Showing posts with label Antipsychotics. Show all posts

Sunday, 6 May 2012

'Antipsychotic drugs

'Antipsychotic drugs made me want to kill myself'

By Melissa HogenboomBBC News

While antipsychotic drugs are seen as the most effective treatment of psychotic episodes, they are also recognised to have devastating side effects.

Doctors say many patients don't like taking medication long term, but a study published in the Lancet suggests that taking antipsychotic medication more than halves the risk of relapse in schizophrenic patients.

"I used to see nasty, dirty rat-like things running around when I went outside, I could see people in the streets screaming abuse at me and making obscene and threatening gestures.

"I was hearing a voice that was saying all kinds of nasty things about me. I was terrified, I tried to kill myself."

David Strange was diagnosed with paranoid schizophrenia when he was 25. He was sectioned and given antipsychotic drugs, which he says made him feel "a bit better for a while," but gave him a succession of unpleasant side effects.

“Start Quote

When I first became ill, I was warned there are certain drugs that weaken the lower lip, even now I still dribble”

Daniel Levy

But without medication, the voice he hears is a constant stream of abuse that "comments on what other people are thinking and the horrible things they want to do to me".

'Unliveable hell'

Professor of psychiatry Stefan Leucht, from the Technische Universitat in Munich, led the latest research. He also found that fewer patients on antipsychotic drugs were readmitted to hospital - one of the highest costs associated with mental illnesses.

David says taking antipsychotic drugs for 14 years has helped him deal with his hallucinations and the voices he hears. They are still present but they no longer dominate his life.

Antipsychotic drugs explained

Antipsychotic medication helps weaken delusions and hallucinations. It can control (but not cure) symptoms in about four out of five people
Older antipsychotics work by reducing the action of a chemical in the brain called dopamine. They can cause side effects such as stiffness, shakiness, restlessness, sexual problems and unwanted movements, mainly of the mouth and tongue
Newer antipsychotics work on different chemicals in the brain. These are less likely to produce unwanted movements but can cause weight gain, diabetes, tiredness and sexual problems

Source: Royal College of Psychiatrists

One of the many drugs he was given was thioridazine, which gave him an irregular heartbeat, something which can be potentially fatal. David remembers lying down with his heart beating really fast, thinking he did not have long left to live.

"Some drugs made me so anxious I tried to kill myself and ended up getting locked up in hospital."

Even what he refers to as the "good ones" give him muscle and joint pain, jerkiness similar to the symptoms of Parkinson's Disease and severe sexual dysfunction.

But he says he would still rather take the drugs than try and function without them.

"Being unmedicated is an unliveable hell. I'm happy to put up with all of this just to be more functional and less scared."

'Price to pay'

The longer antipsychotic drugs are taken, the more chronic the side effects become. The nature of mental illness means patients are often prescribed medication for the rest of their lives.

Daniel Levy, aged 54, has bipolar disorder and has been taking antipsychotic drugs for nearly 30 years. During that time he has been sectioned and has also attempted suicide.

David has been taking antipsychotics for many years

"The drug chlorpromazine made me tremble, it also made me dribble. When I first became ill I was warned there are certain drugs that weaken the lower lip, even now I still dribble.

"I don't know I'm doing it until I notice it on my clothes. It looks absolutely terrible."

But the drug did help him to stay out of hospital and was effective in controlling his symptoms.

"The side effects are the price I pay for keeping out of hospital," says Daniel.

"It's a balancing act - doctors never know in advance how you will react to a particular drug."

Newer "atypical" antipsychotic drugs show fewer of the physical tremor-inducing side effects and are commonly prescribed to patients starting treatment for the first time, says Dr Oliver Howes from the Institute of Psychiatry.

These still often lead to severe weight gain, increasing the risk of diabetes, blood clots and cardiovascular diseases. The risk is especially high for patients who stay on medication for many decades.

"We have no way of knowing in advance if a given drug is going to suit a patient - so sometimes patients have to try several before they find one that both helps them and is tolerable," says Dr Howes.

Unfortunately the drugs with the most side effects are also the ones which have been shown to be the most effective and are supported by many years of research, says Prof Leucht.

He says that if a patient experiences unpleasant side effects, their clinician should always try another drug, but acknowledges that this is not always possible in practice as some doctors are afraid to change their patient's medication if it appears to be working well.

Dr Howes says the side effects of antipsychotics need to be put into perspective.

"Mental health illnesses are devastating. There is a substantial loss of life associated with illnesses such as schizophrenia, predominantly from suicide. We want to prevent that."

Wednesday, 9 November 2011

no official data is kept on the number of youngsters being given anti-psychotics.

The number of children - some as young as five - being prescribed powerful antipsychotic drugs has doubled in the past 10 years, according to an investigation by Channel 4 News.

Numbers of children on antipsychotic drugs doubles (Getty)

As many as 15,000 children and young people under the age of 18 were prescribed this medication last year. But these figures are only from GP surgeries and primary care trusts and do not include hospital prescribing, which suggests the true number could be far higher.

Astonishingly, no official data is kept on the number of youngsters being given anti-psychotics. This has only now been revealed after Channel 4 News commissioned a drug database company to collate them.
The investigation comes as the government announced that GPs could face jail if they are found to be "chemically coshing" elderly patients with dementia. But no mention was made of children and young people in the announcements.
Anti-psychotics are meant for patients with serious mental conditions such as schizophrenia, bipolar disorder and psychosis. But mental health experts now say that they would also appear, in some instances, to be being used to control children's behaviour.

If there is a doubling in the rate of children being given anti-psychotics that is a worry. My worry is that these drugs are being used for other purposes. Professor Tim Kendall

The investigation also found children are being left on the drugs for years at a time and are not being properly monitored, which is against best practice guidelines.
Professor Tim Kendall, who has been asked to write the first ever guidance on prescribing anti-psychotics to young people with serious mental illness, said that these findings are extremely concerning.
"As far as I am aware there is no evidence that there has been a doubling in the rate of psychosis. So if there is a doubling in the rate of children being given anti-psychotics, that is a worry," Prof Kendall said.
"My worry is that these drugs are being used for other purposes."
Family stories
And that would be appear to be what is happening. We have spoken to families whose children have been given the drug for attention deficit hyperactivity disorder (ADHD) and for autism.
The family of one young boy first prescribed an anti-psychotic when he was five for so-called "challenging behaviour" has subsequently been told that he was in fact in pain. The boy, now aged eight, is autistic and regularly banged his head against hard surfaces and lay on the floor kicking and screaming. But his parents said the anti-psychotics he had been on for three years had had no benefit at all.
Eventually he was seen by Professor Chris Oliver, of Birmingham University, who has been researching behavioural problems in children with autism. His conclusion was that the young boy was most probably in pain - suffering from gastro-oesophageal reflux, more commonly known as heartburn. But because of his autism he was not able to articulate that he was physically suffering.
Anti-psychotics were developed in the 1950s and have been widely prescribed to adults since the 1970s. But they can cause, among other things, dramatic weight gain, diabetes and heart disorders. They can also leave patients with a Parkinson's disease-like tremor which does not stop even if they are taken off the medication.

What nobody knows with any certainty, though, are the long-term effects on children. And all approaches made to authorities here to find out if there is any data on trials involving children have been blocked by the pharmaceutical companies.
Prof Kendall was even hampered by America's Food and Drug Administration, which does hold data on any trials conducted on anti-psychotics. When he requested access to the information he was told to put in a freedom of information request.
"If there are trials that are unpublished, what that means is there will either be trials which show the drugs work as well as we think or in fact they might be even more harmful than we think," he said.
"I am appalled, absolutely appalled. This data should be available for people such as us who are working on behalf of the NHS, patients and parents."
In a statement the Association of the British Pharmaceutical Industry told Channel 4 News: "The industry is committed to being as open and transparent as possible in its disclosure of information."
It added that any prescription of anti-psychotic drugs to children "will only occur after careful consideration and risk-benefit assessment by the health care professional on a case by case basis."
Of concern to a growing number of experts is the effect they have on developing brains. They said proper monitoring was essential. But Channel 4 News has obtained a confidential report into the way mental health trusts look after children and young people on anti-psychotic drugs. It found there was "no evidence" whatsoever that some young people are being properly monitored.
'No monitoring at all'
A young girl (her family did not want her identified) we met was put on the medication at the age of nine after she developed psychosis. It is agreed that she needed help, but her father said that he had been unprepared for the effect the anti-psychotic would have on his daughter.
"I was not told how dangerous this drug was," he said. "There was no monitoring at all."
The father said that his daughter lost her memory, could not dress herself, even needed help brushing her teeth.

I was not told how dangerous this drug was. Father of girl prescribed antipsychotics

"You have to get a hold of their hand and walk them everywhere, their thinking is so muddled and the increase in appetite is incredible," he said.
"She would eat raw sugar out of the packet. She would go through a whole bottle of ketchup."
After intervention she has now had her dosage and medication changed and is also receiving intensive therapy. Her behaviour is beginning to improve.
Professor Peter Tyrer, who is an expert in the use of anti-psychotics, said that the unmonitored use of this medication is a "slow fuse to disaster". Prof Tyrer, from Imperial College in London, said that drugs affect almost every part of the body.
"This is particularly alarming because of course children have got their whole lives ahead of them."
Chemical cosh?
What is also alarming experts is that these drugs are being used for the wrong reasons. While nobody disputed that they are sometimes needed and can, indeed, save lives, there is the fear that too often they are being used as a chemical cosh.
A Department of Health spokesperson told Channel 4 News: "NICE guidance states that children and adolescents should only be given antipsychotics following specialist assessment and they should be under specialist supervision.

"For children suffering from severe psychotic illnesses, appropriate drugs can help both the child and his or her parents live a more normal life, and in some cases this can mean the difference between a child going in to care or living at home.

"The government is committed to improving children's mental health and has recently announced £32million to provide access to effective psychological therapies specifically designed for children and young people."

Antipsychotics

About this leaflet

This leaflet may be helpful if:

you have been prescribed antipsychotic medication
a friend or relative has been prescribed antipsychotic medication
you just want to find out about antipsychotic medication

It includes:

What are antipsychotic medications?
How are they supposed to help?
How do they work?
What kinds of antipsychotic medication are there?
What are the possible side-effects?
How long should it be taken for?
How do I stop taking it?
What alternatives are there?

What are antipsychotic medications?Follow @westofmengele

They are a range of medications that are used for some types of mental distress or disorder - mainly schizophrenia andmanic depression (bipolar disorder). They can also be used to help severeanxiety or depression.

What can they help with?

The experience of hearing voices (hallucinations).
Ideas that distress you and don't seem to be based in reality (delusions).
Difficulty in thinking clearly (thought disorder).
The extreme mood swings of manic depression/bipolar disorder.

How do they work?

They all affect the action of a number of chemicals in the brain called neurotransmitters – chemicals which brain cells need to communicate with each other. Dopamine is the main neurotransmitter affected by these medications. It is involved in how we feel:

that something is significant, important or interesting;
satisfied;
motivated.

It is also involved in the control of muscle movements.

If parts of the dopamine system become overactive, they seem to play a part in producing hallucinations, delusions and thought disorder.

Although these medications were known as‘major tranquillisers’ in the past, they are not designed to make you calmer or sleepy – so they are not the same as medications like Valium or sleeping tablets.

The basic aim is to help you feel better, without making you feel slowed down or drowsy. However, high doses may well make you feel too sleepy or 'drugged up'. They can be used in higher doses if you become very overactive, agitated or distressed - but this should usually only be for a short time.

What kinds of antipsychotic medication are there?

For the past 10 years or so doctors have talked about two different groups of antipsychotics:

‘Typical’ - the older drugs
‘Atypical’ - the newer drugs

Recent large independent research studies - not paid for by the drug companies – suggest that the new drugs are not really different – but are, in some situations, easier to use.

Choosing an antipsychotic

Most antipsychotics seem to be equally as good at controlling psychotic symptoms – Clozapine is the exception and is described later. Even so, individuals react differently to them, particularly with the side-effects. We cannot (yet) predict how well a particular person will respond to a particular drug – even whether a newer, or older drug, will be more helpful. It can often take some time, negotiation and ‘trial and error’ to find the best antipsychotic for a particular person.

Older antipsychotics: these first appeared in the mid-1950s. These older drugs are often called‘typical’ or 'first-generation' antipsychotics. They all block the action of dopamine (see above), some more strongly than others.

Side-effects include:

stiffness and shakiness, like Parkinson’s disease
feeling sluggish and slow in your thinking
uncomfortable restlessness (akathisia)
problems with your sex life.

If you have any of these symptoms, you are probably on too high a dose. It should usually be reduced until the side-effects disappear. If you do need a higher dose to stay well, these side-effects can be controlled with anticholinergic drugs - used to treat Parkinson's disease. Orphenadrine and Procyclidine are the two most commonly used anticholinergics in the UK.

A longer-term problem is tardive dyskinesia (TD for short) – continual movements of the mouth, tongue and jaw. This affects about 1 in 20 people every year who are taking these medications.

Some older, ‘typical’ antipsychotics

Tablets	Trade Name	Usual daily dose (mg)	Max. daily dose (mg)
Chlorpromazine	Largactil	75-300	1000
Haloperidol	Haldol	3-15	30
Pimozide	Orap	4-20	20
Trifluoperazine	Stelazine	5-20
Sulperide	Dolmatil	200-800	2400

Newer antipsychotics : over the last 10 years, newer medications have appeared. They still block dopamine, but much less so than the older drugs. They also work on different chemical messengers in the brain (such as serotonin) and are often called ‘atypical’ or ‘second-generation’antipsychotics. This is misleading - they have many of the same effects as the older drugs.

Side-effects

Sleepiness and slowness
Weight gain
Interference with your sex life
Increased chance of developing diabetes.
In high doses, some have the same Parkinsonian side-effects as the older medications.
Long-term use can produce movements of the face (tardive dyskinesia) and, rarely, of the arms or legs.

Compared to the older drugs they seem:

less likely to cause Parkinsonian side-effects (see above)
less likely to produce tardive dyskinesia.
more likely to produce weight gain
more likely to produce diabetes
more likely to give you sexual problems.

They may also help 'negative symptoms' (poor motivation, lack of interest, poor self-care), on which the older drugs have very little effect. Some people find the side effects less troublesome than those of the older medications.

Some of the newer ‘atypical’antipsychotics

Tablets	Trade Name	Usual daily dose (mg)	Max. daily dose (mg)
Amisulpiride	Solian	50-800	1200
Aripiprazole	Abilify	10-30	30
Clozapine	Clozaril	200-450	900
Olanzapine	Zyprexa	10-20	20
Quetiapine	Seroquel	300-450	750
Risperidone	Risperdal	4-6	16
Sertindole	Serdolect	12-20	24
Zotepine	Zoleptil	75-200	300

Clozapine: seems to be the only antipsychotic medication which works better than any of the others. It also seems to reduce suicidal feelings in people with schizophrenia.

It has many of the same side-effects as other newer antipsychotics, but can also make you produce more saliva.

It is different in that it seems to have very little, if any, effect on the dopamine systems which control movement, and so causes hardly any of the stiffness, shakiness or slowness that you can get with other antipsychotics. Although it does tend to make you drowsy, some people are prepared to put up with this because it makes them feel less sluggish than on the older antipsychotics. It also does not seem to produce the longer-term problem of tardive dyskinesia.

Side-effects

The main drawback is that it can affect your bone marrow, leading to a shortage of white cells. This makes you vulnerable to infection. If this happens, the medication is stopped at once so that the bone marrow can recover. So, if you take Clozapine you will need weekly blood tests for the first 6 months and 2 weekly blood tests after that. It can also cause weight gain, over-production of saliva and make epileptic fits more likely.

These problems mean that Clozapine is usually only suggested after at least two other antipsychotics have been tried. It is a difficult drug to monitor and can be difficult to take, but some people find that it gives them a much better quality of life.

‘Depot’ antipsychotics

The word ‘depot’ means that the medication is given not as tablets, but as an injection every 2 to 4 weeks. It releases the medication slowly over this time. The effects are generally the same as medications taken by mouth.

What's good about having a depot injection?

Unlike tablets, you only have to think about it once in a while. As there is someone else to remind you, it can be easier to remember to take than tablets.

What's bad about having depot injections?

Nobody likes having injections – even though the pain is slight and doesn't last long.
It takes a long time to know the effect of changing the dose. If the dose is changed, you may not know what the effect of this change is for several weeks or months – it can take 4 injections or so for the change to work its way through.
If a particular dose is giving you side-effects, lowering it may make little difference for several weeks.

How are the injections given?

A nurse will give you the injection. There is usually no-one else in the room - just you and the nurse.
The first injection is usually a small dose of the medication to check that it does not give you any side-effects.
If there are no problems then, a week or so later, you can start having regular injections at a higher dose.
After each injection,the medicine will stay in your body for several weeks.
The interval between injections is usually between 2 and 4 weeks

Where can you have the injections done?

You can usually decide yourself where to have the injections. This might be:

at your local GPs' surgery
at a community mental health centre
at a special out-patient clinic
at your home, when a nurse visits you.

Some common depot antipsychotics

Depot injections	Trade name	Normal 2-weekly dose	Usual max.	Interval
Haloperidol decanoate	Haldol	50	300	4 weeks
Flupenthixol decanoate	Depixol	40	400	2 weeks
Fluphenazine decanoate	Modecate	12.5	100	2 weeks
Pipothiazine palmitate	Piportil	50	200	4 weeks
Zuclopenthixol decanoate	Clopixol	200	600	2 weeks
Newer	Trade name	Normal 2-weekly dose	Usual max.	How often
Risperidone	Risperdal Consta	25	50	2 weeks

How well does medication work?

About 4 in 5 people get help from them. They control the symptoms, but do not get rid of them. You have to go on taking the medication to stop the symptoms from coming back.
Even if the medication helps, the symptoms may come back. This is much less likely to happen if you carry on taking medication, even when you feel well.

How long should I take an antipsychotic for?

This depends on a number of factors.

Schizophrenia

If you have had just one episode of schizophrenia, you have roughly 1 in 4 chance that your symptoms will not return after you get better. So you may well not need to carry on taking an antipsychotic.

For most people with schizophrenia, the symptoms will continue or come and go over the years. Some things to consider are:

You may find that antipsychotic medication takes your symptoms away completely. It's more likely that they will just make the symptoms less intense and easier to cope with.
As with any medication, you have to balance the help you get from it, against any side-effects it gives you.
For many people the symptoms seem to come and go for no obvious reason – so there may be times when it is more helpful to take such medication, and times when you don't need it so much.
If you have had more than one period of psychotic symptoms and stop the medication, the symptoms will usually return within 6 months.
There is evidence that if major long-term problems are going to develop they do so in the first 5 years or thereabouts. So your doctor may feel that it is important to use medication to try and keep you well through these early years.

Bipolar disorder

Bipolar disorders will almost always return although, during the first episode, it is hard to predict how often this will happen.

What happens if I stop antipsychotic medication?

The symptoms will usually come back - not immediately, but usually within 3 – 6 months.

How do I stop taking it?

If you decide you want to stop taking an antipsychotic, talk it over with your psychiatrist. You and the psychiatrist may disagree about this, but there is a way that can help both sides to feel happier. You can:

make a list of feelings/thoughts/behaviours that might warn you that your symptoms are returning. The pattern of symptoms is often very similar from one episode to another.
make a similar list – with someone you trust and who knows you well - of what other people might notice if your symptoms start to return.
reduce the medication gradually, giving each reduction a few weeks to take effect.

This means that your symptoms are not likely to suddenly return. If they do start to get worse again, you can think about what to do next while you are still well.

If you do stop medication completely, keep in touch with your psychiatrist or mental health worker, even if you have been well for a few months without medication.

What alternatives are there?

The evidence is very clear that nothing else works as well as antipsychotic medications in the treatment of the more troublesome symptoms of psychotic illnesses. Other ways of helping will usually be added to antipsychotic treatment rather than replacing it. These include:

Cognitive behaviour therapy (CBT)

This is a talking treatment which can be helpful if you have distressing psychotic symptoms. It can help you to control them and to feel less distressed by them. It can also be used to help you identify if your symptoms are returning again.

Psychoeducation

This helps you to find out more about your disorder, how to manage it and the treatments available. The purpose is to help everyone (including families) understand the illness better so that they can cope better and be more supportive.

Family therapy

Professionals will meet with the whole family. The aims are:

to reduce tensions between the person with a psychiatric illness and those who care for them;
to give the family practical ways of coping with everyday problems.

We know that these tensions can make it more likely that the symptoms will get worse.

Hearing voices groups

People who have similar experiences of hearing voices get together to discuss their experiences and how they cope with them.

Not all of these are available in all areas, and they may not be helpful for everybody – if you feel that one of these might be helpful for you, talk it over with your psychiatrist or mental health worker.

Which antipsychotic is right for me?

There are no antipsychotics that are clearly 'better' than any others. Clozapine is more effective, but has potentially dangerous side-effects and means that you have to have regular blood tests.

NICE guidelines (England and Wales) suggest that one of the newer antipsychotics should be tried first and then one of the older ones, depending on how well the medication works for you, and any side-effects they give you.

The best thing is to weigh up the benefits and risks of the different medications with your psychiatrist. Write down the things you are worried about before the appointment so that you don't forget anything important. If you're not sure what questions to ask, download our leaflet on “Questions to ask your psychiatrist” .

Further help

Hearing Voices Network

Mind and Mind Cymru

Mindinfoline: 0845 766 0163. Mind provides information and advice, training programmes, Mind in your area, grants and more.

National Schizophrenia Fellowship (Scotland): works to improve the wellbeing and quality of life of those affected by schizophrenia and other mental illness, including families and carers.

Rethink: National voluntary organisation that helps people with any severe mental illness, their families and carers.

Shine: supporting people with mental ill health:

Saneline: Helpline: 0845 767 8000. A national mental health helpline offering emotional support and practical information for people with mental illness, families, carers and professionals.

References

British National Formulary (March 2009). The BNF provides UK healthcare professionals with authoritative and practical information on the selection and clinical use of medicines in a clear, concise and accessible manner.

Schizophrenia: core intervention in the treatment and management of schizophrenia in primary and secondary care. NICE guidelines, 2009.

Schizophrenia: atypical antipsychotics: the clinical effectiveness and cost effectiveness of newer atypical antipsychotic drugs in schizophrenia: NICE guidelines, 2002.

This factsheet was produced by the Royal College of Psychiatrists' Public Education Editorial Board .

Series Editor: Dr Philip Timms

Service user input: Janey Antoniou

Royal College of Psychiatrists. This factsheet may be downloaded, printed out, photocopied and distributed free of charge as long as the RCPsych is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its factsheets on other sites, but allows them to be linked to directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Telephone: 020 7235 2351 x259

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Sunday, 6 May 2012