Aljazeera has an interesting if not worrying article about the fact that antipsychotic drugs have become “the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.”
The huge rise in prescriptions has been sparked by the availability of a relatively new class of drugs called ‘atypical antipsychotics’.
All antipsychotics block the D2 type of dopamine receptor and their effect on the mesolimbic dopamine pathway is what largely causes the reduction in psychotic symptoms.
The older drugs block D2 receptors fairly indiscriminately in the brain, including in the nigrostriatal pathway.
This pathway is involved in movement regulation and blocking dopamine here leads to similar problems to Parkinson’s disease (tremors, rigid and uncontrollable movements) – a type of dementia where this brain area starts to break down due to disease.
The newer ‘atypical antipsychotics’ usually also block serotonin 2A (5HT-2A) receptors in the key movement pathway.
Serotonin normally reduces dopamine release but because serotonin is being blocked, more dopamine is released in the movement pathway with the newer atypical antipsychotic drugs than with the older typical antipsychotic medications.
This means less Parkinson’s-like movement side-effects with the atypicals – a genuine advance – but unfortunately, the serotonin effect causes additional problems with weight gain and often obesity, diabetes and heart problems.
However, these problems are perhaps easier to control and more ‘socially acceptable’ (compare with someone who make strange contorted movements during conversation).
On the commercial side, many newer atypicals are still under patent, meaning one company has sole control over their manufacture and sale, while other companies are not able to make cheaper copies.
Over time, these newer drugs have been promoted, legally and illegally, by drug companies for a wider and wider range of problems – everything from depression to dementia.
Despite limited evidence for their effectiveness in these areas, the sales campaign has been a huge success and the drugs are now being widely prescribed.
Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses – primarily schizophrenia and bipolar disorder – to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis…
What’s especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old – vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.
Antipsychotic drugs have been one of the great advances of 20th century medicine. For the first time we have an effective treatment for psychosis, one of the most disabling of any of the disorders, that works for at least a fair proportion of patients.
The side-effects of both the older and newer drugs, however, are among the worst of any medication and they should genuinely be used with caution.
Unfortunately, the well-being of patients has become secondary to the profit margins of large pharmaceutical companies who continue to promote these drugs to as many patients as possible, regardless of their benefits or adverse effects.
The Aljazeera article tracks this campaign to the point where they have become top selling medications.
Link to ‘How Big Pharma got Americans hooked on anti-psychotic drugs.’
Mind Hacks 
Great post. Once again: nice job, FDA! Are they still not regulating the off-label use of drugs? First rule of medication: use the oldest drug possible that will effectively control your condition. Because that drug has been tested in the real world, with many genome types, not just one.
In almost 2 years of dealing with medical issues for an elderly person, the so-called ‘first rule of medicine” is something I have yet to encounter. What country is that a rule in? I’d like to live there. I’m in the US, state of LA.
In almost 2 years of dealing with medical issues for an elderly person, the so-called ‘first rule of medication” is something I have yet to encounter. What country is that a rule in? I’d like to live there. I’m in the US, state of LA.
In 1997, the head of the FDA granted pharma the privilege to advertise on television. In 1998, he left the agency to become a senior vice president for Searle. Should that advertising privilege be rescinded, America would lose much of its dependence on prescription drugs.
Nice work illustrating the clear adverse effects of atypicals, but I expect more complexity in explaining the mechanism of actions which is still unknown; the single neurotransmitter hypothesis for any disorder is too simple to explain the facts.
A mass psychosis is ongoing, clear, if you look at our media
two comments, the first in response to Carmen and her experience with attending to an elder’s medical care. Carmen, It is fortunate that you have not encountered “medicate first,” this does not mean that your experience is typical or average.
The newer neuroleptics called “atypical antipsychotics” have been advertised and marketed as being safer and more effective–which is not the same thing as actually being safer and more efficacious. As for the drugs not causing the horrifying damage which causes movement disorders, this was another marketing claim which it appears is a claim that was pulled out of thin air; not based on scientific data from clinical trials; or real world outcomes for those who take these drugs. The Practice Parameters for treating Early Onset Schizophrenia written by Jon McClellan and adopted by the American Academy of Child and Adolescent Psychiatry with the newer neuroleptics anticipate that 50% of the children and adolescents who take them will develop Tardive Dyskinesia—These are the drugs which are being widely prescribed off-label to children for negative behavior—including aggressive behavior—despite the fact the drugs are documented to CAUSE aggressive behavior! Then there is the fact that the drugs are also documented to cause DEPENDENCE. The risk for TD, increased aggression, and dependence are rarely shared with those to whom they are prescribed. This belief is based on my experience: in fact none of these risks have ever been talked about by a single psychiatrist who has prescribed neuroleptics to my son who has TD, heart damage and brain damage. I have two friends that are my age who were physically normal adults with traumatic experiences and emotional damage who as a result of neuroleptic drugs are cognitively and physically disabled; one is now in a wheelchair. Neither of these people or their family members who supported them at psychiatric appointments were informed of the risks for the damage they are now stuck with.
But isn’t comparing sales inflates the perceived use of these drugs? Already, atypicals are several times (up to 5 times or more in my country) more expensive that ulcer medicine.
A few years ago as a student on clinical placement I encountered aged care facilities full of people on antipsychotics. The result? Rooms full of tranquilized people, too drowsy to eat, talk, or have any quality of life. I was horrified. At least, I thought their doctors must have had good reason for putting them on it. One day I dealt with a patient who was a bit agitated at having to get up on a cold morning (who isn’t) and at 7.30am, tried to push carers away (once). That was, in my opinion, a reasonable response to the situation. At handover the carers and nurses suggested that this patient be recommended to the doctor for treatment with risperidone due to aggressive behaviour. There are thousands, if not millions of people being given these medications, and when their families don’t visit everyday and take an active interest – who’s to know?
Disappointing report from Al-Jazeerah, but not surprising.
When the diagnostic criteria for a disease, any disease, are not clearly defined with objective and measurable criteria, diagnosis creep and over-prescription are nearly certain to ensue.
It happened with antibiotics, which are meant to treat objectively measurable bacterial infections. How much more so for anti-psychotics and the malleable ever-shifting “diagnostic criteria” of mental illness?
Eli Lilly Zyprexa,Risperdal and Seroquel same saga
The use of powerful antipsychotic drugs has increased in children as young as three years old. Weight gain, increases in triglyceride levels and associated risks for diabetes and cardiovascular disease.
The average weight gain (adults) over the 12 week study period was the highest for Zyprexa—17 pounds. You’d be hard pressed to gain that kind of weight sport-eating your way through the holidays.
One in 145 adults died in clinical trials of those taking the antipsychotic drugs Zyprexa. This is Lilly’s # 1 product over $ 4 billion year sales,moreover Lilly also make billions on drugs that treat the diabetes often that has been caused by the zyprexa!
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Daniel Haszard Zyprexa victim activist and patient who got diabetes from it.
This is one of the most disturbing articles I’ve read in a long time. I work with individuals with schizophrenia and see the awful side affects of these medications. To think that anyone would be prescribed these medications, other than as a last resort, is insanity in itself. I do find it interesting that the taking of antipsychotics causes the taking of even more medications necessary just to combat their side effects. Most of the pills given to my clients is for that very purpose. Which could explain why they are being pushed so often now. The whole thing just sounds odd. I’d love to hear more about what’s being done, or can be done to stop the obvious overprescribing of antipsychotics. I mean, how can it be there are more people who are psychotic (“atypically” or otherwise) than have acid reflux or high cholesterol? Lol
This is one of the most disturbing articles I’ve read in a long time. I work with individuals with schizophrenia and see the awful side affects of these medications. To think that anyone would be prescribed these medications, other than as a last resort, is maddening in itself. I do find it interesting that the taking of antipsychotics causes even more medications needing to be taken just to combat their side effects. Most of the pills given to my clients is for that very purpose. Which could explain why they are being pushed so often now. The whole thing is hu I’d love to hear more about what’s being done, or can be done to stop the obvious overprescribing of antipsychotics. I mean, how can it be there are more people who are psychotic (atypically or otherwise) than have acid reflux or high cholesterol? Lol
[…diabetes and heart problems.
However, these problems are perhaps easier to control…]
Seeing as these are among the 5 leading causes of death in the US today, I strongly disagree that these problems are easy to control.
they are even trying to blame certain gens now and that specific genes are to blame for predispossition however, i may agree this to be the case for early onset TD but people taking them over ten years or will probably develop it also therefore its not genetic as the science has proved they damage the brain but researchers are either paid by the pharmaceuticals to try and blame genes but i dont beleive infact soem researchers dont either.