A study published today, January 4th, in The Lancet, has found that two antipsychotic drugs —Risperdal by Janssen and the older drug, Haldol—that are widely prescribed to many persons with intellectual disabilities to control aggressive outbursts are “no more effective” than placebos. Antipsychotics were originally developed to treat schizophrenia and, as the New York Times notes, are now used as “all-purpose tranquilizers to settle threatening behavior — in children with attention-deficit problems, college students with depression, older people with Alzheimer’s disease and intellectually handicapped people.” In the study, 86 persons with low I.Q. who live in community housing in England, Wales, and Australia were tracked for month. For those who took a placebo, there was a 79 percent reduction in aggressive behavior and a reduction of 65 percent or less in those taking antipsychotics. The findings are a challenge to “standard medical practice in mental health care clinics and in nursing homes” in the US and internationally. The researchers noted that the “findings almost certainly applied to all similar medications,” such as Seroquel.
More details about the study from the New York Times:
Previous studies of the drugs’ effect on aggressive outbursts have been mixed, with some showing little benefit and others a strong calming influence. But the drugs have serious side effects, including rapid weight gain and tremors, and doctors have had little rigorous evidence to guide practice……..
While it is unclear how much the study by itself will alter prescribing habits, “the message to doctors should be, think twice about prescribing, go with lower doses and monitor side effects very carefully,” Dr. [Johnny L. Matson, a professor of psychology at Louisiana State University in Baton Rouge, and co-author of an editorial with the study] continued, adding:
“Or just don’t do it. We know that behavioral treatments can work very well with many patients.”
Other experts disagreed, saying the new study was not in line with previous research or their own experience. Janssen, a Johnson & Johnson subsidiary, said that Risperdal only promotes approved uses, which in this country include the treatment of irritability associated with autism in children.
In the study, Dr. Peter J. Tyrer, a professor of psychiatry at Imperial College London, led a research team who assigned 86 people from ages 18 to 65 to one of three groups: one that received Risperdal; one that received another antipsychotic, the generic form of Haldol; and one that was given a placebo pill. Caregivers tracked the participants’ behavior. Many people with very low I.Q.’s are quick to anger and lash out at others, bang their heads or fists into the wall in frustration, or singe the air with obscenities when annoyed.
After a month, people in all three groups had settled down, losing their temper less often and causing less damage when they did. Yet unexpectedly, those in the placebo group improved the most, significantly more so than those on medication.
This study is of interest to me: Charlie has been taking Risperdal since 2004, when his head-banging was occurring so frequently—20 times, 30 times, more times—-that, if I may understatement the matter, we were seriously, seriously concerned in a stomach-wrenching way. When the neurologist prescribed the Risperdal, he admonished Jim and me that the medicine was only going to help Charlie manage himself a bit better, and that his education would be most important in controlling the head-banging. It’s the combination of medication plus a highly structured school program and a highly structured home program that have helped Charlie learn not to head-bang; we try to keep the dosage he takes as low as possible, and to change our teaching and strategize about what else we can do when the behavior recurs.
On the other hand, an elderly relative who was suffering from clinical depression, was given Seroquel (and other treatments). I don’t know the particulars of her treatment plan but, due to her age and the condition of her health, there was no teaching her new ways of thinking and other things she might do and try to address her depression. The medicine was not at all enough. (She does not live in a nursing home.)
This sentence from the New York Times article stood out to me because of the way it describes an “aggressive outburst”:
Many people with very low I.Q.’s are quick to anger and lash out at others, bang their heads or fists into the wall in frustration, or singe the air with obscenities when annoyed.
It can seem that my son—who, at a first or second meeting, does appear to be of less than average I.Q., due especially to his struggles with language—is “quick to anger and lash out at others.” But his teachers and therapists know that while he may get angry “out of the blue,” there are reasons why this happened and they have to figure this out. (And if I could not talk and were being constantly misunderstood—-as has occurred to me when I spent a summer in Taipei, Taiwan, with a very uncertain grasp of Mandarin—-I remember feeling very and frequently frustrated and annoyed.) For the New York Times to say that one of the persons in the study “singe[d] the air with obscenities” seems a rather loaded way to describe a highly understandable reaction. More understanding of why adults with intellectual disabilities have “aggressive outbursts” —and more time spent teaching them how to learn other ways to express themselves—is needed.
Charlie still has “outbursts” of a very forceful nature. We usually connect these to extreme anxiety and worry, and to the fact that, right now, Charlie cannot tell us in language that he misses my parents and California, that his stomach or head hurts, that he feels bad that another child in his class is crying, that he didn’t want to get out of the car and come home—-I opine these meanings from spending so much time with Charlie and wracking my own mind as to why this happened, why he did this, and emailing and talking to teachers and therapists about what we can do. Just last night I was reading an account I wrote of the period in Charlie’s life when he had so much self-injurious behavior and I’m amazed to be able to say, he does not do that anymore.