Wednesday, November 3, 2010

Supersensitivity Psychosis: Is There Such a Thing, and If There Is Then Why the Hell Haven't We Heard About It Before?

This is the ninth in my series based on talking points raised by Robert Whitaker's eye-opening "Anatomy of an Epidemic."

In his book, "Anatomy of an Epidemic," Robert Whitaker easily debunked the chemical imbalance myth (see earlier blog piece), which rested on nothing more than some observations in search of an explanation.

The observation: "Certain drugs reduce psychiatric symptoms."

The explanation: "It must be because they correct a chemical imbalance."

The reality: "The brain is not chemical soup."

Whitaker then went on to cite with approval a different set of observations in search of an explanation called "supersensitivity psychosis." Supersensitivity psychosis is central to the whole point of Whitaker's book, which posits that our meds may actually worsen rather than improve the natural course of our illness.

This goes much further than stating that well-known side effects tend to make us feel worse rather than better. Suppose, instead, Whitaker asks, our meds actually amplify the very symptoms they are supposed to remedy? We know, for instance, that indiscriminate use of antidepressants can turn depressives into bipolars and classic bipolars into rapid-cycling bipolars.

What about antipsychotics? Are they really as "anti" as psychiatry makes them out to be, or is there a bit of "pro" to their effect? After all, if these meds truly worked the way Pharma would have us believe, there would be a lot less incidence of mental illness, with a lot less severity, rather than a lot more. Consider this the observation. The explanation may have something to do with many of us being hypersensitive to our meds. But does reality bear this out?

The story begins with the investigations of Guy Chouinard and Barry Jones of McGill University back in the late seventies. We know that antipsychotics knock out psychosis by blocking post-synaptic dopamine D2 receptors. But the brain compensates by, amongst other things, increasing the receptor binding sites on these very same neurons. This has been shown in postmortem brain samples of rats, and more recently in brain scans of humans.

If the antipsychotic (or neuroleptic) is suddenly withdrawn, the brain takes time to readjust, during which all manner of bad things may happen. Down in the nigrostriatal dopamine pathway, neurons are firing too rapidly to maintain full motor control, resulting in facial tics, agitation, and other disturbances. Or, should the patient stay on the med, the morphed neurons may reach a point of no-return. These disturbances may in time manifest as tardive dyskinesia, which is permanent.

So far, so good. But what if, Chouinard and Jones asked, something similar went on in the very dopamine pathway - the mesolimbic pathway - that antipsychotics are supposed to restore to normal? If you suddenly withdrew the antipsychotic, could "rebound" psychosis occur? And could a permanently altered brain turn good prognosis patients into chronic bad prognosis ones? As the authors explained in a 1980 article:

According to this hypothesis, the cessation of maintenance neuroleptic medication induces a relative increase in the mesolimbic dopamine function, leading to psychotic relapse or deterioration in the same manner as tardive dyskinesia can emerge or worsen when medication is stopped or decreased.

In a 1990 paper, Chouinard estimated the likelihood of 43 percent of patients on neuroleptics being affected in this manner. In one of his case studies, he cited "Mrs B," who had five relapses of acute psychosis over the first 22 years of her illness vs six in the last 10, and was no longer responding to increased doses.

"What was psychiatry supposed to do with this information?" asks Whitaker in his book. "It clearly imperiled the field's very foundation." Whitaker then relates how the dean of receptorology, Solomon Snyder of Johns Hopkins, came to psychiatry's rescue by assuring readers in a 1986 book that talk of supersensitivity psychosis was premature. Soon after, the hypothesis was consigned to the "interesting" file and the field breathed a sigh of relief.

Today, Whitaker observes, "the notion that antipsychotics increase the likelihood that a person diagnosed with schizophrenia will become chronically ill seems, on the face of it, absurd." Ask anyone - the top experts, the man on the street - and they "will attest that antipsychotics are essential for treating schizophrenia."

So is psychiatry to be damned for turning its back on us, or is Whitaker reaching too far in his quest for an explanation? Or are there simply a lot more nuances to the issue than he suggests?

Next: We look at the nuances ...   


Previous blog pieces:

Tuning Out the Distractions

Thanks to Stupid Advocacy, Your Life is Worth Just One Penny

The Study Psychiatry Wishes Would Just Go Away - Part II

The Study Psychiatry Wishes Would Just Go Away

Is the Cure Worse Than The Illness?

The Whitaker Controversy: An Irony in Search of Nuance

If Meds Work as Well as Our Psychiatrists Tell Us, Why Do We Have MORE Mental Illness Today Rather Than Less?

RIP: Chemical Imbalance in the Brain

4 comments:

Tony Previte said...

Great post John!

This concept of "Supersensitivity Psychosis" really fits my own experience. I grew up, much like you did, in southern New England just a couple of decades later than you. I was an adopted child to a young childless couple and growing up wasn't easy for me. I was constantly sick, many bouts with bronchitis, a few bouts with pneumonia, and according to my mother, a possible borderline case of "Cystic Fibrosis".

Doctors could not figure out what was really going on with me. I was poked, prodded, tested for allergies and was found to be allergic to nearly everything, they couldn't nail down anything specific.

Around the age of 12, my parents started talking about moving somewhere else and I was now excited!! At that ripe old age of 12, what kid do you know would be excited about leaving the only home they knew? ME!

Two years later, we did it! We moved to Phoenix, Arizona and I continued the rest of my High School education there. It was the best time I've ever had, I was socially engaged, popular within many different "cliques". I really came into my own during that time.

During my senior year, in the spring to be exact, I enlisted in the U.S. Navy to be shipped out in October of 1984. I just wasn't interested in any more schooling. My parents were great about not wanting to push me into anything, so they thought it wasn't a bad idea an signed off on it since I wasn't yet 18.

I had both a great and tumultuous experience during my first enlistment. In 1987 it was over and I returned to Phoenix to serve out the rest of my obligation in the active reserves. It was during this time, that I had my first MAJOR episode that landed me in a hospital.

Was it the rapid change in environments that led to it? Was the exposure to toxic chemicals while living full-time aboard an active Navy vessel to blame? Was I just really too stressed out for my own good? All important questions!

In recent years, I've re-connected with lot's of my former "shipmates" from that era and a common thread emerges. Lot's of us ended up having similar problems and most of us have moved on to lead very productive lives, despite the various labels that have been attached to us.

Some however haven't been so lucky. I've lost some friend's far too early from things like Cancer, Lymphoma's and various other physcial maladies that at their source can be broken down to "cells going crazy!!"

So if our cells are going crazy, does it mean that we are as well? If I hear a ringing in my ears, does it mean I have tinnitus? Or can it be that my adrenals are working overtime to correct something that's going on within me?

In my last comment I posed the question that maybe the reason why our Psychiatrists spend so little time with us is because they don't want us to wear our labels.

My personal observation about neuroleptic use? To this day, I declare myself "med-free", however this comes with a caveat. If I'm feeling out of sorts and on the verge of getting physically ill and I'm having a hard time sleeping; I'll take a small dose of a neuroleptic to help me sleep soundly through the night and part of the next day. Why? Because my body needs that rest to heal. I certainly don't use it as a general sleep aid, that would be abuse akin to using a slegehammer to drive a finish nail into a small piece of cabinet molding!

It works for me, what works for you?

John McManamy said...

Hey, Tony. Love your analogy! My meds strategy is similar to yours. Sparing use, small hammer for small nails, though there was a time when I needed a bigger hammer for bigger nails. I experienced my only hallucinations when given an antidepressant, so I'm very wary of anything that goes into my body. I'm very sensitive to stress and lack of sleep, and I need to go into Defcon One when I'm thrown off course on either front. So naturally I'm open to the possibility of others experiencing supersensitivity psychosis, or even placing themselves at risk. Whitaker has sounded the alarm, but whether it's a two alarm fire or a twelve alarm fire bears more investigation.

Maria Minno said...

Gosh did you ever consider nutrition? Maybe the antipsychotics just mask a nutritional deficiency, and all the time it gets worse. Then when they go off the drug, the even more severe symptoms appear. Because the brain chemistry really IS important. But since when does poisoning one enzyme system heal another? That's what the drugs do. Take a dual system where one side has to be in balance with the other. Say then, that one side is sick due to a nutrient deficiency. So the drug will poison the healthy side of the system, making the sick side seem more in balance with it. Eventually both sides of the system become sick, and the whole system collapses. Because the person didn't need drugs, they needed good food. There is a book called "Mood Cure" and another called "Gut and Psychology Syndrome" and others on nutrition and psychology. I know that minerals must be in balance in the body, or mental health problems can occur. Zinc and copper are a good example. It's not so confusing if you take account of nutrition. Good luck in your search for the answers.

Tony Previte said...

Maria Minno said...

"Gosh did you ever consider nutrition?"

It's definitely part of my wellness plan Maria. In fact if I'm beginning to be "episodic" the stress, lack of sleep and my diet are ALL out of whack.

In my comment above about my childhood illnesses, nutrition was a primary concern.

I was on a diet that contained very little dairy because of my propensity to produce that "yucky stuff" that turned into chronic bronchial conditions and pneumonia.

The magic bullet for me at the time however was the change in environment. The dry desert climate did wonders for me and continues to, to this day. I can count on one hand the amount of times in the last 13 years since leaving the Navy that ANY kind of flu or cold has taken me down for any considerable length of time.

Put me in a damp environment for a prolonged length of time and the flu and common cold virus' come marching back with a vengeance.

When I feel the need, Omega III Fish Oils, Vitamin E, Vitamin C, Niacin and the other important B Vitamins (B6 and B12) are also a part of my plan as well.

Lastly, another vital part of what keeps me well is not obsessing on any one part of it. It's all important and there's not one single "thing" in my arsenal that's a magic bullet.

Is some of this stuff poison? Certainly. But so is our environment and even the food we eat if taken to extremes.

My secret is allowing those things to pass through me without much after effect.