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September 9, 2013 by Sandra Steingard, MD

Taking Anti-Psychotics When You Are Not Psychotic

Sandra_Steingard_MDIn brief, the Wunderink study uses a randomized control design and found that, in adults diagnosed with a psychotic disorder, continuous use of neuroleptics was associated with worse functional outcomes than intermittent use. Higher doses were associated with worse outcomes than lower ones.

These days, neuroleptic drugs are widely promoted to treat depression and they are often used “off-label” to treat behavioral problems in children. They are among the most widely prescribed drugs; given the theory that “schizophrenia” affects 1% of the population, it is clear that many individuals – adults and children – who do not have this diagnosis are prescribed these drugs.

Is the Wunderink study relevant to those who do not experience psychosis?

As Joanna Moncrief has argued, there are many reasons to think in a drug-centered rather than a disease-centered way. For instance, it is not controversial to state that the benzodiazepines (Valium and others) affect everyone in similar ways; they will induce a soporific effect on anyone, not just those who have difficulty with sleep.

Although it may be less obvious, we should expect that neuroleptics have similar effects on people regardless of the diagnosis. When we learn that individuals diagnosed with Schizophrenia who take these drugs over several years are less likely to be working, we need to be worried about everyone who takes these drugs over an extended period.

I am not sure child psychiatrists or adult psychiatrists who prescribe these drugs for depression will read the literature on schizophrenia. In a recent report, it was noted that there was a three-fold increase in the incidence of diabetes in children who are prescribed these drugs. It is straightforward and obvious why child psychiatrists should be concerned about that report. But Wunderink’s study raises even more concern.

If psychiatrists choose to prescribe neuroleptics to children, depressed adults, and others, I do not think they can ignore the increasing data on impaired functional outcomes associated with long term use of these drugs.

First do no harm.

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