Side Effects: Schizophrenia Treatments Still Far From Ideal

(October 3, 2005) -- The mentally ill have been tortured throughout history. Many past cultures interpreted the delusions of schizophrenics as signs of demonic possession. In some cases holes were drilled in their skulls so that evil spirits could escape.

The Romans used electric eels to shock such people. They also used starvation and flogging to subdue unruly patients.

During the Middle Ages, people were jailed, chained or put in stocks. Women might be burned at the stake as witches.

In the 20th century, physicians administered electroshock therapy or injected high doses of insulin to induce seizures. In 1946, the lobotomy was developed. In this procedure, the frontal lobe of the brain was surgically destroyed with a tool like an ice pick. Lobotomies were widely used because they calmed agitated people and made them docile.

In the 1950s, drugs for schizophrenia were hailed as a humane advance in the treatment of mental illness. Chlorpromazine (Thorazine), haloperidol (Haldol) and thioridazine (Mellaril) became the standard treatments for schizophrenia.

The drugs reduced agitation and helped control hallucinations. Some mental-health experts believed that these medications would empty the back wards of mental institutions. In the 1970s, patients were discharged from psychiatric hospitals to the community under the false assumption that on these drugs they could lead almost-normal lives.

Experts didn’t foresee how unpleasant the side effects of these medicines would be. Many patients found the drugs so sedating that they felt like zombies. They escaped “ice pick” surgery only to experience a “chemical lobotomy.”

Others discovered that after months or years of treatment, they developed uncontrollable muscle twitches or tics that were often irreversible, even after stopping the drugs. Other side effects included dizziness, urinary retention, dry mouth, constipation, blurred vision, nasal stuffiness, heart palpitations, fainting, sexual problems and seizures.

Such drugs as chlorpromazine can also cause akathisia, a profound restlessness that makes it hard for people to sit still. They feel as if they are about to jump out of their skin.

In the 1990s, a new class of antipsychotics was introduced with great expectations. Such medications as Clozaril and Zyprexa seemed less likely to cause troublesome side effects. These “atypical antipsychotics” were followed by other new-generation schizophrenia medications, such as Risperdal, Seroquel and Geodon.

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Although very expensive, often costing hundreds of dollars a month, these drugs rapidly replaced such older generic drugs as chlorpromazine or perphenazine. However, a new study demonstrates that the more recent drugs are not much of an advance.

When compared with old-fashioned perphenazine, several new drugs were no more effective or better-tolerated. Zyprexa was somewhat better, but it can cause serious weight gain that may predispose patients to diabetes and heart disease. Over the course of 18 months, nearly three-fourths of patients stopped taking their medicines because of lack of effectiveness or intolerable side effects.

Although we no longer burn mental patients at the stake or perform lobotomies, this new research demonstrates that our treatments for schizophrenia are still far from ideal.

Last updated: 10/05

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