Wednesday, February 16, 2011

Antipsychotics Are For Psychosis, Not Insomnia

For quite some time, psychiatrists have known that in many cases of severe chronic schizophrenia, over the long term there was dramatic evidence of marked shrinking of brain tissue and enlarged cerebral ventricles (fluid-filled hollow parts at the center of the brain) - cerebral atrophy.  I had been taught that this phenomenon was first discovered in patients who had never been treated with antipsychotic medication. 

When I mentioned that in an argument on an anti-psychiatry blog, however, I was immediately challenged on whether the subjects studied had really not been treated. 

When I did a literature search, I was surprised to find out that what I had been taught was wrong, and that the other folks were right.  As far as I could find on the search, the subjects whose brains were scanned had almost all taken antipsychotic medication at some point during their lives.   (Hey guys, I can admit when I was wrong!  Can you?)

The black areas on the scan are empty of brain cells

Of course, that still begs the question, what caused the atrophy?  Was it the disease, the drugs used to treat it, or a combination of both?  Of course, even if it was entirely due to the drugs, one would still have to weigh the risks of cerebral atrophy versus the risk of being chronically tortured by accusatory hallucinations and living out on the street, as was well-portrayed in the movie The Soloist. 

Go check out Skid Row in L.A. in person if you don't believe it.  That part of town is actually marked with a sign that says, "Skid Row."  See the folks on street corners loudly preaching incoherent gibberish about the Gospels for hours to an audience one at all.

Unfortunately, due to pharmaceutical marketing techniques and to psychiatrists who cannot tell sedation from other therapeutic effects, atypical antipsychotics are being used for a lot of other things besides psychosis.  Seroquel is being used commonly as a sleeping medication!  Because of TV commercials, most people think Abilify is an antidepressant. 

Now, we've known for decades that in some patients with real and severe melancholic clinical depression antipsychotics can indeed augment an antidepressant in treatment-resistant cases.  But so does lithium, which is both way more effective and a hell of a lot safer than antipsychotics. 

Now, in this month's Archives of General Psychiatry comes a study that adds more information to address the initial question about cerebral atrophy ("Long-term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia," Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Ronald Pierson, MS; Vincent Magnotta, PhD, Arch Gen Psychiatry 2011;68(2):a128-137). The authors followed first-break patients with schizophrenia for many years who were all treated with antipsychotics and took serial MRI tests to continuously measure brain volume. 

On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years). Unfortunately, there was no control group of patients with schizophrenia who were not treated with antipsychotics, because it is considered unethical to withhold treatment.

They instead controlled mathematically for severity of the underlying disorder under the theory that more severe cases were likely to have been given more antipsychotic medication, thereby clouding the picture of whether it was the disease or the treatment causing the atrophy.

The results: more antipsychotic treatment was associated with smaller gray matter (one type of brain tissue) volumes when disease severity was adjusted for.  Progressive decrement in white matter (the othert type of brain tissue) volume was also most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.

The conclusion: it appears that both the disease itself and the medication appeared to both contribute to cerebral atrophy.  Of course, without the control group, this can not be a definitive conclusion.  Also, we do not know if the drugs would do anything like this on patients who do not have schizophrenia but some other psychiatric disorder, or no disorder at all.

Nonetheless, these results should certainly give pause to any doctor treating a non-psychotic patient with anti-psychotic medication - especially since much safer alternative drugs are available.  This potential risk is on top of the serious risks that these medications may cause diabetes, high cholesterol, and a chronic untreatable neurological condition called tardive dyskinesia.  As all these risks are cumulative, long term treatment of non-psychotic individuals with anti-psychotics before all other measures are tried is particularly reprehensible.


  1. Dr. Allen,
    Doesn't the fact that you were taught,"this phenomenon was first discovered in patients who had never been treated with antipsychotic medication" cause you to consider what other falsehoods were part of your education?

    I wonder how it can be ethical to claim that neuroleptics are "treatment" which must be mandated by law and forced on individuals whether they benefit the patient or not? Involuntary and "Assertive" treatment in a facility or in the community for any who are ensnared regardless of outcome is IMHO worse than withholding drugs---at least the individual is not risking diabetes, sudden cardiac death, TD, among other things---While it may be, "unethical to withhold treatment" It is also unethical to insist that neuroleptic drugs are required to treat every person who experiences psychosis, considering the LACK of efficacy for so many and the potential for disability and death.

    I mean really, how helpful, therapeutic or supportive can it be for the individuals who experience coercion, and are diagnosed with anosognosia when they disagree with whether or not they personally are helped or hurt by the drugs; even how much they are helped or hurt is determined for them?

    WHY the hell have not more psychiatrists taken a MORAL stand against the fraud, corruption, and malfeasance which permeates psychiatry?? There is apparently a lack of integrity which is not limited to the actual perpetrators. For instance, how the hell is there no accountability for those "doctors" who mislead and lie to patients, their colleagues and the WORLD about the research, the drugs, etc...--or worse, No accountability for doctors who prescribe combinations of drugs known to be fatal? And WTF?! supposedly Rebecca Riley's parent's took advantage of the psychiatrist's
    lack of ability NOT practice "polypharmacy?!"

    Polypharmacy is a "standard practice" which is NOT evidence-based, for adults, let alone a child of 4!

    Jon McClellan, University of Washington psychiatry professor and Medical Director of Child Study and Treatment Center, Washington State's only state run psychiatric facility for children, used my son in DRUG trials funded by NIMH on the same projects as Biederman, i.e. TEOSS--which have somehow been parlayed into the wholesale "treating" of all undesirable behavior and parental distress by drugging children whose brains are STILL DEVELOPING and this is with the American Psychiatric Association approval. AACAP's Practice Parameters for "treating" schizophrenia with neuroleptics anticipate that 50% of children will develop Tardive Dykinisia as a result!

    I am no doctor, but that does not sound like medicine!

    I have seen in comment threads you and other psychiatrists state that you have patients who come to you who were not told of the so called "side-effects" of the drugs they have been prescribed, have any of you made reports to medical boards about this aggregious lack of Ethics?

    Please do not think this is a personal attack, the questions I ask and observations I make are those of a betrayed and angry mother who has had years to watch the frightful effects of "standard practice" on my beloved son.

    1. Just wanted to say excellent input, you make a lot of sense.. Sad that people who know the most about the dangers and letdowns and myth of Psychiatry and medical field are the one's unfortunate enough to experience it in one way or another... And objective minds are necessary because its like nobody will hear when you're caught up in it. Most ignorant science I know of...yet I've become selectively ignorant about it, plus a bit stubborn, its about what I'm up against being personally effected.

  2. What about fish oil as augmentation to antidepressants

    According to a psychiatrist, Dr. Raina,

    Most studies of omega-3's have tried to answer the question, "Do omega-3 fatty acids help antidepressants work better?" That is, they try to understand the potential of omega-3's as add-ons to antidepressants. However, there has been at least one study in which EPA alone (1000 mg/day) was compared with Prozac (20 mg/day) in the treatment of Major Depression and found to work just as well, with the combination of the Prozac and EPA working better than either one alone."

    She did say that the weakness of the study is the small sample size.

    Here is another site that mentions some fish oil studies. It sounds like the study in Iran that he mentions is what Dr. Raina may be referring to. As an FYI, I was going to post exerts but I ran into a word limit:)

    As an FYI, I feel that Dr. Sahelian's site is way too commercialized in my opinion. But in studying the information he has on various supplemenst, he does seem pretty objective. He keeps stressing that the long term side effects of various ones are not known and that we need to be cautious. I like that.

    Anyway, not to get off the subject but in light of the fact that fish oil may be a viable option as an add on treatment for antidepressants, I am curious as to why psychiatrists don't give this a shot as first line treatment, since the side effects are so few and there seems to be moderate success?

    Maybe this could be a future blog entry as I understand if you won't want to address it under this particular entry.

    ""Ok, back on topic. You said, The conclusion: it appears that both the disease itself and the medication appeared to both contribute to cerebral atrophy. Of course, without the control group, this can not be a definitive conclusion."

    I am struck by this comment for various reasons. You or the researchers (not sure whose words these are) admit there are no definite conclusions but yet it is being editorialized that both the disease and the medication contribute to brain atrophy.

    I found this interesting because the impression is given that folks like you and researchers are totally objective but yet this type of editorializing constantly finds its way into studies.

    To be fair, we all do it, including me but I am not writing a major study.

    Speaking of biases, these researchers could have put out a call for people diagnosed with schizophrenia who are not taking meds and measured their brain volume. But because your colleagues don't think that people with this diagnosis can succeed without meds, there was no chance of getting a control group.

    Of course, I realize that even if these types of folks had been recruited for the study that they still might not have qualified for various reasons. But to not even try definitely shows the biases of psychiatry as far as people being able to make it without meds.

    You then said,

    "Also, we do not know if the drugs would do anything like this on patients who do not have schizophrenia but some other psychiatric disorder, or no disorder at all."

    I don't understand this statement at all. A person's condition has nothing to with whether they develop side effects or not.

    A perfect example is antidepressants as people who were put on them for non psychiatric reasons for psych condition report the same side effects.

    It just seems like this is another justification for denying the seriousness of the side effects that these meds are causing.


  3. First of all, congratulations on being able to admit you were wrong, Dr Allen.

    As for the use of antipsychotics as sleeping and anxiolitic agents. Of course, it's not right, but what is the alternative if you have someone with longstanding sleep problem or anxiety? give them benzoes and/or Zs, creating dependency with all 'bells and whistles'? Is this ethical?

    As for the effect of schizophrenia and drugs on the brain - treat people with psychosis - you 'kill their brains. don't treat them - psychosis kills their lives.

    I think it's all about weighing up poitential benefits and potential risks, the way you do it and if the patient trusts you're doing the right thing.

  4. ps. inspired by your post I've written about non-drug treatment for chronic insomnia

  5. Good comments, all.

    Jackson and associates looked at sleep and bipolar disorder in the Journal of Affective Disorders in 2003.

    He found that 74% of patients identified sleep as the key predictor of the impending manic relapse, long before auditory hallucinations, hypersexual behavior, hyper religious behavior, etc.

    Dr. Paul Keck from the University of Cincinnati said that, "although lack of sleep is not the most important symptom of bipolar disorder; it is the biggest predictorr of improvement or impairment.".

    While agents such as benzodiazepines, trazodone, melatonin, and other medications may be quite effective for insomnia, consideration should be given to mood stabilizers with sedating properties in those patients with bipolar illness, including antipsychotics.

    Seroquel, as you mentioned, is such an agent. The metabolite of Seroquel is very effective at improving bipolar depression. And its efficacy in improving manic symptoms was evaluated in two very large double-blind placebo-controlled randomized clinical trials.

    Of course, Seroquel, as with many other "antipsychotic" agents, has several side effects. Increasing levels of triglycerides and low density cholesterol in addition to the weight gain, increasing capacity for metabolic syndrome, effects on thyroid function, neutropenia, tardive dyskinesia, and other factors all have to be weighed against the benefits.

    In contrast, for periodic insomnia, GABA agonists such as Lunesta, Ambien, Restoril etc. are options, as are serotonin antagonists such as trazodone, or even melatonin type drugs, as well as antihistamine drugs, are all well-established and without the risk of tardive dyskinesia, although they have their own risks, including tolerance and dependence with the controlled substances mentioned above. In those patients who would benefit from restorative sleep, agents such as Lyrica or Neurontin may be preferred, as they specifically target stage IV sleep.


  6. "The conclusion: it appears that both the disease itself and the medication appeared to both contribute to cerebral atrophy. Of course, without the control group, this can not be a definitive conclusion."

    I assert that this statement represents the essence of the reason why psychiatrists, drug companies, and some consumers continue to live within the false belief system that advocates that schizophrenia is a "brain disease" and that neuroleptic drugs are the only current effective means for the treatment of the "disease". Without a control group and a basis for comparison this conclusion cannot be derived. It is poor science, arguably not scientific at all. One cannot conclude from this study that the "disease" had any impact on the cerenral atrophy. One can only conclude that individuals in this study who had been administered neuroleptic drugs showed signs of brain atrophy. The conclusion ascribed to the "disease" is scientifically false.

    Courtenay Harding performed a long term follow up on individuals who had been diagnosed with schizophrenia in Vermont. Her conclusions, 20 years after diagnosis was that in excess of 50% recovered and those who fully recovered had abandoned their pharmaceutical interventions.

    These results should not only give pause to any doctor treating non psychotic patients with antipsychotic drugs but should also give pause to doctors treating pyschotic patients with antipsychotic drugs and should give pause to doctors to question the scientific validity of everything else they have been taught. How much of what they have been taught resides within the domain of generally accepted yet irrational and delusional beliefs? Absent scientific proof we should begin with the notion that none of it is whole, complete, or necessarily true.

  7. Last Anonymous,

    I have no stake in prescribing antipsychotics. In fact, I avoid prescribing them as much as possible. I wish we had better alternatives.

    I have not read the study you mention. Assuming Harding did proper diagnoses and close follow ups with serial mentals status exams and serial function evaluations, what about the 50% that did not recover? Should we just let them suffer?

    Barring a court order, doctors can only "force" neuroleptics on patients for a maximum of about 17 days in most states, and then only if the patients are a danger to self or others.

    By your reasoning, there is also no "proof" that the medicines, and not the disorder, caused the cerebral atrophy seen in schizophrenia either.

    There is also no "proof" for ANY other cause of schizophrenia, including psychological trauma. Truth is, we don't know what causes it.

    There are an awful lot of subtle neurological signs that are more frequent in schizophrenia than in normals. None of them are necessary or sufficent, and many are non-specific, but there are way more of these factors seen than in other psychiatric/psychological disorders.

    Yobluemama, I posted about the horrible trend of using polypharmacy that makes no sense earlier, so I'm definitely with you on that: (

    As to reporting other doctors who patients say have not given info re side effects, etc, I cannot do that unless I witness it myself, because otherwise it is considered heresay by the powers that be. The patient would have to do it him/herself. And patients frequently forget things they have been told.

    To the earlier pro-drug anonymous, antipsychotics should be the very last resort in patients with bipolar disorder because of their high risks. Paul Keck used to be a reliable source, but from what I've heard, he may now be under the influence of the drug companies. As far as ambien, lunesta, etc - the old benzo's are also GABA agonists, have no more abuse potential, and are a hell of a lot cheaper.

  8. I am, in fact, encouraged that you appear to at least be open to questioning the traditional assumptions and false logic prevailing within your discipline.

    I agree we do not know what causes schizophrenia. If we are willing to acknowledge that much we should also be willing to acknowledge that it may not be a biological disease. For example, it may be a psychosocial response brought on by environmental stimulus. Or, it may be neither and something else that we have not even contemplated yet.

    Of the other 50% you will know that near 30% of them threw in the towel and commit suicide and the balance, well they were on neuroleptic drugs and didn't fair out as well.

    You are rather presumptuous in deducing that by my reasoning there is also no proof that the medicines and not the schizophrenia caused the atrophy. Wrong! You cannot extrapolate that conclusion with my reasoning. You need the group that has been diagnosed and that has not taken neuroleptics to arrive at that conclusion. The point was you cannot make any conclusions with respect to the influence of the "disease" on the brain atrophy because, as you acknowledged, there is NO control group.

    The only scientific conclusion you can draw from that study is individuals who were prescribed neuroleptic drugs to treat their schizophrenia diagnosis exhibited signs of brain atrophy during subsequent scans. Because there was no control group it cannot be concluded with any certainty whether the brain atrophy was caused by the neuroleptic drugs, the schizophrenia, or a combination of the two. As a consequence further follow up is advised in order to determine whether neuroleptic drug interventions are causing adverse brain damage.

    Based on your own assertion it is difficult to determine with any certainty whether the "signs" you are pointing to are signs of disease or secondary pathologies/ side effects of medication. Mental illnesses, as I am sure you know, are diagnosed and treated based on symptoms and not signs. It would be much easier if there was a brain sphygmomanometer. There isn't. As a consequence there are no signs and in medical science this would indicate there can't be a conclusive diagnosis. The doctor rrequires both symptoms and signs/ tests in order to diagnose with certainty. Psychiatry is thus far merely symptomatic treatment of a condition manifested by its behavioural symptoms. Pseudoscience at best.

  9. "There is also no "proof" for ANY other cause of schizophrenia, including psychological trauma. Truth is, we don't know what causes it."
    Good! That means there is no proof that schizophrenia is incurable or a brain disease and no proof that treating certain types of Schizophrenics with psychotherapy will not cure.
    I live!
    Thank you for the bullet! I got a testimonial! I will use it well.
    I don't think Anon. said the other 50 percent went off their meds. Psycho-kill them all to save them all?
    I don't know this study, I'm just following the thought.

    Yes, it is the problem, people don't let other people suffer, in the ordinary world and the special world. Suffering is growth, is life, not suffering is lifelessness. I was there, I know. Or should I say I was there on (too much med) when I wasn't there.

    It's better to let people suffer to some degree, or to a great degree. It's where they live, take away a person's suffering you remove tier life.Leave enough least to live on, even more to force change.

    If the observer suffers from watching other people suffer and wants to end their own suffering perhaps the observer would be better off taking meds.

    Better to burn in Hell than reign in Oblivion.
    That LA guy gets around not just in the slums either. Like Ahasuerus, he never dies.

    There is always something else to try, the only limitation is one's imagination.


    Einstein was missing his parietal operculum, so you've found out why Schizophrenics are such a bright bunch.

  10. Interesting comments, and thanks to both of you!

    Of course all of medicine, not just psychiatry, has no cure for (and does not know the cause of) many chronic illneses. Think diabetes and high blood pressure to name but two examples.

    But is there something wrong about wanting to get rid of troublesome symptoms? To suffer with equanimity, as it were? To each his own, I guess.

    By the way, there are no placebo-controlled studies proving that parachutes decrease deaths and injury in falls from airplanes, but I bet you believe they do. But maybe not.

  11. Oh come on!

    The parachute example, while amusing, can't been deemed at all relevant in this debate.

    I do agree with you however that in many cases medical practitioners simply treat symptoms, don't understand, or are incapable of isolating, the underlying causes and as a consequence cannot effect a cure. The fact that one branch of medicine does this should not add weight to another taking a similar approach. The difference between diabetes and high blood pressure and schizophrenia are at least the medical practitioner can measure with an instrument albeit they do in fact then only provide symptomatic treatment of illness.

    I think our comprehension of the human being is far too simplistic presently to isolate causes and cure them. If people's illnesses were cured the health care system would not be as burdened as it is. In many respects modern medicine is only a small step advanced beyond barbershop surgery. Living organisms are complex and humans are among the most complex of living organisms. We know that one's stress responses can affect other body systems and result in biological disease. No doctor would presently dispute this. I suggest we view most problems too locally, too symptomatically, and then at best treat symptoms.

    There is definitely something wrong with symptomatic treatment when the side effects of the treatment and the secondary disease pathologies outweigh any benefit provided by the treatment. This should, at the very least, compel us to look hard at and explore the alternatives. In accordance with your blog statement one of the major impediments is there are lots of special interest groups who want things to stay exactly the way they are.

    Psychiatric drugs are big business. I believe I observed several years ago that revenues derived by drug companies associated with psychiatric drugs were higher than the GDP of no less than 65 countries in the world. Legislators and administrators are reluctant to provide more comprehensive treatments recognizing that in the short term psych drugs are the most cost effective treatment. Long term they are more expensive than the alternatives.

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  13. I am told that psychiatric medications help so many people, but I really question this over the past year.

    My doctors through the years were trying to help me with bipolar disorder, and many of those drugs caused akathisia, a feeling so intense I literally wanted to claw my face off or cut my chest open. Many meds caused aggression and I would kick holes in the walls and argue with my husband often. The docs told me these were my bipolar symptoms, or I had borderline (even though the problems showed up in my 30's only after medications) Last year I got off all the pills I suffered through for 15 years, and am doing a lot better. I'm still a depressed ruin of humanity, but at least I don't need to cut my chest open anymore, and I even patched the holes in my walls this spring. Getting rid of that scrabbling, insect-like feeling in me has been a relief.

    I have nothing good to say about antipsychotics, or any other psychiatric medication for that matter. I "needed" these meds to get better so I could return to work, or at least do my housework. Instead, I got sicker and sicker. I am very troubled by how often abilify and seroquel are being handed out. It seems these drugs are the first things tried in bipolar disorder nowadays. I asked my psychiatrist to document in my records that she thinks it was akathisia that I had all those years, and she will witness my revised psychiatric advance directive. I greatly fear having these drugs forced on me involuntarily in the future.

    I am so sorry kids are being forced onto antipsychotics now, or told it will help them. . . my suffering was increased very much by this class of medications (and a variety of others).

  14. I was on Risperdal for a year and now on Abilify for two , not to mention having been on Zoloft , Akineton , Cipralex and others . I was forced by the police to a hospital because my parents ordered so for more than a month . My family used to hit me , physical violence , deprive me of food make my life difficult , and my reactions were , having some money , going in internet cafe at night and trying to avoid being physically violated by all three members of my family . I do not care about my diagnosis as it does not depict what really was going on in my house , how they behaved and treated me and how they decided to stigmatize and destroy my health and in many ways kill my brain and my body , my intellectual capacity and my physical health . I try to look forward and see what I can do to imporve what has been done to me , these medications caused me great fat gains and probably hypothyroidism . I exercise with weights and try to live healthily but what my family has done to me , they try to make me forget it , to not think about it , about they having destroyed my entire entity . Currently I am on 5 mg Abilify and 50 mg Zoloft and 62 mcg T4 do you have any suggestions on what I can do to improve my situation from now on , apart from exercise is there any supplement or something i can do to improve the damage that has been caused by those poisonous medications , also any suggestions on how to quit them on my own if i decide to do so , Thank you a lot for reading i hope i get some answers . Ioannis AnD

  15. Ioannis AnD,

    Sorry I can't dispense specific medical advice on this blog, but can only talk in generalities.

    If your family is still actively trying to "make you forget" about what happened with them, I'd recommend finding a therapist who can teach you how to handle them without cutting them off completely. Such therapists are unfortunately somewhat hard to find.

    I cannot say whether or not the medications you are on are appropriate for you, but I can tell you that at least you are on relatively low doses of them.

    I can't say how you would respond, but most people can just stop Abilify without much withdrawal. Most people can - without much withdrawal symptoms - taper off 50 mg Zoloft by talking half a pill a day for two or three weeks, then half a pill every other day for two or three weeks, and then stopping.

    One's original symptoms may of course return if one stops taking appropriate meds.

    Neither Zoloft or Abilify causes low thyroid.

  16. I have seen a relevant study on "brain volumes or Marque Monkeys on Nueroleptics" that proves antipsychotics shrink the brain. Also I thought the study in question included treatment Naive patients showing brains had not atrophied? ANDREASON? or is that this one? yet thought they took the stance that it was a therapeutic effect (shrinking the right parts of the brains). I don't know how anyone claiming to be a scientist can assert the idea that the drugs have specific effect on the brain with a condition that is still a mystery, using a particular theory from observing psychotic rats changes in behavior with toxins that have an action that is obviously still unknown. Maybe they won't like to disclose its actual effects to save financial support from drug companies like so many of studies appearing in science journals have.

    Someone mentioned about detaining someone to force medication if they are deemed "at risk to themselves or others" I think it also includes "cannot provide informed consent"... The problem is , this is reliant on subjective observations heresay and opinion they can just tick that box drug them until they don't squirm anymore, no more complaints, just drooling zombie. I doubt a psychiatrist will really spend a moment to determine the facts about the individual...
    I was classified as Involuntary whilst on the road to recovery, hadn't slept for several days and was suffering symptoms of sleep deprivation.. Yet had returned to focus on CHi-Gung and found my spiritual center and ability, motivation to be able to sleep despite discomfort. I had other factors that contributed to diagnosis but Sleep disorder was neglected as a symptom.. I was at no risk to myself yet am still considered to be 8months later. almost entirely since I doubted the use of medication and their philosophy apposed to my own is any sign of resistance and indicates a danger of deterioration or risk of non-compliance, its a mind-F#$k, I can look after myself perfectly well, and kept myself cleaner healthier more inspired when I was off the stuff, in very many ways my mental health has deteriorated because the thought they would force me to be 'helped' in a way I'm spiritually apposed to... I had recovered whilst in hospital after sleeping and a good feed.. Had paradoxical reactions to the drugs making me agitated and thought disorder which they didn't even consider why despite pleading with them that the drugs made it difficult to rationalize and state my case without thought blocking vanishing thoughts derailment incoherence and subsequent irritability for my situation and the stupidity of the doctors wound me up as being put on lithium also..They were also quick to throw around words like 'persecutory delusion of home environment' since I had only just moved house and had unpleasant encounter with the neighbour, based on a fault of my own, I merely expressed uncertainty about my position in new house. No talking or offering suggestion like therapy to help it was used against me to conclude that at two weeks I was still paranoid, or I spoke of issues with family. Just too quick to label everything that was perfectly rational... i guess I have a case for my freedom, yet It' already wasted my time and distorted my life and my word against theirs.. Its been 8months my court order ends soon, but they're just as likely to renew it for some subjective notion that i am a danger "to seek alternatives". \

    The dogma is ridiculous in psychiatric industry, and worse is that the drugs make one easily dominated, hypnotically suggested, vulnerable, listless. My case was that it was doing me no good as It was preventing recovery, which goes over the head of the average Psychiatrist.....