9 ms·

The Most Popular Drug in America Is an Antipsychotic

105 points by samclemens 12y ago

meepmorp 12y ago
> [Thorazine] was an antipsychotic given to mentally ill people, often in institutions, that was so sedating, it gave rise to the term "Thorazine shuffle." I think the term "Thorazine shuffle," refers to the characteristic locked-knee shuffling gait that develops because Thorazine frequently causes tardive dyskinesia as a side effect. Edit: ignore this, see below; though, the drug does induce discomfort and restlessness in the limbs that prompts patients to pace around.
- rosser 12y ago
  It's tardive dyskinesia, and the term is typically used to denote the facial tics that are a sometimes permanent side effect of older antipsychotics. The "shuffle" is a separate effect, and calling it that is often regarded as pejorative.
  - kaffeemitsahne 12y ago
    If you're not mad already a proper dose of Haldol will make you look (and feel) it.
ef4 12y ago
I have heard that people in post-acute care (think nursing homes) frequently end up taking Seroquel because it appears on their hospital discharge paperwork, despite never having any diagnosis of psychosis. It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years. (Source: I sell software to long-term care facilities and their pharmacists.)
- logn 12y ago
  I've had periods of insomnia. Personally, I liked https://en.wikipedia.org/wiki/Trazodone https://en.wikipedia.org/wiki/Trazodone and it comes in generic. I've only ever needed to use it on a short-term basis. Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
  - oldspiceman 12y ago
    This is a great read for anybody with issues sleeping. The vast majority of sleep problems are in your head and after reading this I never had another issue. He debunks the utility of sleeping pills and give you lots of strategies for improving your sleep. http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0805089586 http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0...
  - thret 12y ago
    I think you've got the wrong approach. Sleep is a waste of time! If you can't sleep count your blessings and do something productive.
    - lotsofmangos 12y ago
      I sometimes get severe insomnia. After the third day, the most productive thing I could do is menace in a deranged and hallucinatory fashion anybody who dares hand out this kind of advice.
      - thret 12y ago
        I've always had what you might call severe insomnia. I rarely sleep for more than four hours, and I've found I do pretty well on two. As far as I know I've never slept eight without either being up 2-3 nights beforehand or being very, horribly drunk. In my experience if you are not sleeping, staying in bed will just make you more tired. It is better to embrace it, get up and do something. So that's where I'm coming from, I'm sorry if it caused offence. Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
- hga 12y ago
  I have really bad insomnia, due to genetic anxiety and depression (apparently "of a bipolar nature", but only a drug can make me manic), and without a low dose of Seroquel before bed I'd only be getting ~4 hours of sleep a night (and my anxiety would be much worse). It's been pretty much a life saver. Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous. As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
  - derefr 12y ago
    > apparently "of a bipolar nature", but only a drug can make me manic Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
    - hga 12y ago
      There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day). One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me). Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough. As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336/ http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.
amelius 12y ago
Does anybody know of natural drugs against depression? So far I have only found lavender oil, sardines and chocolate to work.
- intopieces 12y ago
  Saint John's Wort in conjunction with therapy is one that comes to mind. All antidepressants should be combined with active, regular therapy. Often the cause of depression is not chemical imbalance, but an actual issue in the person's life.
  - duckingtest 12y ago
    Warning: Saint John's Wort can cause cataracts if used for a long time.
    - 6581 12y ago
      That is highly disputed - there is only one study suggesting a correlation (not causation).
      - duckingtest 12y ago
        The causation is simple - hypericin becomes toxic when activated by light. While that doesn't mean that it definitely causes cataracts, given available data I think it's more likely that it does. http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/19739671 http://www.ncbi.nlm.nih.gov/pubmed/19739671
  - jsmeaton 12y ago
    > Often the cause of depression is not chemical imbalance, but an actual issue in the person's life. Not trying to be contrary, but do you have a source?
    - oldspiceman 12y ago
ladzoppelin 12y ago
The title is misleading. Abilify is being prescribed for people who are already on SSRI's for depression because the combination helps accelerate recovery and not because these people need traditional anti-psychotic medicine. With this headline you give people a reason to be hesitant before asking for help.
- slazaro 12y ago
  Nevermind the fact that alcohol and coffee are way more popular drugs.
- joesmo 12y ago
  There's no proof of this. I think that's why the article is titled this way.
JumpCrisscross 12y ago
A few months ago I succumbed to a particularly drawn-out case of the hiccups. Two nights in, sleepless from constant hiccuping, I made it to the ER. The cause was heartburn, triggered by an earlier night of celebratory drinking, irritating my esophagus. The irritation was close enough to my diaphragm to stimulate it. One dose of thorazine, given by the ER doctor, and the hiccoughs subsided. Thorazine dampens the vagus nerve. This was the intended effect. Less intended was my complete lack of motivation to do anything outside the confines of my apartment for the rest of the weekend. (I also took great interest in my neighbourhood parks, for once.)
- derefr 12y ago
  Fascinating... and makes me wonder whether anyone has experienced hiccups as a side-effect of amphetamines or other dopamine agonists.
  - girvo 12y ago
    Yes, I have. Also, nictotine oral sprays are known to cause them as well, quite consistently.
phren0logy 12y ago
I'm an MD who specializes in Psychiatry. Although much of this article is somewhere between a little and a lot inaccurate, the basic premise that an absurdly expensive antipsychotic is the most popular drug is alarming. It is a useful and effective medication with a clear role for a relatively small subset of the population. Why it is being prescribed so widely is a question worth asking.
- hga 12y ago
  If you read the article carefully, and/or click through, you'll find it's only #1 in dollar sales, it's still on patent until April or so. I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.
  - refurb 12y ago
    On a per prescription basis acetaminophen plus hydrocodone is the top selling drug.
    - andyzweb 12y ago
      I tried my google-fu at this. what is your source?
      - deleted 12y ago
        [deleted]
      - dmix 12y ago
        Here, most units sold: http://www.drugs.com/stats/top100/units http://www.drugs.com/stats/top100/units acetaminophen/hydrocodone is #2 budesonide is #1 which is used to treat asthma (in puffers I believe). I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
mrbrowning 12y ago
I used to work in a pharmacological research lab, and while I'm frequently discomfited by the misalignment between commercial incentives and social good in the pharmacology industry, this statement isn't quite fair: > Everyone has heard of "mission creep." In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one. This is more accurately referred to as "drug repurposing," and it's hardly the unalloyed evil that it's characterized as here. It's true that drug companies love to repurpose existing FDA-approved drugs, both because it saves them money and because it typically permits them to patent the compound again in a new context, but there are nonetheless real benefits to the public at large when a drug whose side effects are comparatively well-characterized over the long term is put into service to treat a different malady.
- hga 12y ago
  To take the atypical anti-psychotics as an example, it turns out they or at least some of them are good mood stabilizers, i.e. can be used to treat bipolar disorder (manic depression). And while they have their fair share of nasty side effects, there pretty much aren't any nasty side effect free mood stabilizers....
  - djur 12y ago
    I was prescribed an atypical antipsychotic* originally for bipolar disorder in my late teens. At the time, it was an absolute lifesaver. I had almost completely lost my ability to function, and the treatment brought me back to an operating state sufficient to complete high school without completely sinking my GPA. I had to stop using it because of unacceptable side effects (rapid weight gain and sexual dysfunction), and it took me a long time to find something else that worked as well. The medication that ended up working for me was originally developed as an anticonvulsant. My symptoms lessened over time in adulthood, but if I hadn't had the course correction provided by repurposed 'Big Pharma' medications I would be living a much harder life. *: I'm not naming medications because I don't want to promote them. What worked for me isn't necessarily what will work for anyone else.
spiritplumber 12y ago
It was a shock for me to have worked in the US for a few years, and slowly realize that I was in the distinct minority in my circle of friends in not taking any medications consistently (I'm in my thirties). Made me think of Brave New World.
- maxxxxx 12y ago
  I have noticed that too. It's pretty much standard that people take at least some prescription drugs regularly. Also the children of some friends know all the ins and outs of different pills. I don't think I ever had had a headache pill when I was the same age.
- kaffeemitsahne 12y ago
  That's pretty shocking indeed. So what do these people think of their own med use? When I was on antipsychotics I couldn't wait to get off of them, and my psych was very supportive regarding that.
- mercer 12y ago
  I'm Dutch, but I grew up with many Americans around me. It always shocked to see the huge amount of pill-bottles in the bathrooms of my American friends, and how much part of daily life these things were. Anti-bacterial wipes for everything, pills at the smallest sign of illness (even just the sniffles), copious use of sleeping aids, and so on. In my upbringing (which was kind of 'typically' Dutch), we took medication as a last resort. Even painkillers were not something you took unless your headache was unusually bad. I have no doubt that this is also changing in Holland, especially when it comes to prescription drugs for psychological issues, but in general it seems a bit healthier to me to allow the body to take care of itself when it can, rather than stuffing it with foreign bodies that often have all kinds of adverse side-effects. This state of affairs often makes me think about how malleable societies really are, for both good and bad, and how much variation there is even within 'Western-European' nations.
joesmo 12y ago
"The standardized United States Product Insert says Abilify's method of action is "unknown" but it likely "balances" brain's neurotransmitters." The whole neurotransmitter imbalance hypothesis is itself not proven for Abilify or any other anti-depression drug (like SSRIs). At best, it is a guess since there is no way to measure levels of neurotransmitters in live subjects. At worst it is a lie. Regardless, the method of action is irrelevant if medicines work, but considering the efficacy of such drugs (not very good) and their frequency of prescription (very high) it's not surprising that the medical industry would work so hard to push an unproven theory as fact simply to sell more drugs.
- ajarmst 12y ago
  Not only is it not proven for <insert drug here>, it's not even a useful hypothesis in the scientific sense. No one has ever proposed a useful model of the "chemical balance" that is hypothesized to be "imbalanced", so the whole theory is a non-sequitur. It is proposed because the more accurate explanation of "this is a powerful drug that introduces long-term changes to the structure of your brain. A few cherry-picked studies funded by pharmaceutical companies seem to show that there might be some short term amelioration of your symptoms. We have no idea how it works, but that's not surprising, as we have no idea why you have your disorder, or what it is other than a particular constellation of symptoms. We won't find out in the near future, because there's really no money being invested in finding out the ultimate causes for mental illness or in studying the long term effects of these treatments." doesn't get you invited to the really nice pharma-sponsored conferences.
ekianjo 12y ago
I always find it interesting that these kind of articles points the fingers at Big Pharma and completely forget that there's a key element needed for prescription: Doctors. So, why not blame doctors as well, at least as much as Big Pharma? They share a huge part of responsibility in the situation.
djur 12y ago
The insinuation of headlines like this is that antipsychotics are inherently hardcore drugs for people with severe, possibly dangerous mental illness. This delegitimizes depression by suggesting it is not or cannot be a serious mental illness; furthermore, it stigmatizes people who suffer from psychosis by suggesting that their symptom is beyond the pale of what a normal person might suffer. That is: Antipsychotics are for people who experience psychosis, and people who experience psychosis are crazy lunatics, so it's absurd that so many normal people are being prescribed antipsychotics.
- 001sky 12y ago
  This point is sort of irrelevant to the article. Read this, perhaps instead. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/ The issue is not that they are portrayed as too "hardcore", but rather in general things like depression are over-simplified and dumbed down to stoke consumer demand for narcotic remedies. (Trivializing the subject is not a good thing.)
steven2012 12y ago
20 years ago, I dated a pharmacist and she said that two of the most prescribed drugs that she dispensed was ritalin and Prozac. It shocked me back then, so hearing that anti-psychotics are amongst the highest these days is no surprise, unfortunately.

105 points by samclemens 12y ago

> [Thorazine] was an antipsychotic given to mentally ill people, often in institutions, that was so sedating, it gave rise to the term "Thorazine shuffle." I think the term "Thorazine shuffle," refers to the characteristic locked-knee shuffling gait that develops because Thorazine frequently causes tardive dyskinesia as a side effect. Edit: ignore this, see below; though, the drug does induce discomfort and restlessness in the limbs that prompts patients to pace around.

rosser 12y ago
It's tardive dyskinesia, and the term is typically used to denote the facial tics that are a sometimes permanent side effect of older antipsychotics. The "shuffle" is a separate effect, and calling it that is often regarded as pejorative.
- kaffeemitsahne 12y ago
  If you're not mad already a proper dose of Haldol will make you look (and feel) it.

ef4 12y ago

I have heard that people in post-acute care (think nursing homes) frequently end up taking Seroquel because it appears on their hospital discharge paperwork, despite never having any diagnosis of psychosis. It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years. (Source: I sell software to long-term care facilities and their pharmacists.)

logn 12y ago
I've had periods of insomnia. Personally, I liked https://en.wikipedia.org/wiki/Trazodone https://en.wikipedia.org/wiki/Trazodone and it comes in generic. I've only ever needed to use it on a short-term basis. Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
- oldspiceman 12y ago
  This is a great read for anybody with issues sleeping. The vast majority of sleep problems are in your head and after reading this I never had another issue. He debunks the utility of sleeping pills and give you lots of strategies for improving your sleep. http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0805089586 http://www.amazon.com/Say-Good-Night-Insomnia-Drug-Free/dp/0...
- thret 12y ago
  I think you've got the wrong approach. Sleep is a waste of time! If you can't sleep count your blessings and do something productive.
  - lotsofmangos 12y ago
    I sometimes get severe insomnia. After the third day, the most productive thing I could do is menace in a deranged and hallucinatory fashion anybody who dares hand out this kind of advice.
    - thret 12y ago
      I've always had what you might call severe insomnia. I rarely sleep for more than four hours, and I've found I do pretty well on two. As far as I know I've never slept eight without either being up 2-3 nights beforehand or being very, horribly drunk. In my experience if you are not sleeping, staying in bed will just make you more tired. It is better to embrace it, get up and do something. So that's where I'm coming from, I'm sorry if it caused offence. Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
hga 12y ago
I have really bad insomnia, due to genetic anxiety and depression (apparently "of a bipolar nature", but only a drug can make me manic), and without a low dose of Seroquel before bed I'd only be getting ~4 hours of sleep a night (and my anxiety would be much worse). It's been pretty much a life saver. Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous. As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
- derefr 12y ago
  > apparently "of a bipolar nature", but only a drug can make me manic Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
  - hga 12y ago
    There are several kinds of insomnia. In my case, getting to sleep is seldom a problem (and when it is, it's indeed often if not most often that kind of "thinking too much"), waking up too early is the big one. So, besides this being a generic disorder (my uncle the engineer followed the same path as I at the same times in our lives, but he's frankly bipolar with anxiety being of less significance), the effects of Seroquel on dopamine are not much if anything of an issue for me. Then again I'm taking a low dose of it (50-100 mg in one dose before bed, therapeutic dose of it for its formal indications don't go below 300 mg/day). One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me). Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough. As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336/ http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.

amelius 12y ago

Does anybody know of natural drugs against depression? So far I have only found lavender oil, sardines and chocolate to work.

intopieces 12y ago
Saint John's Wort in conjunction with therapy is one that comes to mind. All antidepressants should be combined with active, regular therapy. Often the cause of depression is not chemical imbalance, but an actual issue in the person's life.
- duckingtest 12y ago
  Warning: Saint John's Wort can cause cataracts if used for a long time.
  - 6581 12y ago
    That is highly disputed - there is only one study suggesting a correlation (not causation).
    - duckingtest 12y ago
      The causation is simple - hypericin becomes toxic when activated by light. While that doesn't mean that it definitely causes cataracts, given available data I think it's more likely that it does. http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/19739671 http://www.ncbi.nlm.nih.gov/pubmed/19739671
- jsmeaton 12y ago
  > Often the cause of depression is not chemical imbalance, but an actual issue in the person's life. Not trying to be contrary, but do you have a source?
  - oldspiceman 12y ago

ladzoppelin 12y ago

The title is misleading. Abilify is being prescribed for people who are already on SSRI's for depression because the combination helps accelerate recovery and not because these people need traditional anti-psychotic medicine. With this headline you give people a reason to be hesitant before asking for help.

slazaro 12y ago
Nevermind the fact that alcohol and coffee are way more popular drugs.
joesmo 12y ago
There's no proof of this. I think that's why the article is titled this way.

JumpCrisscross 12y ago

A few months ago I succumbed to a particularly drawn-out case of the hiccups. Two nights in, sleepless from constant hiccuping, I made it to the ER. The cause was heartburn, triggered by an earlier night of celebratory drinking, irritating my esophagus. The irritation was close enough to my diaphragm to stimulate it. One dose of thorazine, given by the ER doctor, and the hiccoughs subsided. Thorazine dampens the vagus nerve. This was the intended effect. Less intended was my complete lack of motivation to do anything outside the confines of my apartment for the rest of the weekend. (I also took great interest in my neighbourhood parks, for once.)

derefr 12y ago
Fascinating... and makes me wonder whether anyone has experienced hiccups as a side-effect of amphetamines or other dopamine agonists.
- girvo 12y ago
  Yes, I have. Also, nictotine oral sprays are known to cause them as well, quite consistently.

phren0logy 12y ago

I'm an MD who specializes in Psychiatry. Although much of this article is somewhere between a little and a lot inaccurate, the basic premise that an absurdly expensive antipsychotic is the most popular drug is alarming. It is a useful and effective medication with a clear role for a relatively small subset of the population. Why it is being prescribed so widely is a question worth asking.

hga 12y ago
If you read the article carefully, and/or click through, you'll find it's only #1 in dollar sales, it's still on patent until April or so. I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.
- refurb 12y ago
  On a per prescription basis acetaminophen plus hydrocodone is the top selling drug.
  - andyzweb 12y ago
    I tried my google-fu at this. what is your source?
    - deleted 12y ago
      [deleted]
    - dmix 12y ago
      Here, most units sold: http://www.drugs.com/stats/top100/units http://www.drugs.com/stats/top100/units acetaminophen/hydrocodone is #2 budesonide is #1 which is used to treat asthma (in puffers I believe). I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).

mrbrowning 12y ago

I used to work in a pharmacological research lab, and while I'm frequently discomfited by the misalignment between commercial incentives and social good in the pharmacology industry, this statement isn't quite fair: > Everyone has heard of "mission creep." In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one. This is more accurately referred to as "drug repurposing," and it's hardly the unalloyed evil that it's characterized as here. It's true that drug companies love to repurpose existing FDA-approved drugs, both because it saves them money and because it typically permits them to patent the compound again in a new context, but there are nonetheless real benefits to the public at large when a drug whose side effects are comparatively well-characterized over the long term is put into service to treat a different malady.

hga 12y ago
To take the atypical anti-psychotics as an example, it turns out they or at least some of them are good mood stabilizers, i.e. can be used to treat bipolar disorder (manic depression). And while they have their fair share of nasty side effects, there pretty much aren't any nasty side effect free mood stabilizers....
- djur 12y ago
  I was prescribed an atypical antipsychotic* originally for bipolar disorder in my late teens. At the time, it was an absolute lifesaver. I had almost completely lost my ability to function, and the treatment brought me back to an operating state sufficient to complete high school without completely sinking my GPA. I had to stop using it because of unacceptable side effects (rapid weight gain and sexual dysfunction), and it took me a long time to find something else that worked as well. The medication that ended up working for me was originally developed as an anticonvulsant. My symptoms lessened over time in adulthood, but if I hadn't had the course correction provided by repurposed 'Big Pharma' medications I would be living a much harder life. *: I'm not naming medications because I don't want to promote them. What worked for me isn't necessarily what will work for anyone else.

spiritplumber 12y ago

It was a shock for me to have worked in the US for a few years, and slowly realize that I was in the distinct minority in my circle of friends in not taking any medications consistently (I'm in my thirties). Made me think of Brave New World.

maxxxxx 12y ago
I have noticed that too. It's pretty much standard that people take at least some prescription drugs regularly. Also the children of some friends know all the ins and outs of different pills. I don't think I ever had had a headache pill when I was the same age.
kaffeemitsahne 12y ago
That's pretty shocking indeed. So what do these people think of their own med use? When I was on antipsychotics I couldn't wait to get off of them, and my psych was very supportive regarding that.
mercer 12y ago
I'm Dutch, but I grew up with many Americans around me. It always shocked to see the huge amount of pill-bottles in the bathrooms of my American friends, and how much part of daily life these things were. Anti-bacterial wipes for everything, pills at the smallest sign of illness (even just the sniffles), copious use of sleeping aids, and so on. In my upbringing (which was kind of 'typically' Dutch), we took medication as a last resort. Even painkillers were not something you took unless your headache was unusually bad. I have no doubt that this is also changing in Holland, especially when it comes to prescription drugs for psychological issues, but in general it seems a bit healthier to me to allow the body to take care of itself when it can, rather than stuffing it with foreign bodies that often have all kinds of adverse side-effects. This state of affairs often makes me think about how malleable societies really are, for both good and bad, and how much variation there is even within 'Western-European' nations.

joesmo 12y ago

"The standardized United States Product Insert says Abilify's method of action is "unknown" but it likely "balances" brain's neurotransmitters." The whole neurotransmitter imbalance hypothesis is itself not proven for Abilify or any other anti-depression drug (like SSRIs). At best, it is a guess since there is no way to measure levels of neurotransmitters in live subjects. At worst it is a lie. Regardless, the method of action is irrelevant if medicines work, but considering the efficacy of such drugs (not very good) and their frequency of prescription (very high) it's not surprising that the medical industry would work so hard to push an unproven theory as fact simply to sell more drugs.

ajarmst 12y ago
Not only is it not proven for <insert drug here>, it's not even a useful hypothesis in the scientific sense. No one has ever proposed a useful model of the "chemical balance" that is hypothesized to be "imbalanced", so the whole theory is a non-sequitur. It is proposed because the more accurate explanation of "this is a powerful drug that introduces long-term changes to the structure of your brain. A few cherry-picked studies funded by pharmaceutical companies seem to show that there might be some short term amelioration of your symptoms. We have no idea how it works, but that's not surprising, as we have no idea why you have your disorder, or what it is other than a particular constellation of symptoms. We won't find out in the near future, because there's really no money being invested in finding out the ultimate causes for mental illness or in studying the long term effects of these treatments." doesn't get you invited to the really nice pharma-sponsored conferences.

ekianjo 12y ago

I always find it interesting that these kind of articles points the fingers at Big Pharma and completely forget that there's a key element needed for prescription: Doctors. So, why not blame doctors as well, at least as much as Big Pharma? They share a huge part of responsibility in the situation.

djur 12y ago

The insinuation of headlines like this is that antipsychotics are inherently hardcore drugs for people with severe, possibly dangerous mental illness. This delegitimizes depression by suggesting it is not or cannot be a serious mental illness; furthermore, it stigmatizes people who suffer from psychosis by suggesting that their symptom is beyond the pale of what a normal person might suffer. That is: Antipsychotics are for people who experience psychosis, and people who experience psychosis are crazy lunatics, so it's absurd that so many normal people are being prescribed antipsychotics.

001sky 12y ago
This point is sort of irrelevant to the article. Read this, perhaps instead. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/ The issue is not that they are portrayed as too "hardcore", but rather in general things like depression are over-simplified and dumbed down to stoke consumer demand for narcotic remedies. (Trivializing the subject is not a good thing.)

steven2012 12y ago

20 years ago, I dated a pharmacist and she said that two of the most prescribed drugs that she dispensed was ritalin and Prozac. It shocked me back then, so hearing that anti-psychotics are amongst the highest these days is no surprise, unfortunately.