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Do antipsychotics cause more harm than good?

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This resource is a wikidebate, a collaborative effort to gather and organize all arguments on a given issue. It is a tool of argument analysis or pro-and-con analysis. This is not a place to defend your preferred points of view, but original arguments are allowed and welcome. See the Wikidebate guidelines for more.

Some authors state that antipsychotics (also known as neuroleptics and major tranquilizers) cause more harm than good. Are they right?

Disclaimer: The found further reading sources seem to be dominated by those arguing for the motion. Finding more sources arguing against the motion seems advisable. This debate was not reviewed by a medical professional.

Antipsychotics cause more harm than good

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Pro

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  • Pro It is so per evidence supplied by Robert Whitaker in his book Anatomy of an Epidemic in 2010. (See also Wikipedia: Anatomy of an Epidemic.)
    • Objection Dr. Torrey has shown why Robert Whitaker is wrong.[1]
      • Objection Whitaker has shown that response to be wrong.[2]
    • Objection That is not a specific argument that can be productively debated.
      • Objection Actually, it can, even if it is laborious. For instance, an objector can select an incorrect argument made by Whitaker and raise an objection to the argument as an objection against the aggregate point for Whitaker.
    • Objection The book is not peer-reviewed and thus is fundamentally unreliable.
    • Objection Multiple sources criticized the book as per Wikipedia: Anatomy of an Epidemic.
      • Objection Whitaker responded to the criticism.[3]
  • Pro It is so per evidence supplied by Robert Whitaker in "The Case Against Antipsychotics", 2016.[4]
    • Objection Whitaker 2016 is not peer-reviewed thus is fundamentally unreliable.
  • Pro It is so per evidence supplied by Peter C. Gøtzsche.[5]
    • Objection Peter C. Gøtzsche gives the impression of being a scaremonger, including the choice of the book titles Deadly Psychiatry and Organised Denial and Deadly Medicines and Organised Crime.
      • Objection What matters is whether he is right. His book Deadly medicines and organised crime was a winner of British Medical Association’s Annual Book Award. Ultimately, one needs to look at the evidence provided.
    • Objection That is not a specific argument that can be productively debated.
  • Pro Harrow 2014 shows that patients with schizophrenia who are off medication are better off long-term than patients on medication.[6] See also Studies by Martin Harrow on treatment of schizophrenia.
    • Objection Harrow 2014 is not a blinded study. The patients who got off medication could have been those with milder disease.
      •  Comment While correct in principle, the confounding via milder disease has not been positively demonstrated. That does not refute the above, but shows the above is not entirely conclusive.
  • Pro Long-term use of antipsychotics in macaque monkeys leads to reduced brain volume.[7]
    • Objection It is not clear to what extent this result carries over to humans.

Con

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  • Con If it were so, they would not be prescribed by psychiatrists.
    • Objection In so far as a practicing clinical psychiatrist practices evidence-based medicine, they rely on published trials and other literature. If that literature is compromised by Big Pharma misconduct and influence, the psychiatrist gets fooled.
  • Con If it were so, FDA would not approve them.
    • Objection FDA does not require long-term studies for approval of antipsychotics.
  • Con Since there are different classes of antipsychotics, less or more modern, it is unclear that it is useful to ask the question on the aggregate level for all antipsychotics at once, as if the answer was the same for all classes of antipsychotics.
  • Con Antipsychotics are beneficial per Goff 2017.[8]
    • Objection Goff 2017 did not investigate "the risks and benefits of antipsychotics in relation to metabolic syndrome". If it is so, it cannot reliably conclude that the benefits are worth the harms since they failed to properly investigate one class of harms.
    • Objection Multiple authors of Goff 2017 declared ties to pharmaceutical industry. That increases the risk of bias, whether conscious or unconscious.
    • Objection Goff 2017 is heavily criticized by Moncrieff 2017.[9]
    • Objection Goff 2017 is heavily criticized by Whitaker 2017.[10]

References

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  1. ↑ Anatomy of a Non–Epidemic – a Review by Dr. Torrey: How Robert Whitaker Got It Wrong, archived, treatmentadvocacycenter.org
  2. ↑ E. Fuller Torrey’s Review of Anatomy of an Epidemic: What Does It Reveal About the Rationale for Forced Treatment? by Robert Whitaker, 2012, madinamerica.com
  3. ↑ Answering the Critics of Anatomy of an Epidemic - Mad In America, madinamerica.com
  4. ↑ The Case Against Antipsychotics by Robert Whitaker, 2016, madinamerica.com
  5. ↑ Neuroleptics do much more harm than good and should not be used by Peter C Gøtzsche, 2023, psychrights.org
  6. ↑ Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study by Harrow et al., 2014, nih.gov
  7. ↑ The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation: A Comparison of Haloperidol and Olanzapine in Macaque Monkeys, 2005
  8. ↑ The Long-Term Effects of Antipsychotic Medication on Clinical Course in Schizophrenia by Goff et al., 2017, psychiatryonline.org
  9. ↑ Inconvenient Truths About Antipsychotics: A Response to Goff et al by Joanna Moncrieff, 2017, madinamerica.com
  10. ↑ Psychiatry Defends Its Antipsychotics: A Case Study of Institutional Corruption by Robert Whitaker, 2017

Further reading

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