Patients should be involved in decisions regarding their treatment.  Many patients have rational reasons for rejecting treatment and concerns about the severe and potentially life-threatening side effects of psychotropic medications.  Many patients to either discontinue their medication or to be unable to retain employment in the community, which consigns them to the vicious cycle of repeated psychiatric hospitalization.

Psychiatric medications frequently cause severe side effects, some of which can be irreversible and for other patients these psychotropic medications fail to help patients.   According to the National Institute of Neurological Disorders and Strokes of the National Institutes of Health, antipsychotic drugs can cause neuroleptic malignant syndrome, a life-threatening neurological disorder.  Additionally, the National Institutes for Mental Health (NIMH) has found that long-term use of antipsychotic medications can cause tardive dyskinesia, a potentially incurable and disfiguring condition that causes muscle movements a person cannot control. For long-term psychiatric patients the chance of contracting tardive dyskinesia from psychotropic drugs is approximately one in four.  One of the most common side effects of antipsychotic drugs is a condition known as akathisia, which is marked by uncontrollable physical restlessness and agitation and by interminable pacing, shaking of arms and legs, foot bouncing, and anxiety or panic.  When this side effect occurs it is often mistaken for symptoms of mental illness itself and then even more antipsychotic medication is administered due to a psychiatrist’s erroneous perception that the signs of akathisia are symptoms of disease, the patient’s agitation and panic increase.   The opposite type of side effect is akinesia, which is typified by drowsiness and the need to sleep a great deal.  This effect is appreciated by those wishing to chemically restrain patients and prevent their moving around or demanding care in the middle of the night.  But this allows caretakers to ignore patient’s problems and use ever increasing amounts of drugs to achieve the desired ends.  This is not treatment of the underlying disease but instead forced drugging for the convenience of the caretakers.  In addition, polypharmacy, which is the prescribing for a single person of more than one drug of the same chemical class (such as antipsychotics), is widely practiced despite little empirical support, and can result in serious adverse reactions and intensified side effects and can lead to early death.

Numerous psychiatric medications are dangerous and even life threatening adverse effects including: weight gain and diabetes, tardive dyskinesia (movement disorder), tremor, akathisia (restless leg syndrome), dyskinesia (uncontrollable movements, tics, tremors), dystonia, as well as the side effects of nausea, dizziness (low blood pressure), and insomnia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It is painful to even watch a video of someone with dyskinesia or dystonia. The doctors when prescribing these medications tell patients and their families just to disregard these potentially life threatening and life altering side effects.

Many of these drugs cause symptoms that can themselves be construed as mental illness. One drug Abilify or Aripiprazole, is known to cause neurological side effects, gastrointestinal signs, movement disorders, disturbances in thinking, anxiety disorders, sleep disorders and even suicidal behavior. These are the actually side effects of the drug – yet when these symptoms occur they are attributed often to what they claim is the medical diagnosis. Doctors reported to the FDA that their patients had hallucinations, psychosis, heart rate, diabetes, cardiac problems, liver dysfunction, coma, and blood coagulation problems while on Abilify. Even a very cursory review of the FDA warnings and listing of adverse side effects would cause any responsible legal guardian to reconsider the use of these drugs on a loved one.

The Food and Drug Administration or FDA is the agency charged with protecting the safety of consumers. Hundreds of cases have been brought in the last several years against pharmaceutical companies arising from deaths and injuries attributed to drugs used to treat psychiatric disorders. The most urgent warnings are those known as “black box” warnings, in which drug companies are required to (or voluntarily) post warnings in bold black print in a bold black box. These warnings appear in the Physician’s Desk Reference and in the package inserts for the drugs, which doctors are presumed to read.    The black box warnings of Luvox included the possibility of violent behavior including homicidal thoughts.

Gary Tollefson, et al., Blind, Controlled, Long-Term Study of the Comparative Incidence of Treatment-Emergent Tardive Dyskinesia With Olanzapine or Haloperidol, 154 AM. J. PSYCHIATRY 1248 (September 1997).

Leonardo Cortese, et al., Assessing and Monitoring Antipsychotic-Induced Movement Disorders in Hospitalized Patients: A Cautionary Study, 49 CAN. J. PSYCHIATRY, 31, 34 (January 2004).

Steven Kingsbury & Megan Lotito, Psychiatric Polypharmacy: The Good, the Bad, and the Ugly, 24 PSYCHIATRIC TIMES 32 (April 1, 2007)

Jeffrey Lieberman et al., Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia, 353 NEW ENG. J. MED. 1209 (Sept. 22, 2005).

Archives of General Psychiatry in October 2006. Peter Jones, et al., Randomized Controlled Trial of the Effect on Quality of Life of Second- vs First-Generation Antipsychotic Drugs in Schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1), 63 ARCH. GEN. PSYCHIATRY 1079 (Oct. 2006).

Linmarie Sikich, et al., Double-Blind Comparison of First- and Second-Generation Antipsychotics in Early-Onset Schizophrenia and Schizo-affective Disorder: Findings From the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study, 165 AM. J. PSYCHIATRY 1369 (2008)

Robert Findling, et al., Double-Blind Maintenance Safety and Effectiveness Findings From the Treatment of Early-Onset Schizophrenia Spectrum (TEOSS) Study, 49 J. OF THE AM. ACAD. OF CHILD & ADOLESCENT PSYCHIATRY 583 (June 2010).

http://www.ninds.nih.gov/disorders/neuroleptic_syndrome/neuroleptic_syndrome.htm.

ProPublica’s Dollars for Docs database includes more than $760 million in payments from 12 pharmaceutical companies to physicians and other health-care providers for consulting, speaking, research and expenses.

Dollar to Docs widget  will let you look up whether their health care providers are taking money from the drug companies in their database. The widget shows the amount of money paid to each practitioner in our database, which company made the payment, and in some cases, what the companies said they were paying for: speaking fees, consulting, etc. The widget also lists what drugs each company sells so readers can check their own prescriptions.

See more information:

http://projects.propublica.org/docdollars/

Local Stories Based on This Data

Conditions Treated: Attention Deficit Hyperactivity Disorder

ADHD drugs:  Atomoxetine (Strattera), Lisdexamfetaminedimesylate (Vyvanse), Methylphenidate (Ritalin, Concerta), Ampetamine (Adderall), Dextroamphetamine (Dexedrine, Dextrostat)

Adverse Side Effects:

Decreased appetite

Tics

Psychosis

Conditions Treated: General Anxiety Disorder, Post-traumatic stress disorder, Social Phobias,  

Antianxiety drugs:  Clonazepam (Klonopin), Lorazepam (Ativan), Alprazolam (Xanax),

Adverse Side Effects:

Dependence

Drowsiness and dizziness

Blurred vision

Nightmares

Antidepressant Drugs: Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro), Venlafaxine (Effexor), Duloxetine (Cymbalta), Bupropion (Wellbutrin)

Conditions Treated: Depression, Generalized anxiety disorder, Social phobia, Obsessive-compulsive disorder,

Adverse Side Effects:

Suicidal thoughts

Sleeplessness or drowsiness

Agitation

Sexual dysfunction

Antipsychotic Drugs: Clorpromazine (Thorazine), Haloperidol (Haldol), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripriprazole (Abilify)

Conditions Treated: Bipolar Disorder, Schizophrenia, Tourette’s Syndrome,

Adverse Side Effects:

Rigidity (muscular tension)

Tremor

Tardive dyskinesia (uncontrollable movements)

Diabetes

High cholesterol

Weight gain

Neuroleptic malignant syndrome (a life-threatening, neurological disorder most often caused by an adverse reaction to antipsychotic drugs)

Hypnotic drugs: Quazepam (Doral), Zolpidem (Ambien), Eszopiclone (Lunestra)

Conditions Treated: Insomnia, Anxiety

Adverse Side Effects: Dependence, Sleep-walking

Mood Stabilizers: Lithium, Divalproex sodium (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal), Oxcarbazepine (Trileptal)

Conditions Treated: Bipolar disorder

Adverse Side Effects:

Suicidal thoughts

Loss of Coordination

Hallucinations

Kidney, thyroid, liver and pancreas damage

Polycystic ovarian syndrome

Weight gain

No type of antidepressant is helpful in every clinical case or even indicated. These drugs can actually make the situation worse. As a class of drugs SSRIs can create a unique combination of side effects that may severely impair judgment and impulse control in individual patients. Excessive doses of antidepressants can cause brain dysfunctions including disorientation, confusion, and cognitive disturbances. In combat veterans suffering PTSD, impulsive behavior, especially if coupled with impaired cognitive functioning, can be dangerous. Antidepressants can also trigger similar, manic-like symptoms in people whose depression is part of a manic-depressive syndrome, which often gets overlooked when people are given SSRIs. Is public safety enhanced when “patients” are given SSRI’s and are persons on SSRI’s less likely to do gun violence? The pharmaceutical corporations would lead you to believe that a person taking these drugs is less likely to commit suicide and less likely to do gun violence to others. But is that really true?

Recent cases of mass violence such as the Joseph Wesbecker in Virginia that shot his co-workers, the Virginia Tech murders, the Columbine Shootings, and the shootings at Fort Hood, all point to the fact that anti-depressant and SSRI medication are dangerous to the public. These medications can cause homicidal thinking which results in public violence and also in suicides. The pharmaceutical industry wants to use the returning veterans as a huge potential pharmaceutical drug customer base. All veterans are trained to use weapons and often have weapons easily at hand. With Post Traumatic Stress a major problem in the returning troops, we have a social problem to deal with their mental health needs. With the US government picking up the tab, the pharmaceutical companies are lobbying heavily to increase their expected profits from the sales of drugs for Post Traumatic Stress Disorder (PTSD) sufferers. The huge numbers of returning veterans are a prime target of their sales efforts. Big Pharma pours lots of money into the political campaigns of those who support their agenda. These huge pharmaceutical companies have persons on the President's New Freedom Commission on Mental Health that are pushing to do wholesale marketing of selective serotonin reuptake inhibitors (SSRI's) and other mind altering drugs to veterans with PTSD. The constantly expanding prison population is another target for the SSRI drug marketing and especially those prisoners facing re-entry and who will soon have Medicaid/Medicare to pay their pharmaceutical bills.

When SSRI antidepressants such as Prozac, Paxil and Zoloft were first introduced in the late 1980's and early 1990's there were reports of increasing violent behavior including suicide and homicide. There were in 2003 reports by British authorities and the U.S. Food and Drug Administration about unpublished studies showing an increased risk of suicide in children and teenagers taking Paxil. Prior reports of suicidal and homicidal acts in adults taking SSRIs have been minimized by the pharmaceutical company defenders and mainstream doctors, who claim that suicide is common in depression anyway.

The recent violence Nov. 5, 2009 at Fort Hood in Texas in which a military psychiatrist shot and killed 13 people and wounded 30 others gives us good reason to reconsider these psychiatric drug treatments for military personnel and veterans. This incident reminded me of the Northern Illinois University mass shootings where former grad student Stephen Kazmierczak killed 5 students and wounding dozens of others before committing suicide himself. This gunman had been taking the drug Paxil prior to his mass killings. The drug manufacturer had been deliberately withholding information about violent behavior as an adverse effect of the medication. Now the drug Paxil carries a black box warning about homicide and suicide. On Sept 14, 2004, an FDA panel voted 18 to 5 to require manufacturers of all antidepressants to add black box warnings to their product labeling. A month later, the FDA adopted the panel's recommendations.

The warning reads in part: "Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior."

The warning specifically links antidepressant use to suicidal behavior in four percent of kids on these drugs compared to two percent for kids on placebos.

Various studies have found that neuroleptics reduce one’s capacity to learn and retain information. Duke University researcher Richard Keefe said these drugs may “actually prevent adequate learning effects and worsen motor skills, memory function, and executive abilities, such as problem solving and performance assessment.” (Keefe, R. “Do novel antipsychotics improve cognition?” Psychiatric Annals 29 (1999):623-629.)

Serotonin Syndrome:

Many of these drugs act upon Serotonin or 5-hydroxytryptamine (5-HT) which is a neurotransmitter.  It is found in the gastrointestinal tract, in blood cells (platelets) and in the brain and spinal cord (central nervous system).  It is known to affect the feel of well-being and happiness and can affect mood, appetite and sleep.  Serotonin has an effect on memory and learning.  Serotonin is a neurotransmitter that affects the brain and plays a role in aggression, pain, sleep, appetite, anxiety, depression, migraine, and vomiting.  Several different classes of psychiatric drugs like anti-depressants, anti-psychotics, anti-anxiety drugs, anti- migraine drugs and psychedelic drugs affect the level of this neurotransmitter inside the neuro-synapses of the brain.  SSRIs act on the brain to raise levels of the neurotransmitter serotonin without raising the levels of norepinephrine. This was thought to be a benefit in treatment of depression, and later anxiety, panic, social phobia, obsessive- compulsive disorder (OCD) , and many other conditions.

However when considering risk vs benefit of these drugs, reasearch has shown that these SSRI drugs do not produce clinically significant improvements in depression in patients who initially show moderate or even severe depression.  They show statistically significant but clinically minor effects only in the most severely depressed patients.

Drugs such as tricyclic antidepressants (TCA’s) and selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin, making it stay in the synapse longer.  The benefits derived by these drugs may decrease in selected patients after a long-term treatment.  Serotonin syndrome is a medical consequence of these kinds of psychiatric drugs.  Serotonin syndrome which can also be called serotonin toxicity is really a poisoning and is the predictable consequence of excess serotonin activity in the brain and elsewhere in the body which can be caused by therapeutic use of these medications.  No laboratory tests can currently confirm the diagnosis and it is usually diagnosed base on the patient’s symptoms and clinical history.  Serotonin syndrome may be mistaken for a viral illness, anxiety, neurological disorder, various kinds of poisonings, or a worsening psychiatric condition.  The Serotonin syndrome presents characteristic clinical signs but can be mistaken for the more dangerous and life threatening neuroleptic malignant syndrome. This presents as twitching, tremors, rigidity, fever, confusion, or agitation.

Serotonin/norepinephrine reuptake inhibitors (SNRIs) also may cause serotonin syndrome by interactions. Most tricyclic depressants do not have these interactions, with the exception of amitriptyline.

The symptoms of Serotonin Syndrome are:

Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma

Autonomic effects: shivering, sweating, hyperthermia (temperature as high as 104^o F and even go as high as 106^oF, hypertension (high blood pressure), tachycardia, nausea, diarrhea.

Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

Tapering off very, very, very slowly has proven the safest and most effective method of withdrawal of psychiatric medications.  When discontinuing or withdrawing from a psychiatric medication that affects the brains serotonin level, a dangerous situation can occur a condition called the "SSRI Discontinuation Syndrome."  When serotonergic activity dramatically decreases because the neurons aren't able to communicate properly with each other anymore. As a result of this decreased serotonergic activity, side-effects occur. Sometimes these side-effects are reported by the patient as feeling like electric shocks, zaps or shivers in the head (brain) or sometimes like “pins and needles” in the skin or like a light flickering in his/her head.  These symptoms are sometimes so severe that the patient feels confused or like on the verge of blacking out or losing consciousness.  These sensory disturbances may make the patient feel very confused and may involve short periods of short-term memory loss or absences.  These absences are actually petit mal seizures which may be invisible to the observer and not recognized as epileptic activity.  

This is an effect of the withdrawal of the prescribed drug itself - not a symptom of mental illness.  It is caused by the drug.

Clozapine and other related drugs are  also associated with neuroleptic malignant syndrome (NMS) which is a rare, but life-threatening, idiosyncratic reaction to a neuroleptic medication which can be fatal. The syndrome is characterized by fever, muscle cramps, unstable blood pressure and muscular tremors. Neuroleptic malignant syndrome (NMS) causes changes in mental status, difficulty thinking, agitation, delirium and even coma. This is a truly life threatening emergency requiring emergency treatment.

One clear outcome of the use of the antipsychotic drug Abilify is tardive dyskinesia. Tardive dyskinesia is a difficult-to-treat and causes the patient to have in involuntary, repetitive body movements that started some time after starting the medication. The only way to prevent tardive dyskinesia is to not give these medications to the patient. It frequently appears after long-term or high-dose use of antipsychotic drugs. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, rapid eye blinking and rapid finger movements. To knowingly force someone unnecessarily on medications that cause this outcome could surely be considered cruel and unusual punishment or even torture – because life with tardive dyskinesia is daily torture. Tardive dyskinesia is often misdiagnosed as a mental illness rather than a neurological disorder, and as a result patients are prescribed more drugs which increase the probability that the patient will develop this disabling disability. In such cases, it is critical to properly identify the signs of the disorder and stop drugs as soon as possible. These drugs have a tendency to mask the very symptoms they are causing, thus making it more difficult to determine what the problem is.

Physicians should educate patients and families about the dangers of tardive dyskinesia. The majority of patients who are on the drugs long enough will develop the disorder of tardive dyskinesia, with some getting this problem after only 4 months of treatment with the medication. The published rate for tardive dyskinesia among people who stay on the older drugs is approximately 3-5% per year - if you stay on these medications, for ten years, the risk of developing TD is 50%. (Dr. Grace E. Jackson MD ‘What Doctors May Not Tell You About Psychiatric Drugs’ Public Lecture, UCE Birmingham June 2004)

There are also long term affects of these drugs called tardive dysmentia and tardive psychosis which are debilitating conditions caused by these medications. But doctors often blame the patient for these problems and attributing symptoms to the underlying condition and not to the medications own effects. Tardive dementia is caused by long-term use of the neuroleptics resulting in a depressive condition similar to NIDS that involves the frontal lobe of the brain. In some individuals, it seemed that long term treatment with neuroleptics was more likely to affect emotional centers in the human brain, and patients were seen to develop dramatic or euphoric mood swings and this was called tardive dysmentia.

The so-called “atypical” antipsychotics are neither “atypical” nor “antipsychotic.” Not infrequently, these chemicals induce or enhance bizarre statements (disorganized speech or delusions), social withdrawal (depression), and sedation (encephalopathy), regardless of dose. The processes through which these medications exert destabilizing effects include receptor blockade (D2, ACH, histamine), electrophysiological (depolarization) blockade; direct toxicity (cell death); and induction of other disease processes (pneumonia, diabetes, hypothyroidism, PE). Unfortunately many prescribing clinicians are largely unaware of these problems and thus do not inform their patients.

Numerous psychiatric medications are dangerous and even life threatening adverse effects including: weight gain and diabetes, tardive dyskinesia (movement disorder), tremor, akathisia (restless leg syndrome), dyskinesia (uncontrollable movements, tics, tremors), dystonia, as well as the side effects of nausea, dizziness (low blood pressure), and insomnia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It is painful to even watch a video of someone with dyskinesia or dystonia. The doctors when prescribing these medications tell patients and their families just to disregard these potentially life threatening and life altering side effects.

This is an inner restlessness and anxiety that many patients describe as the worst sort of torment. This side effect has been linked to assaultive, murderous behavior.

This video is when the patient's  myoclonic jerks became to much to handle. They were worse a few hours earlier resulting in convulsing on the ground like a severe seizure. He started having parkinsons like movement a week after he started the lowest dose of Symbyax (6mg/25mg). The warnings about Symbyax include akathisia which classified as just restlesness. He stated that he  wasn't quite prepared for chorea like uncontrolled movements, extreme stuttering, no cognitive thought process and nearly the complete inability to control all motor functions. It started 5 days  after taking just one doze of fluoxetine (prozac 20mg) with the sudden onset of jerking movements then followed by intense fear resulting in contemplating suicide and losing touch with all reality. He was experiencing also hallucinations and dementia/ This was most likely caused by the Prozac itself and the rest of the time was the effects of the antipsychotic Zyprexa or olanzapine. The next days were better and he thought it would stop but when the seizure-like movements started this morning he was taken to the ER. 

The antipsychotic Clozapine can cause fatal blood problems as well as other side effects of serious concern. Clozaril, which is effective second-generation antipsychotic medication, can cause agranulocytosis, a potentially fatal blood disorder in which the drug triggers a sudden severe deficiency in the number of white blood cells. Clozaril (clozapine) is a drug which was known to be associated with fatal cases of aplastic anemia which causes low white blood cell counts and predisposes patients to infections. Clozapine has also been linked to high blood sugar and diabetes. Doctors are supposed to watch for unexplained fever, fatigue and low energy levels in patients taking Clozaril. Clozaril has been strongly associated with possible fatal heart problems. [Presto v. Sandoz, 226 Ga. App. 547 (1997)].   For this reason, administration of Clozaril requires frequent blood testing and monitoring, and the drug is typically used as a treatment of last resort.

http://www.clozaril.com/info/about/side_effects.jsp.

"It is easy to think the State has a lot of different objects -- military, political, economic, and what not. But in a way things are much simpler than that. The State exists simply to promote and to protect the ordinary happiness of human beings in this life. A husband and wife chatting over a fire, a couple of friends having a game of darts in a pub, a man reading a book in his own room or digging in his own garden -- that is what the State is there for. And unless they are helping to increase and prolong and protect such moments, all the laws, parliaments, armies, courts, police, economics, etc., are simply a waste of time."

-- C. S. Lewis