What does ‘relapse’ mean? Definitions used in long-term antipsychotic treatment trials are inconsistent and unclear.

We are told that long-term antipsychotic treatment reduces the risk of someone having a ‘relapse’ of schizophrenia or psychosis. What ‘relapse’ actually refers to in the studies that are supposed to establish this has not been examined though. Our recent study of relapse definitions, published in Schizophrenia Research, shows that there is no consistent or…

Persistent withdrawal and lasting damage from prescribed drugs

  The recent furore caused by publication of evidence about the serious nature of antidepressant withdrawal made me reflect on the lasting damage that can sometime be done by prescription drugs, and how it has often taken concerted efforts by users of these drugs to bring these effects to public attention. Historically, the medical community…

Commentary on the Finnish analysis of first episode schizophrenia outcomes

A recent study by a Finnish group declares that discontinuing antipsychotics following a first episode of schizophrenia causes higher risk of death or rehospitalisation. The study is based on an observational analysis of routinely collected data, and these analyses can be seriously misleading. It also prioritises short-term outcomes. The study highlights the need for randomised…

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…

Lithium and suicide: what does the evidence show?

There appears to be increasing acceptance of the idea that lithium prevents suicide, and even that it can reduce mortality rates. For a toxic drug that makes most people feel rather depressed, this seems curious. I did wonder whether it might be having this effect on suicide by sapping people of the will to act, but…

NICE guidelines for bipolar disorder- a missed opportunity

There are some things to applaud about the recently released update of the NICE bipolar guidelines (1,2), not least the recognition that the diagnosis has been inappropriately applied to children with behavioural problems. Hopefully this will help curtail the worrying trend of using toxic bipolar drugs in this age group. As usual, however, the Guidelines…

Continuing the antidepressant debate: the clinical (ir)relevance of drug-placebo differences

German psychiatrist, Stefan Leucht and colleagues, have produced another really important paper (1). The results indicate that the small differences usually found between antidepressants and placebo are far below the sort of differences that would be clinically detectable or meaningful. Leucht et al have conducted the first thorough, systematic attempt to provide some empirical evidence…