The Madness of Psychiatry

One hundred years ago patients with psychosis were 4 times more likely than the rest of their contemporaries to be dead at the end of their first 5 years of treatment. The main cause of death was tuberculosis. The asylum was a place where if you had the wrong genetic makeup you were at great risk of catching tuberculosis, particularly if you were a young woman.

the advent of the antipsychotics

In 1954, chlorpromazine, the first of the antipsychotics, was introduced. It seemed extremely safe. In the early days chlorpromazine was given in doses of 50 mg three times a day. Twenty years later antipsychotics in some cases were being given in doses equivalent to 50,000 mg of chlorpromazine per day and the fact that patients still walked around fairly normally seemed to confirm the essential safety of the drugs.

Even if there was evidence the drugs shortened lives, in the 1960s a few years of life lost seemed a reasonable trade to many for the chance to get out of the asylums. But you can’t depend on people to be grateful for ever – and while losing a year or two of life might be a reasonable trade off, losing 10 or maybe 20 years is another matter.

15-20 years of life lost

Shockingly, over the last 5 years, a series of large studies, some looking at national databases, have shown that patients with psychosis are 2 to 3 times more likely to die in any one year than the rest of us. Death is primarily by heart attack or stroke. Being two or three times more likely to be dead may not sound much but other studies point to 15-20 years of lost life. The results have been consistent and have raised concerns about the contribution from the antipsychotics especially the second generation drugs which have bad cardiac profiles.

Even more shockingly, almost no-one knows what happens to patients with psychosis 5 and 10 years after they are first admitted – they do not know in New York, London, Berlin or Paris. No one in North Wales knew until this year. The studies that have already been done survey cross sections of patients and don’t answer this question. No doctor can in fact tell patients or their families how likely they are to be alive or dead 1, 5 or 10 years after first admission. If there are risks they cannot tell them what the risks are. This is important because if we know what the risks are we know what to look out for in order to minimize those risks.

What does happen in the first five years?

The Bad News

Patients with psychosis, just as they were 100 years ago, are now 4 times more likely to be dead after 5 years of treatment than the rest of us. Patients with schizophrenia are 11 times more likely to be dead – this is much worse than 100 years ago.

Patients with schizophrenia are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other illness in medicine where such a statement could be made.

Death in the early years of schizophrenia does not come from heart attacks or strokes – it comes from suicide. In their first year of treatment, patients with schizophrenia are over a  hundred times more likely to commit suicide than the rest of us.

Heart attacks and strokes do happen but they happen in patients over the age of 65 with delusional disorders or acute and transient psychoses.

See Healy et al (2012) Mortality in Schizophrenia.

Some questions:

Some of the reviewers of this article went into orbit – they did not want to see it published. Among the points raised were that of course we know schizophrenia causes suicide – if you didn’t find it one hundred years ago it’s because the hospital hid it well or patients were straitjacketed – anything except accept that we are doing worse.

 Does schizophrenia cause suicide?

No, it doesn’t. The historical data show that the suicides do not come from the illness. Patients 100 years ago did not commit suicide – there does not seem to be a significant risk inherent in the illness.

Did patients 100 years ago have an opportunity to commit suicide?

Yes they did. They spent 99% of their time working on farms or in kitchens or sewing rooms.

Did the hospital hide the suicides?

No. The staff were under a legal obligation to report suicides to the authorities. When patients with mood disorders committed suicide, the records make it very clear what happened and that these reports were submitted.

Does de-institionalization cause these suicides?

No it doesn’t. If patients today were dying 5-10 years into their illness, when they have lost their social networks, jobs, and hopes, the idea that deinstitutionalization might be contributing would seem more likely but in fact they are dying before they lose their families, networks and hopes. One possibility though is that the institution was more of a protective factor for patients 100 years ago than we have appreciated. However it did not protect patients 100 years ago with mood disorders who went on to commit suicide in hospital.

The Good News

So what causes the suicides? The evidence points to the antipsychotics. In placebo controlled double blind trials these drugs show an excess of suicides and suicidal acts with drugs like Zyprexa having the highest suicide and suicidal act rate in clinical trial history.

This is good news because if most deaths in young people with schizophrenia come from suicide and the antipsychotics make a contribution to this, there is an opportunity to correct the problem. The problem almost certainly stems from drug induced dysphoria. Patients are not on the right drug for them. A simple question – do you like the effect of this drug and do you find this effect useful, along with a willingness to switch from a drug that isn’t suiting someone to one that does, could eliminate the problem.

This is worth trying to make part of the culture of clinical practice because if we can eliminate suicides in year one of treatment we could go very close to restoring the life expectancy of patients with schizophrenia or other young people with psychosis to normal.

There may be no other measure in medicine that for such little cost could make such a difference to life expectancy.

There may be nothing else quite as good as this that psychiatrists could do to save their own skins. They have lost antidepressant prescribing to family doctors, clinical psychologists, nurses or pharmacists. But they cannot blame anyone else if things go wrong in the schizophrenia and psychosis domain. If they cannot ensure their patients safety, what brand value is there left in psychiatry?

There is good news on the heart attack front also. The increased risk of heart attacks and strokes lies in people over the age of 65 with acute and transient psychoses or delusional disorders. These patients are at prior risk of heart attacks or strokes, and in many cases we can detect this. The antipsychotics work on dopamine which has significant effects on the cardiovascular system, and in this way the drugs may tip these patients over the edge.

The antipsychotics already come with black box warnings for patients over the age of 65 – who have dementia. These warnings need to be extended to anyone over 65.

These are the patients who need to be screened before being put on treatment and monitored after they start. But it is a much smaller and more manageable group than all patients with psychosis. The acute and transient patients are also a group who do not need in any case to remain on antipsychotics in the longer term. This puts a premium on stopping treatment where possible.

 But who cares about patients with psychosis?

Owing to the hostility of reviewers in order to get published we “toned down” the findings in an article just out in the BMJ Open – Healy et al 2012, so that the abstract of the article points only to the relatively benign tip of an iceberg that lies beneath. The fact that we toned things down may have meant BMJ didn’t press release the article in the way they have done recently for articles pointing to minor elevations in risk of Alzheimer’s in patients taking benzodiazepines. Getting journalists interested has proven difficult. Schizophrenia is not sexy. Young people dying unnecessarily lights no-one’s fire it seems – at least not these young people.

But that’s not all there is as the next posts La Reine Margot and the St Bartholomew’s Day Massacre may bring out.

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  1. All Medicines will Kill you eventually if you take them daily. But at the risk of such a high suicide rate… It is sad. I complained repeatedly about Seroquel and Zyprexa. I was told the medication needed to “Build up in my system” that I needed to adjust with it.
    But no longer is therapy even given to anyone even IF medication is handed out and anyone who Begins a medicated therapy doesn’t “end” in one. Because life changes for everyone. We grow old… Therapies change just as much as fashions and cultures. You claim nothing has changed in 100 years? From what stand point do you make this claim? Do you bother to even look into the variety of reason behind psychosis? From fevers and dyptheria to small tremors in the brain? Do you bother, before you release your bias to the public, to Realise that Something is better than nothing at all?

  2. In the corporate world, mistakes are costly and corporations that want to make a profit utilize the risk management process to come up with best practice standards.

    The industry of psychiatry would be doing society a great deed if they starting using the BMJ’s Best Practice assessment of psychosis guidelines to rule out organic causes. Instead main stream psychiatry uses a rubber-stamp labeling system and ineffective medication management to treat symptoms rather than treat the root cause.

    Medication managers are in need of risk management skills.

    Posted on David Healy dot org 10/29/2012

  3. “…They have lost antidepressant prescribing to family doctors, clinical psychologists, nurses or pharmacists. …”

    I didn’t understand. It must be in Wales but not at other countries.
    Antidepressants are prescribed by psychiatrists and off-label by GPs or other specialities.

    I talked to a Japanese dermatologist who was prescribing Paxil/Seroxat/Aropax to “relief stress because some skin diseases are due to stress.” “And these antidepressants have helped millions of people.”

    Here in Brazil there is not any psychiatrist or doctor who is raising awareness.
    At the internet there is the pharmaceutical industry disguised sites.

    I wrote a book but I know that it’s useless publishing it.
    Suicide is a taboo issue. Nothing is said on the news and there is not data about the rate.

  4. Thanks for writing an insightful article and raising awareness regarding the severe side effects of anti-psychotics.

  5. I have been asked to testify as an expert in a personal injury case that started off as an apparent “simple” whiplash – although one should never make an assumption that these injuries are “simple”. The victim also injured the lower back in the accident although it took a couple of weeks to begin to trouble him. Just before the accident, the claimant had experienced significant stressors including bereavement and job difficulties. After the accident he was, not surprisingly, disturbed, with trouble sleeping, unable to concentrate, unable to work. He saw a psychiatrist who gave him an SSRI and olanzepine at an incredible dosage of 60mg/day. He gained 60lbs in 10 months and now has type 2 diabetes, high cholesterol and triglycerides, and cognitive impairment due to the ongoing chronic pain (the accident happened 5 years ago.) The “independent” examiners who saw him on behalf of the insurance company have attempted to dismiss this as a “minor injury” there being a cap of $3500.00 in this province on such “minor” injuries. His weight gain has been attributed to “laziness and lack of self- discipline” and, correctly, as it happens, identified as exacerbating his back injury. My point is simply that, even in a case like this, an apparent “simple” rear-ender, the victim has been left with not only soft tissue injuries causing chronic pain but, as a result of his “treatment” is in danger of heart attack, stroke, takes medication for high cholesterol and diabetes, can’t concentrate or focus on tasks, has no relationship with his wife and the physicians examining him completely missed the effects of the antipsychotics. I really do believe that they don’t know about them, one being an orthopedist and the other a physiatrist so it’s not only the public that has to be educated, it’s physicians of all specialties.

  6. “I really do believe that they don’t know about them, one being an orthopedist and the other a physiatrist so it’s not only the public that has to be educated, it’s physicians of all specialties.”

    “…has no relationship with his wife …”

    Sexual dysfunction is a side effect of antidepressants that is known since the pre–SSRIs era.

    Tricyclic antidepressants do cause sexual dysfunctions.
    What is not being brought to public attention is that some people have problems after quitting the SSRIs.

    There is a group at Yahoo that started in 2005 where those who lost their sexual lives due to the use of SSRI.

    “Post-SSRI sexual dysfunction (PSSD)[1] is a name given to a reported iatrogenic sexual dysfunction caused by the previous use of selective serotonin reuptake inhibitor (SSRI) antidepressants. While apparently uncommon, it can last for months, years, or sometimes indefinitely after the discontinuation of SSRIs.[2] It may represent a specific subtype of SSRI discontinuation syndrome. This condition has not been well-established or studied in the field of medicine.


    This is the link for the Yahoo group:

    It is heartbreaking reading the messages. Men and women saying that they not only function physically but their sexual fantasies disappeared.

    Men saying that they don’t feel aroused by the sight of a beautiful naked woman.

    I was shocked when I read that SSRIs are being used to “treat” sexual offenders:

    “In recent years SSRIs have been used to reduce sex offenders’ deviant sexual thoughts and fantasies. Serotonin, a neurotransmitter, plays a role in regulating sexual drive, depression, obsessions, compulsions, anxiety, impulsiveness and anger. SSRIs are antidepressants that are also approved by the U.S. Food and Drug Administration (FDA) for the treatment of obsessive-compulsive disorder and social anxiety. Although double-bind placebo controlled trials are needed, studies using self-report measures or PPG have found that these medications do reduce some repetitive sexually deviant fantasies and/or behavior (Greenberg& Bradford, 1997; Kafka, 1991, 1994; Kafka & Prentky, 1992, Stein et al, 1992), and to selectively decrease deviant arousal without significantly decreasing appropriate arousal (Bradford, Greenberg, Gojer Martindole & Goldberg, 1995; Kafka, 1992; Kafka & Prentky, 1994). Greenberg and Bradford (1997) have hypothesized that paraphilias may result when there is an inability to suppress conventional sexual appetites. Since serotonin affects sexual appetite, SSRIs may help alter a dysfunctional serotonergic system, thereby allowing suppression of unconventional sexual appetites.”

    So, the drug that is being used to castrate sexual offenders is being given to people who lost a loved one. are sad because life is hard or for headache and all the others use off-label, without any information about sexual dysfunction.

    It is written at the leaflet but some psychiatrists or physicians don’t… know. (?)

    This alone is a crime against humanity. Some people who are in their twenties will never have a sexual life because they took one of this drug.

    I once talked to a woman who is schizophrenic and she told me she never experience pleasure and pretended all the time with no idea of what is the real feeling.

    And they keep prescribing…

  7. I agree that psychiatric medications can be harmful – I am eternally grateful that I have not taken any for more than ten years and had long periods of time between my three psychotic breakdowns when I was medication-free. However, I think there may be another cause of suicide in ‘Schizophrenics’ – the diagnosis itself. The term ‘schizophrenia’ applied to a person, destroys the ego and consequently saps the soul. A hundred years ago when the term was coined, it did not have this effect, because it had not yet acquired the connotations that have grown up around it over the years. The label, in my experience, is the most damaging aspect of the condition – it negates hope and acts as a barrier to recovery. Please let’s do away with ‘Schizophrenia’ and call it ‘Thought Disorder’ instead. It’s only humane!

  8. Ann Kelly says:

    For the government and health board to suggest that they clump prescription dependency with street drug addiction:
    Its like asking the fox to take care of the chicken coup. Many people have yet to realise this, burt what the government are doing is betrayal on an undescribably huge scale. Many people who are prescribed anti depressants come off them when they experience huge weight gain, depersonalisation and detachment from their life and from connecting to people and situations emotionally. The If it weren’t for organizations like CITAp and Oldham Tranx, people would not know the real horrors of what these drugs do. All too often, people try to come off the drug, only to find that the symptoms are so frightening, and bewildering that they can only conclude that what they are experiencing is who they actually are. If it weren’t for CITAp, I’d have thought the same. My doctor is happy to be passive in this, and allow me to carry the can for it so that I blame myself. I wake with heart pounding anxiousness, stabbing pains behind my eyes, burning head pains so severe that all I can edo is to curl into a ball, hold lmy head and pray for it to pass. I experience fatigue so severe, that I’m dragging my legs like lead weights. That is when they are not buckling underneath me.

    At the end of the day, you only have to look at the “marvellous” job that they are doing with street drug addiction to see that the care is simply not there. The government do NOT accept drug withdrawal and dependency for what it is, especially given that they have caused it. For them to manage it, would allow them to put their own spin on it, and bury it under even more addictive drugs. It really is a road to nowhere.

    Ann Kelly
    1st November 2012

  9. I used to wonder why I couldn’t go to a methadone clinic when I was coming off Seroxat. It was the same horrific, excruciating withdrawal and yet, I was abandoned by every single person in the medical profession, and, even worse, experienced more criticism and more vitriol than could ever be contemplated.

    I was so severely punished, by so many people, that I could almost have done away with myself due to human cruelty. Notwithstanding, pure ignorance about Seroxat withdrawal and it’s excruciating properties.

    Four years of all this, and I came out the other end. I came out the other end, because I did my research, I followed the Social Audit for years and I got a handle on it and I am damned if these people who so abused me are going to get away with it.

    On we go…………………………………………and how dare they do this to me. I am getting cross now; not psychotic, that is all over.
    Seroxat made me into a crying, emotional wreck, who lay in bed writhing in agony and all I got was relaxation tapes and benzos. How could they leave me like this and go on with their lives……………………….shameful and massively cruel.
    Thank god, my daughter, lived through it and thank god, my aged mum, fed me and managed to support me just to the loo and back for months and months.

    To be on the receiving end of this tyrannical mental abuse was almost more than I could withstand. This is why I feel more upset about the prescribers than I do about GSK.
    I understand GSK, got their number, but how the people supposedly caring for me, misjudged and misinterpreted Seroxat mania as my illness, is totally beyond me.

  10. Chris Evans says:

    The damage that has been done to countless lives by prescribing psycho-active drugs is an absolute scandal tantamount to corporate manslaughter. Can we blame GPs and Psychiatrists for this? A resounding YES! The evidence from various independent researchers has been available for many years for all to see. Evidence that
    anti-depressants work no better than placebo was known to the pharmaceutical companies from their own clinical trials and not released. It took a meta analysis of their statistics by Professor Irving Kirsch to reveal this. Is it not a criminal act to knowingly administer toxic substances to another person?
    These statistics were not volunteered by the pharmaceutical companies but obtained through the Freedom of Information Act. If members of the public can find this information then why can’t the people who should know, such as GPs and Psychiatrists, be so ill-informed. The placebo issue is not the most important point of concern. The side effects can be horrendous and life threatening and the long-term effects are ruining the mental and physical well-being of vulnerable patients. A UK parliamentary report (2005) states “… the inappropriate or excessive use of medicines can cause distress, ill-health, hospitalisation and even death. Adverse drug reactions are responsible for about 5% of all admissions to (UK) hospitals.”
    What did the government do to as a result of this damning report? Nothing! Why? Maybe the answer lies in an earlier entry, “The industry … has understandably been described as “world class and a jewel in the crown of the UK economy”. It is the third most profitable economic activity after tourism and finance. …”

    There is a lot of data collected on the adverse effects of anti-depressants and anti-psychotic medication on the following website:

  11. To be able to make an informed consent about MH treatment all people need enough information to be able to make intelligent choices. Lack of transparency re drug effects, treatment and outcomes from various MH organisations maintains unitelligent choices.

    Lack of transparency is just one of MH professonals’ attributes which adequately serve to maintain scanty information based upon the DH ‘need to know’ basis.

    Other inadequate behaviour – which I have experienced – incudes manipulation, coersion, bullying, threats, power inbalance, denial, defensiveness, vindictiveness and incestuous relationships involving collusion amongst colleagues.

    Such behaviour is indicative of people who have fragile personal boundaries under the disguise of besotted power; simultaneously this causes a loss of humanity.

    Such attribues require a lengthy process of psychological behavour make over by people who are enbued with humanity and strong personal boundaries.

    MH professionals need vetting by the people they ‘serve’ prior to being let loose on the public and potential future victims.

    Good on you David for this article.

  12. Catherine,

    100% in agreement with you on that.

  13. An interesting book – PORPHYRIA:The Ultimate Cause of Common, Chronic, & Environmental Illnesses, by Prof. Steven Rochlitz postulates that people who have severe drug reactions have hidden porphyria
    It’s worth a read in my opinion…..
    Apparently severe drug reaction was considered, in medical circles, as a sign of porphyria years ago.

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