they could’ function without medication.”

I’d argue that, given the problems with diagnosis of illnesses like schizophrenia and bipolar disorder (which can also cause psychosis), people with a “mild form” of schizophrenia might not have schizophrenia at all.

A headline like “Revisiting Schizophrenia: Are Drugs Always Needed?” is kind of sexy in these days of complete (and justified) disgust with the pharmaceutical industry. But I’ve seen too many lives destroyed by this illness, too many people who wind up in jail or on the streets because they refuse to take meds.

Let’s not dump those pills so quickly. At least not based on this article.

liz | 10:19 AM | Uncategorized