Welcome to From Insults To Respect.

Back in 2019, I criticized the use of “antipsychotics” and on Facebook someone criticized what I had written saying, “all of the research clearly indicates that the “antipsychotics,” when used by people diagnosed as having schizophrenia, decrease the risk of dying.” I then, very respectfully, asked that he supply me with the references that he is relying on to make his assertion, and within a very brief period, he did just that.

In looking at his list, I noticed immediately that he left out every one of the studies that provided strong evidence published in peer reviewed articles that suggest this class of drugs actually reduces longevity. For example, a 2007 study was published in the Archives of General Psychiatry titled “A Systematic Review of Mortality in Schizophrenia: The Differential Mortality Gap Worsening Over Time.” The authors wrote:

Mental health services have advanced in many parts of the world during the past few decades. Apart from a different mix of community-based care, the introduction of the second-generation antipsychotic medications [also referred to as atypical antipsychotics] in the early 1990s was initially found to be associated with better quality of life and reduced risk of relapse.^77–79 More recent trials have questioned the clinical superiority of second-generation antipsychotic medication,^80,81 and concern is now widespread about the adverse effects associated with these medications.⁸² In particular, compared with typical antipsychotics, several of the second-generation antipsychotics are more likely to cause weight gain and metabolic syndrome.⁸³ Because the metabolic syndrome is associated with a 2- to 3-fold increase in cardiovascular mortality and a 2-fold increase in all-cause mortality,⁸⁴ these adverse effects would be expected to contribute to even higher SMRs [Standard Mortality Ratio] in the next few decades.^85,86

After summarizing the many studies revealing these types of troubling findings, I then took a look at the studies that were cited by the person who criticized my position, and wrote up my findings (see HERE).

I don’t know where this person obtained his list, but it appeared to me, as I began to study it, that it was probably made by a pharmaceutical industry salesperson who goes to doctors’ offices to convince them to prescribe their drugs. I say this because there are articles on the list that had titles that sounded like they were relevant, but when reading them, they were not. For example, the first study on my critic’s list was published in The Lancet in 2018, and titled “Second-generation Antipsychotic Drugs and Short-term Mortality: A Systematic Review and Meta-analysis of Placebo-controlled Randomized Controlled Trials.” It looked at 596 studies, all of which looked at patients that were randomly assigned to either an “antipsychotic” or a placebo for 13 weeks or less. For the patients in this analysis that had been labeled as having schizophrenia, there was no statistically significant difference in mortality between the two comparison groups.

Upon reading this article, I was left puzzled. Why was this article included in my critic’s list. As I have said, his contention was that every research paper published demonstrated “antipsychotics” decrease mortality for schizophrenia labeled individuals, which was not supported in this study. 

In another study on the list, “Effectiveness of Antipsychotic Treatments in a Nationwide Cohort of Patients in Community Care After First Hospitalisation Due to Schizophrenia and Schizoaffective Disorder: Observational Follow-up Study,” published in 2006 in the British Medical Journal, the most important finding is that patients that were on “antipsychotics” for less than 6 months had a lower rate of dying than those who were on the drug for longer periods. The authors note this in the results section of their article with a single sentence, stating,”Patients who used antipsychotics for less than 6 months had especially low mortality rates.”

However, if you read just the abstract of the article, as many practitioners do because time reading research studies is not billable, you would find no mention of this statistically significant finding, a finding that could have life saving implications.

After completing my review of the various studies on my critic’s list, I concluded that the studies claiming support for the notion that “antipsychotics” increase longevity are seriously flawed and the weight of the evidence indicates they do just the opposite.

Since my analysis, Robert Whitaker, to my mind the premier science writer on psychiatric drugs, published an article in the peer reviewed research journal Psychological Medicine. The article is titled “Do Antipsychotics Protect Against Early Death? A Critical View” (see HERE). The journal is published by Cambridge University Press, and to read it you have to have a subscription to the journal. Fortunately, Whitaker has made his findings available for free HERE.

Whitaker’s article covers much of the same territory as my own, but he adds some insightful additional analyses so worth considering that I want my readers to become aware of its existence. After all, the information addresses life and death issues.

As I have said, Whitaker’s analysis is freely available. However, because he so thoroughly covers the relevant research it is rather long. Therefore, to make his analysis more accessible to a wider audience, below I provide a few of his summary statements.

Whitaker’s Summary Statements

As can be seen in the research summarized to this point, there are compelling reasons to conclude that these drugs contribute to early death. To wit:

• Both first-generation and second-generation antipsychotics cause adverse effects that are known to increase the risk of dying from cardiac, respiratory, and endocrine diseases.
• Psychiatric users of antipsychotics die at high rates from these somatic illnesses.
• Non-psychiatric patients who use these drugs also die at elevated rates from these illnesses.
• In both psychiatric and non-psychiatric patients, the use of antipsychotics doubles the risk of death in comparison to matched cohorts of patients who do not take the medications.
• Studies of smaller cohorts of schizophrenia patients have found that antipsychotic use is associated with elevated rates of death, with this risk rising with higher doses and polypharmacy.
• Suicide rates for patients diagnosed with schizophrenia are dramatically higher in the antipsychotic era than in the pre-antipsychotic era, and this risk soars during the first year after initial treatment with an antipsychotic in the hospital.

…A number of longer-term studies have found higher recovery rates for those off medication. Add in research findings that antipsychotics shrink brain volumes, with this shrinkage associated with cognitive decline and a worsening of negative symptoms, and psychiatry is confronted with an “evidence-based” crisis.

The “antipsychotics lengthen lives” research gave the field a new claim to hang onto and to promote. A treatment for a disease that increases survival…can lay claim to being effective. During a time of doubt, that is a conclusion that provides a sigh of relief—and comfort—for the field.

But as can be seen in this review, that belief arises from research that is flawed in so many ways. There is evidence, time and again, of a process that was designed to justify the long-term use of antipsychotics, rather than honestly assess their impact on mortality.

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

AntipsychoticsRobert Whitakersafety of antipsychotics