NIMH Director Thomas Insel's latest thoughts on long term use of antipsychotics

Recently, results from several studies have suggested that these medications may be less effective for the outcomes that matter most to people with serious mental illness: a full return to well-being and a productive place in society. Read the full post here.

It was only a short while ago that the National Institute of Mental Health Director was singing a different tune, that schizophrenia and other mental health disorders were developmental brain disorders that needed better drugs to target underlying causes. He was describing the problem from a purely scientific perspective:

We must address mental illnesses, from autism to schizophrenia, as developmental brain disorders with genetic and environmental factors leading to altered circuits and altered behavior. Today’s state-of-the-art biology, neuroscience, imaging, and genomics are yielding new approaches to understanding mental illnesses, supplementing our psychological explanations. Understanding the causes and nature of malfunctioning brain circuits in mental disorders may make earlier diagnosis possible. Interventions could then be tailored to address the underlying causes directly and quickly, changing the trajectory of these illnesses, as we have done in ischemic heart disease and some forms of cancer. For serious mental illness, this is a new vision for prevention, based on understanding individual risk and developing innovative treatments to preempt disability.

So, his latest post shows an important shift in thinking in its questioning long term use of the drugs and acknowledging the neglected importance of what is needed to help people to achieve better outcomes - family engagement and education, employment, and therapy. 

Neither first nor second generation antipsychotic medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.

He ends on a humble note.

These new data on the long-term outcomes for people with “schizophrenia” remind us that 100 years after defining this disorder and 50 years after “breakthrough” medications, we still have much to learn.

My next post will highlight the" Recovering our families" on-line course that I find, from my own experience, to be the best and the most innovative guidance one can find for helping family members transform and heal from the emotional distress associated with trauma and challenges surrounding mental health diagnoses.