Posted by yxibow on September 24, 2005, at 21:02:26
In reply to NEUROLEPTICS, posted by med_empowered on September 23, 2005, at 5:18:42
>The idea that antipsychotics "correct" some sort of "chemical imbalance" is not only weak, its not even an "idea" or "theory" in the truest sense of the word; its based on the observation that the damaging, much-despised drugs given to those with schizophrenia (often against their will) dampen dopamine.
Actually direct dopamine blockade function is only one of the components of antipsychotics, especially current neuroleptics. 5HT blockade shows additional aspects of neuroleptic treatment.
>So..basically, we don't *know* that dopamine malfunction causes schizophrenia, but we do know that if you dampen dopamine enough you can make a patient shut up and quit making trouble.
And possibly prevent suicide, which is one of the leading causes of death among people who are afflicted with severe schizophrenia.
>Drug companies, of course, can now charge outrageous prices for drugs that are only marginally better than the old meds and still claim that they are "on the cutting edge of schizophrenia treatment." Please. They may well be on the "cutting edge" of false advertising and price gouging, but their reformulated Haldols don't represent all that much of an advance in improving the lives of those with schizophrenia.
They represent a significant advance in improving the lives of those affected by schizophrenia who otherwise would discontinue old line medications because of severe EPS. Not every drug is tailored to the entire schizophreniform disorder population. Agreed, the industry is a very expensive one -- at least 1% of the population of this country suffers from some spectrum of the neurobiological disorder. But tell the person suffering on thioridiazine or fluphenazine with severe EPS that the relief they get from Zyprexa from these debilitating side effects that they're not on the "cutting edge" and I think one would get a different story. Its all a matter of the patient, and I agree the patient's needs and wants should be closely listened to.
>Then there are the psychiatrists, who are now RXing these expensive, side-effect ridden pills for everything from florid psychosis to mild insomnia.
Very low dosage Seroquel may in fact help some people with severe insomnia where other treatments havent, but I agree that neuroleptics should be considered a last line of medication in those who are otherwise not suffering a psychotic form of illness. On the other hand, psychotic depression is just that, psychotic depression. It may not be something that can necessarily always be dealt with purely through behaviour and psychodynamic counseling.
>Talking to yourself? Seeing things? How about we throw you in an asylum, isolated from the rest of humanity, for the next 10-15 years, all the while preventing you from escaping or even trying to live a life outside? Is that *treatment*? Is that *respect* ? Of course not.
Agreed -- current, at least current western medication, here in the United States, does not follow the 1950s idea of "throwing people into asylums". Rather, when schizophrenia is discovered early (and this is the best time, it is debatable how degenerative it is over a lifetime without treatment, but thats another argument), a patient may be in a psychiatric ward for 4 to 6 weeks to stabilize and monitor the patient, prevent suicide, provide counseling, in addition to possible medication use, for that individual. To leave the patient wandering the streets of a major American city is simply just as callous as treating the patient as a number. Again, here is the point that while the CATIE study may have proved that old and new line neuroleptics have similar functions, they dont always have the same side effect profile for the individual patient.