Some schizophrenia patients can cope without medication
New study challenges our understanding of schizophrenia as a chronic disease that requires lifelong treatment.
A new study shows that 30 per cent of patients with schizophrenia manage without antipsychotic medicine after ten years of the disease, without falling back into a psychosis.
The results go against conventional treatment of psychosis and schizophrenia.
Patients are usually prescribed medication for an unlimited length of time after it has been established which medicine works best without too many side effects.
But perhaps doctors should think about helping people to transition off their medication, suggests the authors behind the new study.
“It shows that there’s actually a large group, though still a minority of patients, who can function without medicine and without developing psychosis. So as a doctor, you shouldn’t rule out that patients could give up their medicine,” says co-author Merete Nordentoft, a professor in psychiatry at the University of Copenhagen, Denmark.
Women who do not use drugs cope best
In the study, scientists collected observations from 496 patients who were diagnosed with schizophrenia ten years ago and started on a treatment with antipsychotic medicine for ten years.
A decade on, the doctors invited the patients in for a follow up interview to find out how they were doing. The patients were previously interviewed at the first, second, and fifth year after their initial diagnosis.
303 patients took part in the follow up interviews and 30 per cent of them were doing well despite not taking their medication. The scientists found that this group was in remission.
According to Nordentoft, this means that they no longer have many of the symptoms of schizophrenia. Some were healthy and others may suffer occasionally from anxiety and have a few minor psychotic symptoms.
One group in particular had an especially high chance of coping without medication: women who did not take drugs, with a high level of functionality and connection to the labour market.
“We can see that those who have a high level of functionality to begin with—those who can manage well and have a good social life—are also the ones who cope without medicine after ten years,” says Nordentoft.
The most well-functioning schizophrenics cope best
Bjørn H. Ebdrup, a senior scientist and doctor at the Center for Neuropsychiatric and Schizophrenia Research at the University of Copenhagen Hospital, is surprised by the new results.
“It’s really very interesting. It goes against the whole idea that schizophrenia is always a disease that lasts a lifetime. If that was correct then they wouldn’t observe [what they do here],” he says.
Ebdrup underlines that the most well-functioning of schizophrenia patients are probably those who manage best without their medication.
In the study, many of the worst suffering patients did not turn up for follow-up interviews.
Moreover, the study is probably not representative of all patients who suffer from schizophrenia, he says.
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Medicine can have harmful side effects
But why is it so important to find out whether people can manage without medicine? Surely the most important thing is that people are not sick?
The problem is that antipsychotic medicines often have harmful side effects, including excess saliva, stiff muscles and shakes, breast milk production (also in men), and increased effort in daily life.
They can increase the risk of developing diabetes and naturally make it harder to live a normal and a good life if patients put on 20 to 30 kilograms extra weight.
A Dutch study published in JAMA in 2013 demonstrated that a group of patients who received less medicine or stopped their medication managed better seven years after the experiment when compared to a control group who had continued with the high dose medication.
“It’s really positive for people if they can stop taking medication and manage anyway,” says Nordentoft.
She emphasises that those who came off medication did so of their own accord.
“There’s nothing built into the system to say that you should try to take people off the medications if they no longer suffer psychosis. So these patients have done it themselves or in some cases in consultation with their doctor,” she says.
Read more in the Danish version of this story on Videnskab.dk
Translated by: Catherine Jex
- 'Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis', Skizophrenia Research (2017), doi: http://dx.doi.org/10.1016/j.schres.2016.10.030