Revisiting Schizophrenia: Are Drugs Always Needed?

(March 21, 2006) -- The only responsible way to manage schizophrenia, most psychiatrists have long insisted, is to treat its symptoms when they first surface with antipsychotic drugs, which help dissolve hallucinations and quiet imaginary voices.

Ann Johansson for The New York Times QUESTIONER John R. Bola at the University of Southern California.

Delaying treatment, some researchers say, may damage the brain.

But a report appearing next month in one of the field's premier journals suggests that when some people first develop psychosis they can function without medication — or with far less than is typically prescribed — as well as they can with the drugs. And the long-term advantage of treating first psychotic episodes with antipsychotics, the report found, was not clear.

The analysis, based on a review of six studies carried out from 1959 to 2003, exposes deep divisions in the field that are rarely discussed in public.

In the last two decades, psychiatrists have been treating people with antipsychotic drugs earlier and more aggressively than ever before, even testing the medications to prevent psychosis in high-risk adolescents.

The studies demonstrate that the drugs are the most effective way to stabilize people suffering a psychosis. Millions of people rely on them, and the new report is not likely to alter the way psychiatrists practice anytime soon.

But some doctors suspect that the wholesale push to early drug treatment has gone overboard and may be harming patients who could manage with significantly less medication, perhaps because they have mild forms of the disorder.

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About three million Americans suffer from schizophrenia, and a vast majority of them take antipsychotic drugs continually or periodically.

"My personal view is that the pendulum has swung too far, and there's this knee-jerk reaction out there that says that any period off medication, even for research, is on the face of it unethical," said Dr. William Carpenter, director of the University of Maryland's Psychiatric Research Center and the editor of the journal Schizophrenia Bulletin, which will publish the article on April 1, along with several invited commentaries.

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Source: NY Times

Last updated: 3/06

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