My cousin is schizophrenic. He never stays on his meds very long. It is only a matter of time before something bad happens to him. I wonder if it would be possible to make an implantable device that would deliver meds so that he could be on them for more than a month or so. Note I am only asking if this is plausable. I know that it may or may not be ethical, but that would be a GD thread.
From a strictly technical standpoint, yes, it’d be just like an insulin pump. However, the treatment of diabetes is significantly more simple than the treatment of schizophrenia, and there may be medical reasons why you wouldn’t want to do this in addition to the ethical concerns.
Edit: That’s just the implant. It still needs to be filled with the medicines, and that has to be done by a person.
Currently they can use depot injections of antipsychotic medications in the treatment of schizophrenia where the patient doesn’t take their meds reliably. Depot injections are deep intramuscular injections that are slowly absorbed into the body. I believe they’re usually done every two weeks.
When starting a depot injection you have to be careful with using the correct dose, as you can’t “take back” or “decrease” the dose once it’s given. If the dose is a little too high and causes excessive side effects, it still takes a few weeks to wear off.
A family member of mine takes his medication in monthly injections. I am not sure of the medication name. He has been diagnosed schizophrenic, but I believe his most recent diagnosis was schizoaffective disorder.
One thought of mine is that those patients who might most need what you are proposing would probably be the ones least able to afford it.
This thread will end well.
Why not? The thread is in General Questions and it’s about the technical plausibility, not the ethical or other implications.
Yes, they already have depot injections that last for several weeks.
I know there is work on implantable medical devices to release drugs, but I don’t know if they are on the market or not.
The technical barriers probably aren’t insurmountable, but the patient still has to go back and get the injection or implant. If the patient doesn’t like the effects of the medicine, simply changing to a monthly dose won’t solve the problem.
I’m just reminded of a thread where I broached this exact concept. The reactions to my post started with someone promising to use deadly force to defend himself against me. It actually cooled down from there.
I’m guessing that implanting a device in a person who believes that CIA aliens are implanting devices in his brain is not a recipe for success.
What is it about schizophrenia treatments that are significantly more complex than treating diabetes? I’m just curious because insulin pumps are highly manual critters that are not particularly simple at all.
And either way… I don’t think this is what the OP is looking for. A pump can be ripped off in about half a second. It seems the OP is looking for something a bit more permanent than that.
You are right about the practical problem of getting schizophrenics to stay on their medications.
I would not personally consider there to be a large ethical dilemma here. There is a formal evaluation process already which removes autonomy from people who are truly mentally ill in order to protect them, and it’s likely that is the process which would be followed.
There are other considerations for any sort of surgical procedures or external devices for the mentally ill; any drug administration device would have to be completely implantable, and I suspect research is being done although I am not familiar with it.
Depot medication (a large bolus of medicine injected deeply in a slow-release carrier vehicle that medicates the patient over a period of weeks) has long been used for various psychotic illnesses, for obvious reasons. Here are a couple of sample articles you may wish to peruse:
The first one essentially makes the point that depot medications are effective and useful; there is an increase in motor disorder side effects but in general there is a slight global advantage to using them.
I’m speaking outside of my area of expertise here, so take this with a grain of salt until an actual expert comments on this, but as I understand it, insulin has pretty much the same effect on everybody with a similar degree of insulin sensitivity. So to treat diabetes, you pump in enough insulin to keep the patient’s blood sugar levels stable and then stop. You have to monitor their health to be sure that it’s not getting worse, but that’s pretty much it in a nutshell.
Psychiatric medications, on the other hand, have a significantly wider range of effects, and there’s much more individual variation in how people respond to them. Furthermore, that response can change over time. So simply putting a bunch of a particular drug in a device and having it slowly released might be good, or it might be bad, or it might be good sometimes and bad at other times. That’s where the complication comes from.
More like a pacemaker, then. The point is that we already have implantable medical devices like the one being proposed, so the barriers aren’t technical.
Heh, nope, that’s not at all what insulin therapy is like. I don’t want to hijack this thread, but insulin therapy varies widely with every individual, and can vary from day to day for the same person. It varies with what you eat, your activity level, and your own personal physical needs. Whether on multiple daily injections or using a pump, insulin therapy requires a lot of training and knowledge, and blood sugar levels must be monitored and (if off) corrected multiple times a day or risk unpleasant and possibly very destructive highs or lows. It’s not at uncommon to do more or less the same thing, eat the same food, and use the same amount of insulin from one day to the next and have your blood sugar be wildly off for no good reason at all.
So, in short, it’s anything BUT simple. Many people have a hard time with it, which is why I asked why schizophrenia treatments were significantly more complex - people of sound mind can have a hard time with insulin therapy, I couldn’t get my head around someone suffering from schizophrenia handling the day-to-day complexity of insulin thereapy much less something MORE difficult.
(For the record, I’m diabetic, I use a pump, that’s where I get my info.)
Do we? Pacemakers are electrical devices, they don’t need to be filled with medication. Do we really have anything that’s implanted far enough under the skin that it’s difficult for an individual to remove and can be filled with medication easily?
(I hope you don’t think I’m picking on you, ultrafilter! You just bring up some topics that intrigue me… I’d be all for something that did a better job at delivering medication…)
What about something like Norplant - birth control that is implanted silicone capsules/rods filled with the medication, which is released over a period of years.
Maybe this is something to research? I don’t know if something that long-term would be appropriate for schizophrenia, since their condition will vary over that long a period, side-effects may appear requiring the dosage to be changed or discontinued, and other medications may be required at the same time.
ETA: I read further on the Wikipedia article and it appears it’s easy to remove the capsules ahead of schedule. Also, they are implanted subdermally (just below the skin), so I guess a patient who really didn’t want them there could find a way to dig them out on their own.
I’m no expert, but I think the fundamental difference between insulin and schizophrenia treatments is that when done right insulin doesn’t have any inherent negative side effects. On the other hand, schizophrenia drugs do remove something from the subjects personality that they may to some degree cherish. I’m not saying that having that something is worth, well, being psychotic, but I can understand missing the creativity or whatever.
And even someone basically committed to staying under treatment might be tempted reduce their meds to try and get closer to the line where they stay under control but have less side effects. And of course, the problem is, slipping on the wrong side of the line makes it more difficult to recognize that you’ve done so, and more difficult to get back.
So, yeah, I can understand how schizophrenia treatment is more challenging than diabetes treatment.
Not all schizophrenics are delusional all the time.
Well, except that part where if you don’t get it quite right (which is easy to do - can you look at a plate of food and accurately figure out how many carbs are on it?) and don’t notice it in time, you could die. Or if you forget a dose, you could die (as happened to Casey Johnson recently) 
But let’s not turn this into an insulin-versus-schizophrenia debate. Diabetes has its challenges, and it can be frustrating, but schizophrenia is hands-down more horrible in all ways in my opinion, at least. The only reason I pipe up about the diabetic stuff is that there’s a lot of misinformation about it, and if I can’t try to fix that here where we’re dedicated to fighting ignorance, where can I?
We’re dealing with several different kinds of crazy here, but I don’t think medication noncompiance via do-it-yourself surgery would come up much for any of them.
First, there’s the guy who won’t take his meds because he thinks they’re really nanobots from the dreaded CIA aliens. Someone that out of touch with reality should probably be inpatient, where a nurse will give him meds orally or as a shot–no implant needed; that is, if they can legally medicate him at all. (Legally means sweet talk him or get a court order.)
Second, there’s the guy who won’t take his meds because their side effects are worse than being terrified of the CIA aliens. He needs a psychiatrist who’ll take the time to talk to him and takes his concerns seriously. There are lots of medications, and everyone’s body is different; if olanzapine makes him throw up, maybe risperidone is worth a try.
Then there’s the guy who is willing to take the meds, but isn’t quite organized; he forgets to take them, misplaces the bottle, etc. That’s someone who could use depot antipsychotics, a visiting nurse, or our hypothetical med dispenser implant.
Figure9, do you think a visiting nurse or, as previously mentioned, depot meds might help your cousin?
IANAPJALM. (I am not a psychiatrist, just a lunatic magnet.)