Q:I wonder if your doctors could comment on the poor quality of life of sufferers from psychosis who are taking antipsychotic drugs long term, and on the possibility of alternative non drug ways of managing the condition. I myself suffer from schizophrenia/manic depression (I have been given both diagnoses) and am on injections of haloperidol (Haldol). The effects I have noticed (apart from the undoubted fact that the drug prevents recurrences of the mania and delusional thinking) are general tiredness, stiffness of muscles, apathy, impotence, sexual dysfunction, inability to sing and to appreciate art and music, all of which I could do when off the medication in sum an absence of those things that make life livable and worthwhile. When asked about side effects psychiatrists or GPs tend to deny them or play them down. A.M., Dublin.......
A:We put your letter to Dr Vicky Rippere, who has done some non drug work with psychotic patients. Her response:"The points you raise are all well considered about doctors dealing with psychiatric patients. Many psychiatrists tend to play down the side effects of drugs or attribute them to the patient's illness, so that if a patient is suicidal they look to the illness and not the chemical 'cure'. There seems to be a particular reluctance to discuss alternatives with patients, particularly psychotics.
"Nevertheless, it is possible to find consultants with a less drug based approach. I suggest that you contact the Schizophrenic Association of Great Britain (Bryn Hyfryd, The Crescent, Bangor, Gwynedd LL57 2AG Tel: 0248 354048). Through their own grassroots channels they have compiled a list of doctors or therapists and can recommend some people to you.
"Although it is important that you actually see a doctor, you might consider several alternatives to injected haloperidol. One is to take the drug orally, which makes it easier to modify (ie lower) the dosage. Your doctor could experiment to find the very minimum level you need to control symptoms.
"Another idea is to try a drug called carbamazepine (sold as Tegretol). This anti convulsant developed to control epilepsy has been found to have a stabilizing effect on manic depression. Although it has its own side effects, including dry mouth, drowsiness, and double vision, it is a much safer drug than the antipsychotics, which cause tardive dyskinesia, or involuntary movements of the fingers, toes and lips and sometimes eventual immobility. [The Health Research Group estimates that some 200,000 people in America suffer from drug induced tardive dyskinesia. editor.] Carbamazepine given in small doses to people suffering from manic depression seems to stabilize it without the serious side effects that you are complaining about.