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Questions about Clozapine

Z

zak

New member
Joined
Nov 1, 2009
Messages
4
Hi

my brother has been on mediaction now for 8 years. I have heard and read alot on clozapine and the positive effects it can help in bettering lifes. My brothers doctor is relucatnt to put him on this drug although 2 years ago he was told it can work for him. I am eager to hear from someone who has ben on this medication or how still is. I am now in a position where i am going to the doctor with him to persuade his doctor to try him on ths medication.It may seem a bit selfish the way i sound but i have seen his medication cahnge over the years and although he is not as bad as he was at the start,he will often talk to himself and has alot of issues with his speech.He does not stutter but will use words in a sentaence that may not make sense to someone whohas met him for the firstt time and i will know what he is trying to say.

Please , please can someone help me with my questions on this medication.
 
v01ce5

v01ce5

Well-known member
Joined
Dec 11, 2007
Messages
160
Hi

See this interview with Professor Richard Bentall, he has a new book called Doctoring the Mind: Why Psychiatric Treatments Fail ALLEN LANE/PENGUIN


Bentall: What's striking about the story of the neuroleptics is that, in terms of efficacy in their effect on the so-called positive symptoms of schizophrenia (hallucinations and delusions), there has been no real improvement since the discovery of chlorpromazine, the first neuroleptic to be used on psychotic patients. There is no evidence that the new 'atypical' neuroleptics that are available today, and that have been pushed by drug companies at a huge expense to the British taxpayer, are any more effective than the older drugs.

Neuroleptics do have an effect on positive symptoms, and I believe that's been proven, given the amount of trial evidence available. But they have many negative effects, which are also well understood. The old fashioned, so-called typical, neuroleptics, for example, produce side effects that are really dreadful: the patients have parkinsonian symptoms; they have a terrible inner sense of restlessness and depression; they get muscle dystonias, which are muscle spasms. In some cases they get tardive dyskinesia — pronounced involuntary movements of, for instance, the tongue, the lips and mouth, which can be very debilitating to people.

And these drugs also appear to have an extremely negative effect on people's motivation, so that patients taking them often have what's been described as a neuroleptic-induced deficit syndrome. So, although users may experience fewer positive symptoms, they're also less able to achieve things in their lives.

Now, the new, or atypical, neuroleptics are being touted as much better because they don't produce these side effects, but the truth is that they produce lots of other side effects. For example, if you take a drug like olanzapine, which is probably the most widely used neuroleptic in this country at the moment, massive weight gain is a serious problem. At least 50 per cent of people have sexual dysfunction and there is also a high risk of diabetes, so these drugs have pretty nasty side effects.

Tyrrell: Clearly, any benefits need to be balanced against all those side effects.

Bentall: Ah, but you also have to take into account that maybe a third of patients don't get any benefits at all; they don't get a reduction in positive symptoms, although they are still given the drugs and so still get the horrible side effects.

Tyrrell: So why do they keep on being prescribed the drugs?

Bentall: Psychiatrists tend to think the drugs are the only thing there are, therefore they must be prescribed, even if the patient is not getting any obvious benefit. I think patients should be asked if they want to take these drugs. The benefits and the side effects should be explained, and, if they do want to take them, they should be given a low-dose typical neuroleptic like chlorpromazine for three months. At the end of that time, a detailed account should be taken of the costs and benefits, and then the patients should decide if they want to continue or to try another drug. If the costs seem to be outweighing the benefits, then it makes sense to try another drug. If that doesn't work after another three months, it makes sense to try an atypical neuroleptic. If that doesn't work, then step four is to give up on the drugs. But that never happens.

You find, in Britain, that probably under five per cent of psychotic patients are not given neuroleptic drugs and they're usually people who have been labelled as non-compliant: the people who have the guts to say firmly that they don't want to go down that route. And they're treated in a very pejorative way by the psychiatric establishment because of that. If taking a drug were based on an analysis of cost and benefits, you'd probably find just 50 per cent of patients would be on neuroleptic drugs.

Tyrrell: That's scandalous!

Bentall: There is also a bit of a scandal about the dosage of these drugs that are used. I think everybody in psychiatry knows about it and I’ve heard it discussed at conferences, but in a strangely detached way, as if this issue isn't really having an impact on patients' lives. The evidence is that you get no benefit whatsoever from doses above about 300mg per day of a chlorpromazine equivalent, and that's easy to work out for each of the main neuroleptics. If you go above that level, you get a massive increase in side effects but no added clinical benefit. And yet, it is still very common to find patients who are on much higher doses than that. We did a study of patients in the North West recently, which included recording their neuroleptic medication, and out of 200-odd patients we found that the median dose was about 600mg a day of chlorpromazine — in other words, double what the evidence says is the optimum dose. And there are plenty of people around who are taking more than a gram a day of chlorpromazine equivalent.
So there are people literally being poisoned by their psychiatrists. Of course, the paradox is that, by overprescribing medication in this way, psychiatrists actually deprive patients of benefits that they might otherwise get from the treatment.

Tyrrell: That's outrageous. And the only beneficiaries are the drug companies.

Bentall: Yes, they are beneficiaries. I give a lecture every year to our Masters students — we have a Masters in research methods and I give a lecture every year called "The science and politics of clinical trials" — and I say at the beginning that, if they don't feel less comfortable going to their doctor after this lecture, they've not been listening! I have lots of case studies of ways in which randomised controlled trials are subverted to give misleading results. So, for example, in the case of a newer atypical neuro-
leptic versus a typical neuroleptic, most trials have compared the new drug with an irrationally high dose of the old one, and they find that the atypical neuroleptics have a much better side-effect profile. Well, of course they do, because they have been compared to a toxic dose of the typical neuroleptics! I can't think that drug companies don't know what they've been doing, so it's a way of making a compound look good by comparing it to a wrong dose of a traditional one.

Tyrrell: Neuroleptics are supposed to be anti-psychotic but they don't address the psychosis at all, do they? Don't they just calm people down?
Bentall: Well, I don't think that's actually quite true; I think they are to some extent anti-psychotic. As I've said, in some patients, they have a very strong anti-hallucination and anti-delusion effect. But they also have quite a profound effect in calming manic patients down, which is a good thing because, if you've ever seen someone in a manic episode, it's pretty frightening. It's pretty frightening for them and it's also pretty frightening for everybody else around them.

It's important with psychiatric drugs not to throw the baby out with the bath water. There should be some people on anti-psychotic drugs, a lot fewer than are actually on them, and most of those who are on them should be on a lower dose. I would like to see the rational prescribing of psychiatric drugs. They are dangerous tools that have some benefits, if used carefully. But they're not used carefully.

Tyrrell: There's been some debate, particularly in America, I think, about whether psychologists should prescribe psychiatric drugs.

Bentall: I would welcome having a prescription pad. Most of my time is spent on research projects but I see patients one day a week, and it would be wonderful to be able to say, "I'll deal with the whole package, the medication as well as the psychological treatment". Equally important, it would give me un-prescribing rights. Then it would be possible to deliver a treatment for patients that actually matches their needs.

Full article here:
http://www.hgi.org.uk/archive/newlook-psychosis.htm
 
Lucas

Lucas

New member
Joined
Nov 23, 2009
Messages
2
Hello

I have been taking clozapine for along time, and it really works for me, it doesnt get rid of voices all together, but makes them less severe, i used to take risperidol and olanzapine but they didnt agree with me! My mother is worried about long term affects like obesity and strokes, in the evening the pills make me very hungry and i have gained over 2 stone in weight in the last 2 years!:oops:
Have you guys heard of a organisation called N.I.C.E?
 
Z

zak

New member
Joined
Nov 1, 2009
Messages
4
I have been taking clozapine for along time, and it really works for me, it doesnt get rid of voices all together, but makes them less severe, i used to take risperidol and olanzapine but they didnt agree with me! My mother is worried about long term affects like obesity and strokes, in the evening the pills make me very hungry and i have gained over 2 stone in weight in the last 2 years!:oops:
Have you guys heard of a organisation called N.I.C.E?
Thank you for your reply I have not heard of n.I.c.e n who are they
 
jax

jax

Well-known member
Joined
Nov 23, 2008
Messages
868
Location
Belfast, N.Ireland
I'm not on clozaril myself - but I have seen a lot of peoples lives transformed with clozaril. I worked in mental health in the States for a year and we had a lot of patients who had been in hospital for years and years who came out to live in out houses. Ihave seen the same here at home. I have know of two long stay psychiatric patients who were in a ward for violent patients. Both are now living out in the community.

I was told I might have to go on clozaril last year. I really didn't want to due the the awful side effect of drooling and weight gain. Thankfully I didn't have to go on it - but it definitely is a wonder drug for many people. Hope your brother gets to go on it.
Jacqui
 
Lucas

Lucas

New member
Joined
Nov 23, 2009
Messages
2
ok

N.I.C.E stands for National Institute for Clinical Excellence. ;)
 
A

AuroraBlues

Active member
Joined
Nov 21, 2009
Messages
32
My Brother has been on this for a while and there's been a big change in him for the better. After being diagnosed 19 years ago, he's finally starting to question his belief in his Hallucinations and Dellusions, his mood and motivation has lifted a lot and he's started to discuss his future.

But what you have to remember is, what may work for one, may not work for another. In the grand old world of psychotropic medication, it could go either way. His doctor may see him as stable, and that his current drugs are working for him. Hence the possible reluctence.

Aurora :)
 
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