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Tuesday, May 20, 2003
all the ladies in the house do tha thorazine shuffle
Allow me to engage in a bit of personal talk, albeit on a subject that relates to a larger issue.

The New York Times today published a story about the new generation of anti-psychotic medications and how studies are beginning to show that they're not the miracle cure they appeared to be at first. The old stuff, like Haldol or Thorazine, was given in massive doses to psychotics and resulted in a kind of zombie state of sedation and Parkinson's symptoms that caused muscle spasms and a signature stiff-legged walk, "the Thorazine shuffle." The new generation of antipsychotics, like Zyprexa and Risperdal, seemed much gentler and to have far fewer side effects, and patients and doctors embraced them eagerly, to the degree that they started to be prescribed for "Alzheimer's, personality disorders and nonpsychotic depression, and for conduct disorder and severe aggression in children." But it's become clear that the side effects these drugs (the "atypicals") have been known to cause, such as fatal blood clots and diabetes, require such expensive monitoring (mainly blood tests) that the benefits may not be worth it. Of course, the cycle of "New miracle drug!" -> acceptance -> "Oops, maybe it wasn't such a good idea..." -> "New Miracle Drug!" has been repeated ad naseum in the last fifty years, but it's a healthy reminder that this might not be the smartest practice.

Now, what they don't make clear is that all these drugs are essentially tranquilizers, as far as I know, and that the atypicals are just slightly gentler tranquilizers. They can talk about targeting specific brain chemicals all they want, but as far as I'm concerned, the class of antipsychotics basically works to slow down your brain in one way or another. You can see how this would work in the case of the other disorders for which antipsychotics are now being prescribed.

I was prescribed Risperidol by one of the top neurologists dealing with my condition, which is not psychosis, and even that was a fight--he wanted to put me on Haldol, which was "standard," but I assume you can see why this might not be the most promising option for someone who, say, writes as much as I do. (At least until the Thorazine shuffle becomes the dance craze I hope to one day make it.) Risperidol was gentler, as far as I could tell, and it seemed to work OK, although I was worried about it--depression was one of the most notable side effects, and I went on antidepressants at the same time as I started Risperidol. Still, it seemed the best thing at the time.

Then I gave some to a friend who was having trouble sleeping. And she took it, and reported back that she had slept for 18 hours and been depressed for a day afterwards. And I thought: hmm, maybe that's why I've been tired and depressed for the past six months. So I got off that as fast as I could and onto an entirely different class of medications--which cost $1000 a month and has thrown me into an insurance company pit of hell, but that's a story for another time. This is all to say nothing of tardive dyskinesia, which is, as the Times article puts it, "a disorder that causes repetitive movements — chewing motions, lip-smacking and contortions of the arms and legs — that sometimes persisted even after the drugs were stopped." More specifically, it's known to cause permanent eye tics, and when that's sort of the behavior the drug's meant to cure, it's a problem. My friend Liz did a study and found a distressingly high probability of getting a form of tardive dyskinesia if you take anti-psychotics for three years.

None of this is to say that the atypicals aren't great for people who, you know, actually have schizophrenia, and blood disorders and increased risk of diabetes aside, Risperidol et al are way, way better than Haldol ("Bretta M., 34, a Brooklyn woman, for example, said that the Zyprexa she takes is an improvement over Haldol, an old-generation drug that she said made her feel "like a zombie.") although, honestly, that wouldn't have been too hard. But to read that its use on other disorders isn't limited to weirdoes like me is troubling, especially when coupled with the assertion that "It's probably the best growth market in the business." It's an awfully blunt way of dealing with a lot of these things, and seems a strange substitute either for effective behavioral counseling or actual scientific progress in finding more specific treatments for these disorders. It also exposes patients to unnecessary side effects and does, to a certain degree, sedate them (a charge leveled at antidepressants which turns out to be largely untrue but which would seem to be the case here) which is problematic both because it lessens their social value and makes it much harder for them to get off the medication if it's causing problems, as happened in my case.

I guess I don't really know what I'm talking about here. I'm just a guy who took Risperidol, and I'm unfamiliar with the science behind them and the institutional context that leads to their acceptance and wider use for treatment of secondary disorders. But I do think that it's dishonest for the drug companies and doctors to push something in this way. That's all.