Free Anatomy of an Epidemic by Robert Whitaker Page B

psychiatrists to see their therapies through a very particular prism, and even at the 1956 conference, New York State Psychiatric Institute researcher Joseph Zubin warned that when it came to evaluating a therapy for a psychiatric disorder, a six-week study induced a kind of scientific myopia. “It would be foolhardy to claim a definite advantage for a specified therapy without a two- to five-year follow-up,” he said. “A two-year follow-up would seem to be the very minimum for the long-term effects.” 13
The Case for Neuroleptics
    The Psychopharmacology Service Center launched its nine-hospital trial of neuroleptics in 1961, and this is the study that marks the beginning of the scientific record that serves today as the “evidence base” for these drugs. In the six-week trial, 270 patients were given Thorazine or another neuroleptic (which were also known as “phenothiazines,”) while the remaining 74 were put on a placebo. The neuroleptics did help reduce some target symptoms—unrealistic thinking, anxiety, suspiciousness, auditory hallucinations, etc.—better than the placebo, and thus, according to the rating’s scales cumulative score, they were effective. Furthermore, the psychiatrists in the study judged 75 percent of the drug-treated patients to be “much improved” or “very much improved,” versus 23 percent of the placebo patients.
    After that, hundreds of smaller trials produced similar results, and thus the evidence that these drugs reduce symptoms over the short term better than placebo is fairly robust. * In 1977, Ross Baldessarini at Harvard Medical School reviewed 149 such trials and found that the antipsychotic drug proved superior to a placebo in 83 percent of them. 14 The “Brief Psychiatric Rating Scale” (BPRS) was regularly employed in such trials, and the American Psychiatric Association eventually decided that a 20 percent reduction in total BPRS score represented a clinically significant response to a drug. 15 Based on this measurement, an estimated 70 percent of all schizophrenia patients suffering from an acute episode of psychosis “respond,” over a six-week period, to an antipsychotic medication.
    Once the NIMH investigators determined that the antipsychotics were efficacious over the short term, they naturally wanted to know how long schizophrenia patients should stay on the medication. To investigate this question, they ran studies that, for the most part, had this design: Patients who were good responders to the medication were either maintained on the drug or abruptly withdrawn from it. In 1995, Patricia Gilbert at the University of California at San Diego reviewed sixty-six relapse studies, involving 4,365 patients, and she found that 53 percent of the drug-withdrawn patients relapsed within ten months versus 16 percent of those maintained on the medications. “The efficacy of these medications in reducing the risk of psychotic relapse has been well documented,” she concluded. 16 *
    This is the scientific evidence that supports the use of antipsychotic medications for schizophrenia, both in the hospital and long-term. As John Geddes, a prominent British researcher, wrote in a 2002 article in the
New England Journal of Medicine
, “Antipsychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.” 17 Still, as many investigators have noted, there is a hole in this evidence base, and it’s the very hole that Zubin predicted would arise. “Little can be said about the efficacy and effectiveness of conventional antipsychotics on nonclinical outcomes,” confessed Lisa Dixon and other psychiatrists at the University of Maryland School of Medicine in 1995. “Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.” 18
    This doubt prompted an extraordinary 2002 editorial in
European Psychiatry
, penned by Emmanuel Stip, a professor of psychiatry at the