A decade ago, drug companies started heavily marketing the antipsychotics Abilify, Seroquel, and Zyprexa as treatments for depression — despite concerns over serious side effects. That marketing is subsiding now as generics hit the market, but it may have created a dangerous clinical standard.
In a television commercial from a few years ago for Abilify — one of the world's top selling drugs — a sad cartoon woman looks down at the ground and sees an expanding black hole with bulging eyes. "Here's my depression," she says.
Regular antidepressants weren't working to keep her depression in check, she explains. But then her doctor told her about Abilify. She began taking the drug along with her antidepressant and felt well enough to have a picnic with her family. "Depression used to define me," she concludes. "Now I feel better."
Abilify, or aripiprazole, is an "atypical antipsychotic," a class of drugs that debuted in the 1990s as a safer, more humane means of curbing psychosis in people with schizophrenia. But over the past decade, these drugs' manufacturers have successfully pushed for their use in far more common mental illnesses, such as dementia, childhood conduct disorders, and especially depression.
Sales of aripiprazole and its competitors, quetiapine (Seroquel) and olanzapine (Zyprexa), have skyrocketed. At more than $450 a bottle, Abilify was prescribed to nearly 9 million Americans in 2014 and grossed $7.8 billion — making it the second best-selling drug in the U.S., just behind the new (and very expensive) hepatitis C drug Sovaldi, according to healthcare analytics company IMS Health.
Many psychiatrists and scientists worry about this antipsychotic boom. They point out that there's limited evidence of the drugs' usefulness in treating depression over the long term, and that they have serious side effects, such as sedation, dramatic weight gain, and an increased risk of diabetes. In about one-quarter of cases, these drugs also cause akathisia, a pronounced feeling of restlessness described as making you want to jump out of your skin.
"What's happened recently is remarkably heavy marketing of antipsychotics," Allen Frances, former chairman of the psychiatry department at Duke University School of Medicine, told BuzzFeed News. Doctors, he added, are prescribing antipsychotics for depression "too quickly, without clear indication, and under pressure from pharmaceutical companies."
For some people with depression, Frances noted, these drugs work wonders. But that's probably not the case for the majority of people trying them. A 2009 paper found that, statistically, for every nine people with depression who take these drugs, just one is effectively treated. "These drugs should have a narrow indication, and instead they've become the highest revenue-producing drugs in America," Frances said.
Frances, who led the group that developed the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, is an outspoken critic of the pharmaceutical industry. But he's by no means the only expert who says antipsychotics are probably overused.
"Antipsychotic medication should be used judiciously — and for the most part, sparingly — in treating nonpsychotic disorders, including depression," Jeffrey Lieberman, chairman of psychiatry at the Columbia University College of Physicians and Surgeons, told BuzzFeed News.
Doctors don't stop at schizophrenia and depression when it comes to antipsychotic prescriptions. The drugs are now commonly prescribed to calm patients with dementia, despite the fact that the drugs double the risk of death (and that the drugs' labels now warn against their use in dementia). Doctors also prescribe them for behavioral issues in young children, who are particularly vulnerable to side effects like weight gain and type 2 diabetes. The effect of antipsychotics on the developing brain is also not well-understood.
"I think there's the possibility that antipsychotics are overprescribed, not just for depression, but in other areas," Lieberman said.
Last month, Abilify's patent expired, making way for cheaper generics. All of its competitors had already gone generic, and consequently the manufacturers have all stopped marketing these drugs.
So now the question is, how will this drop in advertising affect sales? Will taking the pressure off doctors and consumers spur a drop in prescriptions — or is this surge in antipsychotics the new normal?
Aripiprazole
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