Posted by med_empowered on December 29, 2005, at 22:02:18
In reply to Re: Don't be Scared of Antipsychotics!!!!!!, posted by linkadge on December 29, 2005, at 21:22:38
hi! I'm glad this guy doesn't have (noticeable) tardive dyskinesia. But..why was he on chlorpromazine at age 5? That strikes me as a sort of medical child abuse.
From what I understand, the first cases of TD popped up around 1957. Apparently they paid more attention to this problem in Europe than in the US (US doctors also seemed to use higher doses of neuroleptics than European ones).
Anyway, with the Patient's Rights and Psychiatric Survivor's movements of the 60s and 70s (and the anti-psychiatric literature of this period), there was more attention paid to the problems these drugs were causing..also, it became possible for patients to sue their shrinks, which they did. Often. In 1980, the American Psychiatric Association finally got around to compiling some data on TD. According to their (conservative) estimates, about 3% of patients will develop TD per year. Factor in certain at-risk groups (people on lithium, older people, children, people with affective disorders, etc.) and the number comes up to 20% at the end of 5 years of treatment. From what I understand, the APA data was "processed" in such a way that the numbers don't reflect the actual incidence--if you look at more minor cases of TD, the number for 5years could be more like 30%, and the numbers for "long-term" treatment could be over 50%.
Newer antipsychotics seem to be better. It seems like the data is strongest on Zyprexa, which apparently causes TD at a rate of about .5-1%/year. That's much better than Haldol, but think about it: the way atypicals are being sprayed on everyone, for everything (sleep, anxiety, OCD, depression, Bipolar, Boredline Personality Disorder, etc.) we could still be looking at a whole lot of new cases of TD, since the number of patients being treated with neuroleptics is being greatly increased.
Also, patients with mood disorders tend to develop TD more often than those with "classic" schizophrenia, so I find it disconcerting that so many mood-disordered patients are being put on atypicals instead of other, less potentially harmful medications. Think about it this way: there are about 2 million schizophrenics in the US. The vast majority of these people are medicated, or will take medication for a good while before discontinuing treatment. Even if only 1/8 of them--250,000--complete a year of treatment with an atypical antipsychotic, there will still be about 1,250 new cases of TD **per year** of exposure to the drug. And that's if you use low-end numbers (to take into account the patients who stop taking meds) for patients and the low-end rate for development of TD.
Its important to realize that, the first time around, TD was kind of denied. Doctors said it was infrequent for movement disorders to be permanent, the meds were safe, blah blah blah. Also, APs have other risks, like the often-fatal Neuroleptic Malignancy Syndrome. I read one estimate that puts the number of fatalities due to this "rare" syndrome at about 100,000 worldwide since Thorazine was introduced. Think about it: 100,000 people dead. Benzos, on the other hand, have hardly killed anyone. They may be "addictive," but they dont cause fatal reactions and overdoses are rarely fatal. So, compare and contrast: docs hesitate to RX benzos, the "bad" drugs, b/c they might be "addictive"...but they'll hand out super-expensive drugs that can cause TD and NMS.
Personally, I think neuroleptics should be considered controlled substances. They may not be "addictive" in the conventional sense, but the risks inherent in neuroleptic treatment call for more stringent monitoring of dosing and prescribing habits of doctors.