Another short snip about clozapine which begs the important question: what does it feel like

Another snip from
http://bjp.rcpsych.org/cgi/content/full/189/2/184
SHORT REPORTS
Generic clozapine: outcomes after switching formulations
Carol Paton
The British Journal of Psychiatry (2006) 189: 184-185. doi:
10.1192/bjp.bp.105.017079

"
Almost 8% of patients discontinued clozapine after switching but before
the 3-month follow-up period was complete. Although this attrition rate
seems high, it is consistent with the meta-analysis of Wahlbeck et al
(1999); 14.8% of patients in short-term randomised controlled trials and
39% of patients randomised to treatment with clozapine in long-term
randomised controlled trials `left the study early'.
"

Why do patients stop taking clozapine when doctors (and carers) love it
so much? Something that stops a person being suicidal would, if common
sense were what happened in mental health, be something that does that
by making a person's life better. For example antidepressants make a
person less suicidal by lessen feelings of low mood and promoting
feelings of good mood which can help with negative thoughts and
persistent low mood that can lead to suicide.

From personal experience of suicide and parasuicidal behaviour caused
by psychosis and of treatment with high doses of antipsychotics I might
guess at the reason why patients don't like clozapine is because of it's
effect and side effects. I would guess it treats the suicide rate by
leaving the patient somewhat 'zombified' (not a technical term) and
'coshed', i.e like a chemical straightjacket for the mind had been applied.

The side effects of clozapine that affect lifestyle are high compared to
other atypical antipsychotics. All of the problems of other
antipsychotics are worse with clozapine and it causes more mortality. It
works across many neurotransmitter sites and systems in the brain in a
'shotgun' approach whereas a modern targeted third generation
antipsychotic like aripripozole (Abilify) affects a small number of
sites. The shotgun approach means many more areas of the brain and brain
function are affected which may cause the significantly higher level of
side effects and contributes to the reduction in life expectancy caused
as a result of clozapine.

Again it's important to note that to (poor) quantitative science and
people who have not experienced what taking an antipsychotic is like it
is the best treatment and a life saver. For those who have experienced
psychopharmacy, for example someone who's taken 700mg of quetapine
fulminate (Seroquel), its possible to see that treatment may not be what
the patient desires. The medicine is worse than the illness. But many
people are happy on clozapine.