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Long-term Recovery: More Options, Better Treatment Needed

by Kathleen Vogtle, NAMI Communications Coordinator

Dr. Thomas Insel, NIMH Director weighs in on study results that, for some, may turn age-old thinking in the mental health field on its head: long-term recovery in schizophrenia may not necessarily include taking antipsychotic mediations.

Insel is very clear that he is not negating the benefits of popular and even “atypical” antipsychotics. However, he states that while these medications are largely helpful for those experiencing their first psychotic episodes, their reliability decreases over time.

Insel illustrates his claim based on a recently published finding by L. Wunderink in JAMA-Psychiatry. The study followed 103 people with schizophrenia over a seven-year period. After six months of remission, the participants were randomly selected to either wean off the medication, or to continue with maintenance treatment.

The results were, at first, predictable. Those who were taken off the medications “experienced twice the relapse rates in the early phase of the follow-up.” Within a few years, these rates evened out, and by the conclusion of the study, a remarkable trend was revealed.

Among the 103 participants, the group who had discontinued the medications had achieved a 40.4 percent “functional recovery rate,” as opposed to the 17.6 percent who had continued to use the antipsychotic.

The results of the study, though, should not call into question all preconceived notions of how to treat schizophrenia. Instead, Insel believes this is an opportunity to reframe and expand upon this knowledge. He urges a more comprehensive approach: for some, antipsychotic treatment is a necessity; for others, a combination of medication and psychosocial treatment, such as Cognitive Behavioral Therapy (CBT) might prove most effective. Still others may be most productive with no medication at all. However, it is important to assess the potential risks involved in changing any treatment or medication regimen. It is up to the individual and his/her health care provider to decide on the best course of treatment.

Above all, Insel states, the term “schizophrenia” was defined a mere 100 years ago, and first generation medications developed only 50 years afterwards. This research, then, is a reminder of how much is still to be learned about this mental illness.

Read the full article here.