How do antipsychotic drugs have their effect?

Today I’d like to draw your attention to a new paper just published by Moritz and colleagues (link here), which examines how antipsychotic drugs have their effect.

What did it do?

This on-line study involved 95 people, who had experience of taking antipsychotics, completing a questionnaire called the Effect of Antipsychotic Medication on Emotion and Cognition, which asked 49 questions about the subjective effects of antipsychotics. The participants had a range of psychiatric diagnoses, with 69 having a probable diagnosis of psychosis. They appear to have been mainly recruited through moderated German discussion forums for psychosis and other psychiatric disorders.

What did it find?

  • “patients strongly and rather consistently attributed a dampening of emotion,
    clouding of cognitive faculties and decreased joy to antipsychotic treatment”
  • “patients reported that antipsychotics decreased their emotionality, creativity and also exerted a detrimental effect on their cognitive faculties”
  • “Negative effects largely prevailed”
  • “patients reported that they were more doubtful due to antipsychotics”

[the measure of doubt included items such as mistrusting one’s own thinking, being indecisive about what is wrong, higher self-doubt]

  • “the majority of patients reported somewhat greater hard-headedness under antipsychotics”

[the authors explain their term ‘hard-headedness, by indicating that people predominantly endorsed the response option “narrow-minded and not open to other ideas”].”

  • “Doubt, numbing and withdrawal were the main subjective antipsychotic effects”

What do the authors conclude?

The authors conclude that “The induction of doubt and the dampening of emotion may be one reason why antipsychotics reduce positive symptoms” and note that their findings of reported antipsychotic effects including cognitive and emotional numbing, and social withdrawal are “disquieting”.

Limitations of the study

The authors note that the limitations of their study mean that they “have to refrain from bold conclusions”.

The first limitation was “that self-report assessments might be problematic in psychosis patients, as they have been consistently shown to lack metacognitive awareness”.

But this seems to suggest that people diagnosed with psychosis can’t be relied on to accurately report their experiences of antipsychotics being problematic, which is at best a questionable statement. Also, if a person said antipsychotics worked for them, would anyone question whether they were right on the basis that they may be saying this due to a lack of “metacognitive-awareness”?

The authors also note another important limitation, namely that the Internet population (where they recruited people from) “is probably different from a clinical population as it contains a subgroup of subjects who are not willing to undergo treatment and are thus less compliant with the psychiatric health care system”.


It is clear we need better ways to help people. And we need them yesterday.



I’d encourage you to read the paper for yourself. The reference (and link) is:

Moritz, S., Andreou, C., Kilngberg, S., Thoring, T., Peters, M. J. V. (2013). Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect? Neuropharmacology.

If you can’t access the paper on-line, I’m that sure if you emailed the authors that they would be happy to send you a copy for your own examination.