The Future of Second Generation Antipsychotic Meds

My forecast: As evidence mounts showing that the second generation antipsychotics (SGA) are to first generation antipsychotics what SSRIs were to older antidepressants – a meager advance at the very best, look for SGAs to make up for declining schizophrenia market share by moving into bipolar disorder (despite being no more effective than lithium) and into child behavior problems and autism (where anything goes in treatment due to the general lack of treatment response). Look for more and more people to get labeled as bipolar. This will happen because of research using sloppily designed surveys which show "surprisingly high" prevalence rates for bipolar. The real market might come from Bipolar II, in which people are "just too darn energetic" at times despite generally having no functional impairment. There will of course be “disease awareness” campaigns and both direct to consumer and journal ads mentioning that bipolar is reaching epidemic proportions. Bipolar will be discussed as "undertreated," "underrecognized," and "tragic." Mind you, real cases of bipolar are indeed tragic and often undertreated. But when the bipolar II "epidemic" hits, mark my words, the scripts will be written quicker for these SGAs than you can believe.

The second use: Kids with behavior problems. If they're acting out, try an SGA. If that doesn't work, up the dose. If that doesn't work, add another SGA. Given enough SGAs, Genghis Khan would likely chill out, but at what cost? Add autism to the mix as well.

I see the trends already forming and within five years, bipolar disorder will have (allegedly) spread like the flu and those badly behaving children will increasingly swallow Zyprexa and other SGAs to control their behavior.

Of course, if SGAs go generic in the next few years, look for another new set of "miracle drugs" to replace them.