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Antipsychotic Drugs and Tardive Dyskinesia

Antipsychotic Drugs and Tardive Dyskinesia Scientific Literature 

Antipsychotic Drugs and TD Resources Center

 

See Section (21) on Withdrawal Symptoms including Behavioral Abnormalities in Children and the Unmasking of Anguish, TD, Psychosis, Cognitive Deficits, and Dementia

 

Table of Contents

  1. TD rates among healthy young adults on antipsychotics
  2. TD rates among older adults on antipsychotics
  3. TD rates among children on antipsychotics
  4. New “atypicals” harmful as old antipsychotics
  5. Cognitive dysfunction, dementia, tardive psychosis and brain damage from antipsychotics
  6. Antipsychotics damage the basal ganglia
  7. Tardive Dystonia
  8. Tardive Akathisia
  9. Neuroleptic Malignant Syndrome (NMS)
  10. Early reports of Risperdal-induced TD
  11. James McCracken, defender of child TD
  12. Case against Johnson & Johnson
  13. Standards of care for preventing TD
  14. Physicians often fail to recognize TD
  15. Dr. Peter Breggin’s TD work
  16. TD’s many manifestations and courses
  17. Historic Documents: Delay & Deniker vs George Crane
  18. The Ongoing Debate over Safety and Efficacy of Antipsychotic Drugs
  19. Mortality, Sudden Death, and Other Physical Harms (Excluding Brain Damage
  20. Forcing Patients to Take Antipsychotic Drugs
  21. Withdrawal Symptoms from Antipsychotic Drugs
  22. Predisposing Factors

 

(1) Tardive dyskinesia (TD) rates in adults are very high. Note the “authoritative” sources that confirm high rates, including the American Psychiatric Association (see documents labelled APA). TD occurs in young adults up to age 40 at a rate of at least 5–8% per year, accumulating with a risk of 20%–24% after four years (American Psychiatric Association, 1992, pp. 67-8; Chouinard et al., 1988 for the higher rate; Wojcieszek, 1998). TD annual rates rise steeply for middle-aged people: “For a 40-year-old patient, the risk is 18% at 2 years [9% per year] and 30% at 4 years” (Wojcieszek, 1998, p. 220). In patients older than age 45 years, “the cumulative incident of TD after neuroleptic exposure is 26%, 52%, and 60% after 1, 2, and 3 years, respectively (Wojcieszek, 1998, p. 220).

 

(2) TD rates in the elderly are astronomical. Tardive dyskinesia in the elderly is one of the worst medical catastrophes. In controlled clinical trials, rates for the elderly for TD exceed 20% per year, and accumulate year after year. In addition to the Black Box Warnings about increase mortality in elderly patients for all antipsychotic drugs, the risk to patients is enormously greater than any possible benefit. Numerous studies confirm even more tragically high rates of TD in people 55 and older: 41% in 24 months (Yassa et al., 1988); 35% in 20.7 months (Yassa et al., 1992); and 26% in 12 months (Jeste et al., 1993). The elderly may develop tardive dyskinesia after 2 weeks exposure (Saltz et al., 1991) and probably after a day or two in my clinical experience.

 

(3) TD rates in children are similar or higher than in adults. In one of my earliest medical books (P. Breggin, Psychiatric Drugs: Hazards to the Brain, Springer, 1983), I marshaled evidence for the first time about the high risk of tardive dyskinesia in children. Since then, “authorities” routinely admit that it is risk, but too many negligent prescribers act as if it is not. Estimated TD prevalence rates in children vary widely but are generally very high at “8%-51% of antipsychotic-treated children and adolescents” (Cozza et al., 2003). p. 1422).

 

(4) Scientific studies confirm that “atypical” antipsychotic drugs cause typical extrapyramidal reactions (EPS) and TD. In addition to the scientific studies, Full Prescribing Information are provided for Risperdal, Abilify (aripiprazole) and Saphris to show that they block dopamine type 2 neurons and that they are considered to cause TD by the FDA. Indeed, all so-called atypicals are dopamine blockers and therefore they cause TD. For example, J&J (Johnson & Johnson), their medical consultants, and scientifically alert prescribers from the beginning should have known that Risperdal (as well as other so-called atypicals) would cause tardive dyskinesia at a high rate. From the beginning, the FDA-approved Risperdal label or Full Prescribing Information stated that Risperdal was an “antagonist” (blocker) with “high affinity” for “Dopamine Type 2 (D2).” That is, Risperdal is a potent blocker of D2 neurons and therefore would inevitably cause TD. Similarly, Abilify’s label states that the drug “exhibits high affinity for dopamine D2…” A new drug Saphris has similar observations and all three have warnings about TD. In addition to the studies cited in this group, see group (10) below with more than two dozen reports of tardive dyskinesia caused by Risperdal published prior to 2005.

 

(5) Permanent brain damage and dysfunction, including cognitive dysfunction, dementia, tardive psychosis, and atrophy (shrinkage) of brain tissue with cell death caused by antipsychotic drugs. Brain atrophy can occur early in treatment even before TD develops. I was among the first to warn about the risk of antipsychotic drug-induced dementia and atrophy of the brain in my 1983 book, Psychiatric Drugs, and I have continued to document this risk in my most recent textbooks, Brain-Disabling Treatments in Psychiatry (2008) and Psychiatric Drug Withdrawal (2013). These drastic, tragic outcomes are the result of the extreme neurotoxicity of the antipsychotic drugs.

A. Cognitive Dysfunction and Dementia

B. Tardive Psychosis [Also see section (21) below]

C. Atrophy (Shrinkage) of the Brain in Animals and Humans (Adults and Children)

D. Neuroleptic-Induced Deficit Syndrome (NIDS), Behavioral Toxicity, and Overall Suppressive Effects on Behavior and Willpower

E. Antipsychotic drugs especially damage the basal ganglia where the dopamine neurons originate. Tardive dyskinesia results from the permanent hypersensitivity and proliferation of these neurons as a compensatory reaction to the suppression and dysfunction caused by the antipsychotic drugs. A rudimentary knowledge of the function of the basal ganglia informs us that the dopaminergic nerves in the basal ganglia provide a main nerve trunk into the frontal lobes, as well as affecting the temporal lobes and other regions of the brain involved with memory, cognition, and all the higher human functions. It is no surprise, therefore, that tardive dyskinesia, a manifestation of damage to dopaminergic neurons, also causes cognitive deficits and even dementia. Here are a few of many scientific studies of the complex functions of the basal ganglia and the dopaminergic neurons that originate in them.

 

(6) The Vulnerability of the Brain to Injury by Antipsychotic Drugs. It was known from the earliest research that antipsychotic drugs (neuroleptics) were extremely neurotoxic or deadly to brain function and anatomy. See Part (17).

(7) Tardive Dystonia is a variant of tardive dyskinesia (TD) that has been recognized for decades in the scientific literature. It shares many basic characteristics with TD in general, except it is characterized by tension and spasms in the muscles, and can be very painful. Some of the articles in this section will make comparisons to “classic TD” and some will discuss the rates.

 

(8) Tardive Akathisia is a variant of tardive dyskinesia that has a powerful emotional component. An inner agitation that feels like being tortured from the inside out drives people to keep moving in a vain effort to find relief. Attempts to describe these feelings often impress hasty diagnosticians as evidence for delusions and hallucinations. Many such patients end up getting more of the drug that is driving them over the edge. The movements vary from running and pacing to tapping feet, wringing hands or squirming. I have seen people contain them for a while with great effort. Other people end up with the agitated feeling, even though they have not been or are no longer feelings driven to move about. Although little is written about it, I have found that paresthesias (abnormal feelings in the skin) often go along with akathisia, including crawling and burning sensations that may at times be felt inside the mouth as well. This condition is caused by both SSRI antidepressants and antipsychotic drugs. Among the antidepressants, Paxil may be a special offender. Among the antipsychotic drugs, Abilify is far the clear leader in causing it. The Full Prescribing Information for Abilify, found in this section, even calls it “common.” So does an Abilify advertisement contained here. Akathisia always worsens a person’s condition and can lead to psychosis, violence, and suicide. These dreadful outcomes from both SSRIs and antipsychotic drugs were recognized in the APA’s Diagnostic and Statistical Manual of Mental Disorders found in this section.

Akathisia can be acute without turning into chronic tardive dyskinesia. Acute cases usually started in the first three months of treatment, sometimes with the first dose. There is no clinical difference in how acute akathisia and tardive akathisia feels to the person or looks to the clinician, so I have included some poignant articles on acute akathisia to also emphasize how horrible tardive akathisia also feels. If akathisia appears after several weeks or months, it is important to consider it tardive akathisia until proven otherwise. Not everyone with akathisia will display the compulsion to move about. Many patients suffer an inner torment similar to akathisia without looking hyperactive.

 

(9) Neuroleptic Malignant Syndrome (NMS). Although neuroleptic malignant syndrome (NMS) is not a form of TD, if the individuals survive, NMS can leave them with a wide variety of symptoms associated with TD, including abnormal movements and cognitive changes. The classic symptoms of neuroleptic malignant syndrome are (1) fever; (2) abnormal movements, such as rigidity, Parkinsonism, and TD-like reactions; (3) worsening mental status, and (4) autonomic nervous system dysfunction, such as rapid respirations, elevated pulse, unstable blood pressure, chills, sweating, and incontinence. However, in my clinical experience and confirmed in the literature (Levinson and Simpson, 1986, see below), NMS or NMS-like disorders caused by antipsychotic drugs can have many variable forms, intensities and durations. These drug-induced disorders, with or without a fever, must be recognized and the medications removed in order to prevent serious and potentially lasting harm.

I was probably the first scientist to observe that an acute case of NMS is indistinguishable from an acute episode of an epidemic called lethargic encephalitis that was recognized during the First World War and spread during the following decade (see my 1993 article in this section).

 

(10) Early Reports of TD Caused by Risperdal, Abilify and other “Atypicals.” One of the false claims made by drug companies and their psychiatric advocates is that Risperdal, Zyprexa, Abilify, Seroquel, Invega and other “atypical” antipsychotic drugs do not cause TD or cause it rarely. This section contains articles demonstrating that the atypicals do in fact cause tardive dyskinesia at a significant rate.

A. Risperdal. For the purpose of demonstrating how long it has been known that Risperdal causes TD in children and adults, these articles were published before 2005. Many more have been published since.a

B. Abilify

 

(11) James McCracken recently testified for the defense in a malpractice case involving tardive dyskinesia in a child. The case, in which I was an expert for the plaintiffs, was settled in trial shortly before I was scheduled to testify. Here are scientific articles jointly authored by McCracken favoring Risperdal for children with autism. These articles also mention some of his affiliations with drug companies; other times he avoids listing them. Check with Dr. Breggin for more information in this regard.

 

(12) Criminal and civil fines imposed on Johnson and Johnson, or J&J, (and subsidiary Janssen) for false marketing of Risperdal, leading to massive off-label, negligent use for children and the elderly, and all age ranges in general. J & J secretly and illegally paid Harvard psychiatrists Joseph Biederman, Thomas Spencer, and Timothy Wilens to promote Risperdal to children for the invented diagnosis of childhood bipolar disorder (Sarchet, 2011; Yu, 2011). This caused a forty times increase in children diagnosed with bipolar disorder between 1994 and 2003 (Moreno et al., 2007).

 

(13) Standards of care for preventing TD in children, adults and the elderly are well-documented. Here are a few psychiatric sources that are particularly useful from the American Psychiatric Association. Of special interest are three publications from the American Geriatric Society (AGS) concerning the Beers Criteria for medication use in the elderly, which make clear that antipsychotic drugs should be “avoided” in treating the elderly. This folder contains a Beers Criteria article from 2012 and 2015. A second 2012 article intended for the public provides an excellent summary.

 

(14) Physicians and patients often fail to recognize or document TD. Neurologists, who often depend on psychiatrists for referrals, will often go to extremes to avoid actually diagnosing a patient with TD. I have seen cases in which everything in the patient’s history and clinical findings indicate TD but the consultant psychiatrist or neurologist refuses to make the specific diagnosis. Here is one article about non-recognition of TD by psychiatrists and two articles about the failure of patients to recognize their own symptoms.

A. Doctors and patients fail to identify obvious symptoms

B. Specific symptoms doctors often fail to recognize

 

(15) Dr. Peter Breggin’s work. The best sources of my current research on these subjects are in two of my more recent books, Psychiatric Drug Withdrawal (2013) and Brain-Disabling Treatments in Psychiatry, Second Edition (2008). I am also including a few of my articles that deal with antipsychotic drug adverse effects, including tardive dyskinesia, tardive psychosis and tardive dementia.

 

(16) Tardive dyskinesia has infinite manifestations and a varied course. The shape-changing, manifold manifestations of TD are demonstrated in many of the citations in this TD Resource Center. Here are some useful descriptive sources, especially the WHO citation:

 

(17) Historic Documents. Tardive dyskinesia should have been widely recognized by psychiatrists within the first few years when the drug was already being prescribed to millions of patients (1952-1954); but resistance was strong until 1970, and today too many psychiatrists continue to ignore it and fail to warn patients and their families. Ironically, the pioneers of the antipsychotic/neuroleptic drugs, starting with Delay and Deniker in 1957, began openly comparing the neurotoxic effects of the drugs to a highly neurotoxic deadly epidemic called lethargic encephalitis that afflicted one million people during and for a decade after WWI. Although the abnormal movements caused by the epidemic often became permanent and looked exactly like the symptoms in their drugged patients, Delay, Deniker and psychiatry in general nonetheless kept denying that the abnormal movements or other disorders caused by the drugs were permanent or, indeed, anything to worry about. This historic section presents articles by the unscrupulous pioneers, Delay and Deniker; and then articles by George Crane, the psychiatrist who finally blew the whistle on tardive dyskinesia, and made sure he got heard. Finally in 1980, 22 years after the first published articles describing the neurological disorders inflicted on the patients, the American Psychiatric Association published a Task Force Report on the pandemic drug-induced usually irreversible disorder called tardive dyskinesia.

A. Delay & Deniker vs. George Crane

B. Earliest Reports and Discussions of TD

 

(18) The Ongoing Debate over Safety and Efficacy of Antipsychotic Drugs. In my early books, Psychiatric Drugs: Hazards to the Brain (1983) and in Toxic Psychiatry (1991), I concluded that antipsychotic drugs were ineffective and much too harmful to be routinely used in psychiatry, if at all. In scientific papers, I pointed to their ineffectiveness and brain damaging effects. I emphasized the remarkable similarity between antipsychotic drug effects and the neurotoxicity of the pandemic called lethargic encephalitis that began toward the end of World War I and continued for several decades (Breggin, 1990 & 1993, see below in this section). This section will provide a sampling of scientific papers and more recent blogs especially relevant to the dangerousness and ineffectiveness of the medication. The blogs I will cite are more rational and scientific, often with more documentation, than the so-called scientific publications generated by the Pharmaceutical Empire.

 

(19) Mortality, Sudden Death, and Other Physical Harms (Excluding Brain Damage) (in progress, much more to come).

A. Adults

B. Children

 

(20) Forcing Patients to Take Antipsychotic Drugs

 

(21) Withdrawal Symptoms from Antipsychotic Drugs is Associated with Emotional Suffering, Behavioral Worsening, Psychosis and Dementia. When withdrawing from antipsychotic drugs, patients commonly experience dreadfully painful emotional reactions of a wide variety including despair, depression, paranoia, and severe anxiety. They often have unbearable physical feelings. The withdrawal can unmask temporary or permanent symptoms of worsening behavioral problems in children (see Gualtieri 1988, p. 148). Withdrawal can lead to temporary abnormal movements or to the unmasking of permanent tardive dyskinesia. It can unmask cognitive dysfunctions and dementia which may or may not subside, and tardive psychosis that can be temporary or permanent. Misled patients and families fear that the drugs are necessary when they are in reality causing these symptoms that become apparent on withdrawal. These patients do not need a resumption of the drugs; they need help in withdrawing from them permanently. For the most comprehensive review of withdrawal symptoms from psychiatric drugs, see Dr. Breggin’s book, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.

 

(22) Predisposing Factors

 

 

Antipsychotic Drugs and TD Resources Center

 

 

WARNING:
Psychiatric drugs are not only dangerous to take, they are also dangerous to withdraw from. Withdrawal from psychiatric drugs, including antipsychotic drugs, should be done cautiously with professional supervision.Please see my book, Peter R. Breggin, MD, Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.

 

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