Tag Archives: neuroleptics

The efficacy of neuroleptics. Why a change in injection technique might settle a score between biological and social psychiatry.

Mental health nurses have been involved in the administration of depot neuroleptics ever since the first depots were designed in the 1960s. They are given by a deep intramuscular injection into the gluteal muscle every fortnight or so and are particularly useful for people with schizophrenia who we believe are not to be trusted with remembering to take their medication by themselves.


There appears to be a shift at the moment in the UK in the way depots are administered, away from an injection in the gluteus maximus (the dorsogluteal method, using the upper outer quadrant method to correctly site the injection), to the injection being given in the gluteus medius (the ventrogluteal or hip site, midway between the top of the hip bone and the crest of the pelvis). The old method is relatively more dangerous (the sciatic nerve is nearby, there is a large blood supply to this muscle), and we now also know that the chances of actually injecting the muscle using this method are quite poor, because there is a large amount of subcutaneous tissue around this muscle. One study has shown that as many as 19 out of 20 people might be being injected into fat rather than muscle. On the other hand, the ventrogluteal method is safer because there are no major nerves are arteries nearby, and we can inject into the muscle with greater confidence as there is less subcutaneous tissue around the gluteus medius. In short, we’ve not actually being treating people with the correct dose of neuroleptic for years, but now we can because we’re going to use a site that is more effective.


So this change in technique might lend weight, one way or another to the debate about whether neuroleptics actually work. The commonly held belief about neuroleptics is that they help regulate dopamine and other neurotransmitters in the brain, an overexcitation of dopamine being responsible for the so called positive symptoms of schizophrenia, such as the hearing of voices or having unusual thoughts. Some people take the view though that there is poor evidence to support this theory. A purely biological explanation for schizophrenia is unsatisfactory. Schizophrenia is a complex ‘illness’ which can be explained just as well in psychological or sociological terms than by the medical model. In fact, some say, there is no such thing as schizophrenia, and it’s not very helpful to be labelled so. Some service users will say that neuroleptics have never helped their voices go away, and some do not actually want this to happen anyway!


If you believe that neuroleptics help reduce the symptoms of schizophrenia, but now know that people on depots have not been receiving anywhere near the correct dose, what has been keeping people well for so long? Have people been well? Have we been actually defining wellness based on how willing the recipients of depots have been to drop their trousers every fortnight?


If you don’t believe that neuroleptics work, knowing that they’ve not been given correctly anyway adds a little bit of weight to your argument. But now that people are going to receive the correctly prescribed dose, we should be able to tell once and for all whether they work.


Although this is clearly an oversimplified way of looking at just one element of a well documented debate, think about this – how would you feel if you found out that the injection you were receiving (often unwillingly) for many years, wasn’t actually being given properly?