Do Antipsychotics Help or Harm Psychotic Symptoms?

from: Allen Frances
Professor Emeritus, Duke University

This is the latest, and perhaps last, of several debates with Bob Whitaker on the role of antipsychotics in treating psychotic symptoms. It was triggered by a recent email exchange that clarified our areas of agreement and disagreement. Bob’s blog summarizing his views and how he arrived at them can be found here.

Bob and I agree strongly on the following:

  1. Antipsychotic medicines are used far too often in people who don’t need them.

  2. Even when necessary, doses are often too high and polypharmacy too common.

  3. Antipsychotics are neither all good, nor all bad. Used selectively, they are necessary and helpful. They are harmful when used carelessly and excessively.

  4. The treatment of people with psychosis relies far too much on medication alone, far too little on social engagement, psychotherapy, vocational rehabilitation, and providing adequate housing. We both like the normalizing, recovery models offered by Trieste, Open Dialogue, and Hearing Voices.

  5. The care provided for the mentally ill in the U.S. is a disaster that shames our country.

Bob and I disagree strongly on the following:

  1. Bob believes that long term use of antipsychotics makes psychotic symptoms worse. He therefore recommends that patients try to avoid antipsychotic medicine altogether or taper off them, whenever possible.

  2. Bob believes that psychotic symptoms return when meds are stopped because of medication withdrawal, not relapse of the original disorder that first led to the use of antipsychotics.

Bob probably doesn’t have a clue.


This Bob Whitaker should meet Jenny McCarthy, and together they can educate the masses on the importance of feelings over evidence when it comes to medical decisions.


I actually agree with Bob Withaker. I do believe medication can cause and worsen psychosis and relapse, as was the case in me. Of course, people can relapse as well because they just relapse. But it is proven that medication makes people more sensitive to psychosis.

In my case, I am quite sure:

  • Antipsychotics and other meds were used much too easily.
  • They refused to give me “real” treatments, like psychotherapy and practical support, which would probably have prevented relapse.
  • Withdrawal from meds directly caused my first and second psychosis and a worsening of all symptoms after that.

I was prescribed benzo’s and antipsychotics against anxiety and insomnia because of a truly threatening situation. Upon withdrawal I had my first psychosis. I was without symptoms and meds for 2 years. Then I used antidepressants and upon withdrawal I had my second psychosis. Most of the following psychoses were a direct response to medication withdrawal and came together with new symptoms like nightmares, physical symptoms, mood swings and anhedonia. I must say I have always been extremely sensitive to meds, both the effects, side effects and withdrawal. But I am quite sure the meds have harmed me.

I truly believe the meds caused me to be sicker than I would have been without meds and with good support. Personally, I preferred my original problem (temporary terror related to the circumstances) above what psychiatry caused in me (chronic psychosis and anhedonia). I think I would have had a big chance to be healthy now, if I would have gotten real help (EMDR, psychotherapy, help in raising my child, etc) instead of meds.

In my case, it was not schizophrenia though, but a reactive psychosis induced by the combination of trauma and meds.

I am reading right now Bob Withakers book (Anatomy of an Epidemic) and I strongly believe in the point he makes.


I have been reading a lot about alternative approaches to psychosis…

I am a big fan of:

  • Dr. Loren Mosher. With his Soteria approach he could get 95% of people out of psychosis with only psychotherapy, safe environment and empathic connection. People would recover better, cheaper and with better social functioning. His research was stopped when they found this out (!). He resigned from APA. I love his resignation letter:
    In Germany and Austria there are psychiatric wards were they use the Soteria approach, but with an adjustment: they do sometimes use meds. I have visited one of their wards and it is much better than in the Netherlands (my own country). F.e. in NL I was in a ward and they did not even HAVE a psychologist and refused my access to one. In Germany they had 2 psychologists on the ward, you could always walk in for a chat and they were leading in the treatment (psychiatrists only came in now and then, when needed). Here, when there is a minor problem, they would already forcefully drug you (f.e. I have been drugged for praying in the garden or standing on a chair for a moment or wanting to fast). There, when there is a problem, they stay with a person all the time and make sure he’s safe.
  • Jaakko Seikkula with Open Dialogue in Finland. A psychotherapy based approach. 80% of people recover well from a first psychosis. 67% of people never use drugs.
  • Elvin Semrand. He would use psychotherapeutic approaches to help psychotic patients. His point of view: “There are 2 main approaches: A, do something with the problem, with the person who has the problem and help her master it; or B, stay away from the problem, from the person and do something to her.” He chose A.

Yeah but that doesn’t apply to anyone. My psychosis is not the case for example, they can’t reason with me or make me want to change when I’m psychotic, because it usually is accompanied by mania and I feel on top of the world so there’s no risk for change. I went to psychotherapy when I was full blown psychotic and spent all sessions trying to convice the therapist that I was god. Then I stopped going because I thought I had convided him.

My mom approached my current therapist, CBT, that refused to help me psychotic and told her for me to schedulle an appointment when I was better and med complaiant, because if not there was nothing he could do for me and he has experience with sz patients.

So… You can find a lot of things on the internet.

I highly doubt your psychosis was brought on by meds, it was there already, and either you are allergic to them, which sucks, or it was the wrong one. Sometimes it’s hard to find a med that works well.

@77nick77 was at Soteria and doesn’t have good things to say about it. He’s now medicated and a high functioning member of the board, which he wasn’t back then.

So, maybe, just maybe, you need to reavaluate if thats the correct approach to recovery you’re attempting. But it’s your choice, and you’re free to your opinions. I’m just stating mine :smile:

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Well… I do think I need medication NOW, I simply can’t function without them anymore. But I think I did not need medication, especially not something heavy like Seroquel, for “adjustment disorder with anxiety” (as was my first diagnosis). And I strongly believe I would not have needed lifelong meds if I would in an earlier stage have gotten real help solving my real problems instead of meds and nothing else.

Off course, my story does not apply to everyone, I already stated that. But be realistic: neither does yours!! I think it’s a bit strange to say (from such a distance and without knowing my story) my psychosis was not caused by medicine and I was already psychotic. Both my parents and even a psychiatrist and the responsible nurse stated that my psychosis was caused by the medicine withdrawal.

It’s just a fact:

  1. Meds are not needed for everyone with a psychosis (and especially not for people with diagnoses as my original one). Lots of people can come out of psychosis without meds or learn to function with their psychosis. Actually, I once came out of deep psychosis (thinking my parents were devils and not daring to eat or drink anything) just by talking to someone that really listened and comforted me.
  2. Medication withdrawal, especially abrupt withdrawal, can cause psychosis in previously healthy people who were prescribed medication for other reasons.
  3. It is proven that medication makes one more sensitive to psychosis. Your brain adjusts to the medication, makes more dopamine receptors and sometimes less GABA receptors, so you’re more prone to psychosis. Simple fact.
  4. Medication has horrible, horrible effects for some people. Both short term side effects and longterm damage. I find life on medication (I’ve tried several ones) worse than living with strong fear.

I don’t think medication is never needed or never useful. I think psychiatrists should be much much much more aware and much more honest towards their patients about the side effects, the long term damage, the withdrawal syndromes and the alternative treatment options.

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So if you don’t have SZ, why are you posting in this community?


Because I had reactive psychosis and later developped psychotic disorder NOS (and now chronic psychosis if I’m without meds)… which has loads of symptoms in common with schizophrenia and no fora of it’s own. Are people with a different diagnosis but similar symptoms not welcome here?

she had psychosis surely thats enough reason too post here

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Anti-med trolls with an agenda aren’t welcome here.


I beg you pardon? Have you read the personal stories I shared and the responses to other topics? Are people with different opinions then your own not welcome here…?

I am definitely not a troll and am am deeply hurt by this comment, since I have been sharing some very personal fears, stories and comments on this forum. And was surprised by the thoughtful and nice responses of some members.

I am not completely anti-meds, I just believe the medication has had a very bad effect on me personally and I struggle daily with it’s effects on my life. I think doctors should be more critical and honest about meds. I believe there are other ways to help people with psychosis in an early stage of the illness and wanted to share those ideas.

I am quite shocked by this response.

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Where are the role models that conquered schizophrenia without medication? I must admit, I sometimes think I could have recovered from my episodes without it, and think I have taken a shortcut by taking medications. Then I wonder why I conceive of a shortcut as something bad. I love it when I discover a new shortcut in the city I live in, and will take it anytime i can. So I think of having taken medication. But the real question is, of course, whether it was a shortcut to begin with. So again, where are all the rolemodels who gloriously conquered the terrors of schizophrenic psychosis without medication?

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I have read some nice stories about them, and think it would be useful and encouraging for people in early stage schizophrenia/psychotic disorder to read about them, but don’t dare to post anything anymore… :disappointed:

Like I said, one can find a lot of things on the internet, doesn’t mean it’s true.

I’m yet to see a recovered schizophrenic without meds. I see people that battle symptoms without them, but not recovered. I’ve seen here recovered schizophrenics on meds only.

I guess if your diagnosis isn’t schizophrenia there is no way you actually know what it is like to have schizophrenia. The anti med talk is not welcome here because there’s a lot of susceptible people that can go off meds because of it and relapse and learn the lesson the hard way, or even never to come out of it, like some cases we’ve seen here.

It’s not pretty to go off meds in schizophrenia and that shouldn’t be advised to anyone. That’s why we’re being a bit hostile. Hope you get it now.


Occam’s Razor:

  1. You had temporary psychosis that presented as SZ symptoms and the APs meds left you with permanent psychosis. Highly unlikely. Statistically improbable.

  2. You presented with the symptoms of SZ. You were medicated for it. The meds alleviate the symptoms somewhat imperfectly (and this is normal). When you go off the meds you relapse because you have SZ and have just been misdiagnosed. Much more probable statistically speaking.



I think there’s a discussion to be had as to whether antipsychotics are overprescribed/the limits of their effectiveness/whether some can come off them but where Whitaker and others overstep the mark is in their general " meds are ultimately bad for everyone " approach. Yes meds are not perfect,yes they have limitations,yes they may be not needed for some,but for many they are a lifeline and for many going off them even with careful withdrawal can be disastrous .
I personally have little time for the Whitaker/meds are ultimately bad camp or those who see meds as being perfect and without problems.

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Minni, thanks for the explanation.

Pixel, I did not have the SZ symptoms before starting meds. I had anxiety. There are just different roads to psychosis, with different treatment needs and meds have different effects on different people. Some get better with meds, some get worse.

What I CAN understand is that my information can make people go off meds and that it can be dangerous in schizophrenia to go off meds. Sorry for not realising that my story could have that effect, that’s not what I intended.

On second account, I think we do have different views because of a different background. In cases like mine… I would have loved to have information about alternative routes to take besides medication, hopeful stories about people doing without meds and am very frustrated about the lack of information before I took them. I hate the way psychiatry treated me and would have really wanted to know things like these in the beginning of my illness. Something like Soteria or Open Dialogue would have been very good for me.

On the other hand, I can understand, for many people…quitting meds can be a danger. Even with the best of psychotherapeutic methods (Open dialogue is supposed to be really good), there are still people in need of permanent meds. For them I can understand it’s not good to read about quitting meds… and even a danger.

I can understand for some people meds are a Godsend. But for me personally I would have loved if other methods would have been explored first.

It’s way more than 20%

Sorry, I should have been more clear: of people presenting with a first time psychosis. This includes not only people with schizophrenia, but also brief reactive psychosis, postpartum psychosis, etc.