Psychiatric medications are no panacea.
Recent studies have raised questions, for instance, about whether antidepressants are really any better than placebo pills. While I still believe that antidepressants can be very useful when prescribed by experts for the right patients, this data highlights the continuing importance of psychotherapy, behavioral techniques, diet and exercise to overcome depression and anxiety.
No credible study, however, has suggested that medicines that treat psychosis—the delusions and hallucinations that can occur with schizophrenia—are ineffective. They have been and remain important therapeutic tools to free patients from hearing voices, seeing visions or living with paranoia.
Antipsychotic medications seem to work by blocking the brain chemical messenger dopamine, which is thought to be overactive in patients suffering with psychosis.
Too few clinicians and too few patients, in fact, are aware that patients can opt for a monthly injection of such medications (marketed as Risperdal Consta and Invega Sustena, among others), rather than a daily oral dose. This is particularly important for those individuals who aren’t certain they will remember to take their medicines or who can’t be relied upon to do so. Noncompliance with antipsychotic medications is commonly responsible for relapses into psychosis, resulting in repeatedly cleaving the patient from his or her social and clinical supports and, often, in the need for more frequent psychiatric hospitalizations.
Part of the problem is that many psychiatrists remain unfamiliar with the straightforward protocols by which they can dose and deliver these monthly medications. So they may tend not to suggest them. This means that patients who feel they could benefit from the monthly dosing may need to search for clinicians who offer it. They may find that hospital-based outpatient clinics and community mental health centers are more likely sources.
In addition to those who would voluntarily take monthly injections of antipsychotic medications to control their symptoms, I believe that courts (including judges, defense attorneys and prosecutors) and prisons, should consider the risks versus benefits of insisting that those who have committed crimes while psychotic (a vast minority of psychotic individuals) show up for monthly injections of depot antipsychotic medications as a condition of probation. Some states have laws that allow such enforced, outpatient treatment, while others do not. I believe every state should.
Indeed, the use of monthly injected antipsychotic medications could, arguably, drastically reduce recidivism in those whose violence is due to severe disorders of impulse control. It is well known that certain antipsychotic agents reduce aggressivity.
The availability of monthly injections of antipsychotic medications that make compliance with them so much easier to achieve and simpler to keep track of also raises the issue of why more medications are not available in this form. Where there is little incentive to provide such medicines in the marketplace (due to relatively small demand), but potentially great gains to the community (such as creating a monthly injectable form of disulfiram, which causes severe, toxic reactions when alcoholics—i.e. repeat drunk drivers—drink alcohol), the government has a proper role in incentivizing the pharmaceutical industry to create them.
Dr. Ablow is the author of "Inside the Mind of Casey Anthony." He is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at email@example.com. His team of Life Coaches can be reached at firstname.lastname@example.org.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.