Royal College of Psychiatrists still not interested in discussing important evidence on long-term antipsychotic treatment

The annual meeting of the UK’s Royal College of Psychiatrists is in full swing at the moment in London. The conference will again not be debating important new findings about antipsychotic drug treatment. Two years ago the conference organising committee rejected a suggestion to discuss this issue.

This year I proposed a similar symposium, which would have included Lex Wunderink, who led the Dutch first episode antipsychotic reduction and discontinuation study and Robin Murray who was going to present data from imaging studies (including an ongoing study at the Institute of Psychiatry) on how antipsychotics affect the brain. I was going to speak briefly about the subjective effects of antipsychotics, and about the Radar project, a national research programme funded by the UK’s National Institute of Health Research.

The proposal was rejected again. I am extremely concerned that the Royal College conference organising committee do not appear to be aware of the importance of this issue. Here is my correspondence with committee:

 

Dear Chair of the Conference Committee,

I was disappointed that my suggested symposium concerning new evidence about the potential drawbacks of long-term antipsychotic treatment was rejected again. There is increasing public and professional concern about the use of antipsychotic drugs, and yet it seems the Royal College is not interested.

To my mind and many others, the long-term results of the Dutch First Episode study (Wunderink et al, 2013) are some of the most important research results ever published in the mental health field. They raise questions about our whole approach to treating schizophrenia and psychosis. In addition to this, the evidence that long-term antipsychotic treatment is associated with brain shrinkage is obviously a hugely significant issue (Robin Murray was going to present data on this in the proposed session).

Other institutions are aware of the importance of this research. There was a session at last year’s APA conference in Toronto on long-term antipsychotic treatment, which was so well attended people had to be turned away. I was recently approached by the Editors of PLoS Medicine to write an article on antipsychotic treatment, because they were concerned about these issues. Moreover, I am part of a group of investigators, including several leading British psychiatrists, who have just been awarded a large grant by the NIHR to study antipsychotic reduction and discontinuation in the light of the concerns about the long-term impact of these drugs.

I have now twice asked the principle investigator from the Dutch First Episode study to present at the Royal College annual meeting, and twice I have had to tell him that the Royal College do not want to hear from him. I strongly believe that British psychiatrists need to hear about this research. I speak frequently all over the country, and I know that many are not aware of it.

If my presence in the proposed session is a problem, I am most happy to withdraw in favour of another speaker. In fact I would be grateful for any suggestions the conference organisers had on improving or expanding the proposed session.

I believe the Royal College’s lack of interest in this topic reflects badly on the College in particular, and on British psychiatry in general. Hence I have copied in the President.

Yours sincerely,

Joanna Moncrieff

 

This is the reply I received (with names redacted):

Dr Moncrieff

I do not really have anything to add to [the original standard rejection email], other than to reiterate that we had many more suggestions than it is possible to accept (the acceptance rate is well below 1 in 3). We use a system of rating submissions by all committee members to inform our final choices. There were many excellent submissions this year and we have been unable to accommodate them all – not because they are flawed or uninteresting, but simply because they did not compete successfully for the limited spaces available. Your submission was in that category. There is no reason that a future submission may not be successful, but it must be competitive with other submissions for that meeting.

Many thanks for your interest in organising a session for the meeting and I am sorry you were not successful on this occasion.

With best wishes, sincerely

 

To which I replied:

Dear congress organising committee representative,

Thank you for your reply.

I remain astounded and concerned that the Royal College of Psychiatrists’ International Congress organising committee do not regard the new evidence on long-term antipsychotic treatment as important enough to include in the programme for the annual Congress.

I will indeed keep trying. I believe that British psychiatrists would welcome, and benefit from, the opportunity to consider this challenging research.

Yours sincerely,

Joanna Moncrieff.

 

I did at least receive a courteous reply, encouraging a future submission:

Dr Moncrieff

Thank you very much for your email – and your intention to submit a future proposal on this interesting topic.

Many thanks, best wishes

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12 thoughts on “Royal College of Psychiatrists still not interested in discussing important evidence on long-term antipsychotic treatment

  1. Increasingly, with massive uptake of internet, email and social media, people are becoming better informed in the area of psychiatry. Increasingly they are not settling for the mindless biomedical marketing and one-dimensional treatments pedaled by mainstream psychiatrists. More and more they’re looking for, and finding, integrative GPs and psychiatrists willing and able to get to the heart of their particular difficulties, who offer effective interventions and empowering resources regardless of which scientific discipline that knowledge comes from. Increasingly, as public funding of health services falls away, it boils down to the economics of a free market. People are paying for what they know works, and consulting physicians who are wise, mature, empathetic and open-minded. Physicians who are familiar with, and are willing to apply, knowledge from new research. People are increasingly aware that, in these early days, such an integrative practice puts that doctor at risk, for example, of vexatious notifications to registration authorities by frightened, vindictive colleagues. There are more and more of us prepared to take that risk in pursuing our noble and beloved art and science – medicine. And so we have cause for optimism, and so we hold our nerve……..

  2. Robin Murray did present on the Treatment Resistant Psychosis section, I am not sure if you are aware of this. His talk was exactly on the subject above to which you refer. In my feedback, I did request that next year more time is given to this and that he should present again

  3. http://blogs.discovermagazine.com/neuroskeptic/2017/01/14/fmri-mental-illness/#.WHt2EFzRMk4

    ‘A remarkable and troubling new paper…Sprooten et al.’s analysis included 537 studies with a total of 21,427 participants. Five mental illnesses were examined: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and obsessive compulsive disorder (OCD)…

    …The results were rather surprising. It turned out that there were very few differences between the different disorders in terms of the distribution of the group differences across the brain…In other words, there was little or no diagnostic specificity in the fMRI results…

    …Sprooten et al. suggest that “the disorders examined here arise from largely overlapping neural network dysfunction”, in other words that the transdiagnostic trait is a neurobiological part of the cause of the various different disorders. But it seems to me that there’s no reason to assume this.

    What if the common factor is more straightforward: something like anxiety or stress during the MRI scan?’

    • That is really interesting- thank you for drawing my attention to it. I agree, it could easily be a non-specific, scan-related factor such as stress, but it could also be an indicator of a non-specific brain-based vulnerability, or possibly a common consequence of prior drug treatment.

      • I see. Yes, it could be a lot of things.

        I’m trying to figure out what exactly the differences between the “patients” and the “normals” could be. One thing comes to mind: A recent study showing people living in areas with less green and blue experience more anxiety and other problems than people in areas with lots of green and blue: “Our analyses do indeed show a relationship between GSA [green space availability] and any anxiety disorder, with prevalence being lower when more green space is available…BSA [blue space availability] was related to all health variables, with the exception of any substance use. Moreover, its associations with these health variables were stronger than those of GSA.” https://www.madinamerica.com/2016/12/access-green-blue-spaces-may-improve-mental-health/

        Maybe the “patient” group has a disproportionately large number of city-dwellers? I don’t know, it’s just a wild guess. Is there any data on whether people who live in cities are more likely to encounter psychiatry than others?

  4. There are podcasts on the RCP site one is called : Personalised approaches to pharmacotherepy for schizophrenia. It’s quite something! an analogy is drawn with trying on clothes to ‘trying on’ antipsychotics…. I mean as if anyone in their right mind would want to make such an analogy. If these people try on Olanzapine for a few months there wont be any clothes that will fit at all in the ‘trying on anti psychotic clothes shop’. And if I remember correctly wasn’t it the case that a psychiatrist was asking the Govt to pay patients to take their antipsychotics a few years back? It’s so gone wrong and crazy it’s a wast of time engaging with these people. I know who the loonies are !

  5. This is a recent reply from the Dept of Health :

    “unfortunately it is not possible to predict who may experience a side effect before taking the medicine.”

    This is totally wrong, with a Cytochrome P450 test it is possible to ascertain the phenotype of an individuals P450 enzyme system, but guess what.. not available to the public in the UK!!!

    Further:

    “The adverse effect of akathisia you refer to is a recognised side-effect of many drugs used to treat psychiatric disorders, such as many antipsychotics and antidepressants. For these medicines, akathisia is listed as a possible side effect in the product information. The product information consists of the Summary of Product Characteristics (SmPC) for prescribers, and the Patient Information Leaflet (PIL). SmPCs and PILs can be found on the MHRA website at the link below:”

    Nope! since when was Akathisia on any patient information leaflet? I have loads from the drugs coerced into taking, none of them have Akathisia as a ‘side effect’ including Olanzapine and Risperidone.

    Those of you who have suffered will know with horror how serious this condition is, and to be sure anyone can get this.

    Also it seems, the next front on all this is going to be anti inflammatory drugs… sirukumab is being trialed (or ‘trying on’ ) for major depressive disorder. I will return fire with my usual obsessive compulsive treatments of dark sarcasm and urge everyone to do the same.

  6. Just watch the two on the left in this video, one makes an analogy of his patients to pigs and calls them ‘selfish’ for not taking their “medication”

    We know Socrates mostly through two of his pupils: Plato and Xenophon

    This is from The Memorabilia Recollections of Socrates by Xenophon some 2400 years ago

    “He was astonished they did not see how far these problems lay beyond mortal ken; since even those who pride themselves most on their discussion of these points differ from each other, as madmen do. For just as some madmen, he said, have no apprehension of what is truly terrible, others fear where no fear is; some are ready to say and do anything in public without the slightest symptom of shame; others think they ought not so much as to set foot among their fellow-men; some honour neither temple, nor altar, nor aught else sacred to the name of God; others bow down to stocks and stones and worship the very beasts: so is it with those thinkers whose minds are cumbered with cares concerning the Universal Nature. One sect has discovered that Being is one and indivisible. Another that it is infinite in number. If one proclaims that all things are in a continual flux, another replies that nothing can possibly be moved at any time. The theory of the universe as a process of birth and death is met by the counter theory, that nothing ever could be born or ever will die.”

  7. Joanna,

    Good work, full of passion for the right reasons.

    Fight the good fight from where you are.

    Antipsychotics along with many other GP and psyche prescribed meds have hopefully hit their peak. At least now we are even contemplating their efficiency.

    Prescription drugs including Opiates, Benzodiazepines and anti-depressants have all been increasing at an alarming rate.
    Perhaps it is in tandem with the alarming rate of anxiety and general emotional malaise experienced by many of us.

    Our Doctors and mental health practitioners our clearly trying to alleviate suffering, a noble cause indeed, yet the problem only seems to get worse, not better. Are we ready to perhaps entertain the idea that we are doing something that actually makes the problem more real? Is it time to stop the medicating and see what is going on?

    There are simpler, more kind, natural and inexpensive ways to tackle this increasingly worsening situation. For at least 60 years we have taken the pills offered by our Doctors and created by our drug companies, and if we take the cynical route (follow the money trail) we can see where the problem lies: a self-serving system that never wants to end the problem. It’s no conspiracy theory; it’s business as usual. Chemo and radiation “success” rates for cancer treatment sits at around 3%. The figures are slightly better for specific treatments like testicular cancer (around 40%), but overall these rates are real, and what is more startling is that we have accepted that it’s the only way. The rates for “success” in dealing with drug and alcohol addiction (5 years or more sobriety after treatment) are around the same. The common link is the pharmaceutical/medical input and our acceptance of shockingly low results.

    It seems that we are blinded by the string-pullers at first glance. Yet it is really down to ourselves. We cannot go on blaming “them”; there is only “us”.

    Herbs. There you are, I said it. Plants. Stop me now. No, I’m pressing on. I know you’ll consider me a tin-foiling, sage-stick waving tree hugger but I’m still pressing on.

    There is so much healing to be gained from natural plant-based remedies it’s frightening. Not to me, I’m a skeptic by nature but I have seen and experienced what goes on. Including curing cancer. Yes, really. The system will do all it can to stifle the perceived threat; there’s no money in it. Simple herbal remedies are performing seeming miracles in all areas of health and well-being. They cost next to nothing, and there’s the rub. It’s true that some individuals and companies have tried and succeeded in exploiting their potency (Firms like HorribleLife and JuiceBus) and these exploitations have, quite rightly, sharpened our cynical eye. But let’s just put their MLM, Pyramid scheme, over-priced stunts to one side so we can focus on a viable, authentic solution.

    Traditional Eastern medicines are not subject to the rigours of Western Pharmaceutical scrutiny. Just to take an aspirin we need to know the elevation of the building they are made in, the ambient mean temperature of the cleaner’s holiday home, and the exact metallic compound breakdown of the spoon they use to mix in the binders.

    A local Thai ‘Doctor’ will advise, for sleep problems, “Boil two handfuls of fresh passion flower leaves for a short while then allow it to steep for a few hours or overnight”. I know, it’s not very scientific but let’s look at the consequences.

    The Western prescription for anxiety and sleep disorder will be an expensive, often state-funded course of pills which may work for a month or so. Until dependence rears its ugly head. So you’ll get prescribed the next super-duper pill. The hook has been cast and we’ve opened our mouths. All the while we are warned about some side-effects like:

    “May cause dependency”

    “Do not drive”

    “May cause depression”

    “Overdose can be fatal”

    and possibly my favourite:

    “May cause suicide ideation”

    The Thai doctor may tell you that if it’s not working yet, use three handfuls. If you “overdose” you may poop the bed.

    I know which one I prefer. My maid disagrees.

    Unless we tackle this problem now, we’ll be having similar and worse conversations in another 50 years. There’s no point lobbying senators or MP’s or standing outside the head office of Travisno or Buyer screaming for change with a placard with the words “BIG PHARMA IS NAUGHTY” smeared with menstrual blood, rewarding as that may seem. Do we really believe the CEO will pop out and agree with us? Professionals have a tendency to protect their profession, first and foremost. And we have to acknowledge the good that they do. No-one feels like a doing a neutral self-analysis based solely on criticism.

    So perhaps an answer lies not with the professionals. The local Thai community where I live (Chiang Mai) are growing herbs and sharing their healing knowledge and have been doing so for hundreds of years, for next to nothing. Maybe when the string-pullers see the results they’ll start to weigh the passion flowers and advise 11 ounces of fresh leaves to 2 pints of water for 21 minutes at 212 degrees Fahrenheit in a copper pot. They are not being robbed of their science; the universe is a big enough place for us all.

    Clifford Edwards.
    Co-Founder of banyantree21.com

    An alternative herbal drug, alcohol and addiction rehab and treatment centre in Chiang Mai, Northern Thailand.

  8. The way to deal with this is the share price of the drug companies. Hedge funds have no moral compass, they are motivated by greed and fear. That is what you see when you look at a price/time chart going up and down. Now there is a slow way and a leveraged (fast) way on this. The slow way is that we all plug on informing the public posting comments and what not on social media, making documentaries, the academics do their papers, and the fast way is to use leverage, that leverage is hedge fund power. They have to be convinced that none of these drugs work, and that they do vast harm. This message has to get through to these people loud and clear. How to do this is the question ? For me, the slow way has to inform the fast way, but it has to be effective !

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