Thursday, November 09, 2006

Seroquel for Anxiety? Say What??

According to Bloomberg, AstraZeneca is going to do the following: "[CEO] Brennan said he planned to grow sales of top drugs like Seroquel, by expanding its use into generalized anxiety and bipolar disorder, and by introducing a once-a-day version of the pill."

Say what? GAD is one of the more treatable mental illnesses around. It response quite well to psychotherapy (with CBT being the most studied intervention, but other psychotherapeutic interventions also appear efficacious) though residual symptoms are often present. Giving someone a heavy duty medication such as an atypical antipsychotic? I don't think so!

I can see it now. The wheels are in motion. A review in a recent (September) issue of the Journal of Clinical Psychiatry states that "The efficacy of these agents [atypical antipsychotics] in various anxiety conditions needs to be further investigated with large, well-designed comparison studies." This may surprise you, but most of the authors had significant financial ties to AstraZeneca.

The buzz is starting. Follow up with a couple short-term trials showing greater reduction in anxiety than a placebo (though perhaps not by a large margin) and then make sure that the paid speakers discuss it at fancy dinners and that the trials find their way into prescribers' inboxes. Don't worry -- Seroquel won't be compared to an SSRI and certainly not to psychotherapy in an AZ-sponsored trial -- we wouldn't want to compare it to treatments with greater efficacy and/or fewer side effects! It's a rather predictable formula.

Of course tranquilizing medications such as antipsychotics reduce anxiety. It's just that there are much better treatment options available. What a great example of trying to expand the market for an existing drug! Profit over patient welfare.

Hat tip: Furious Seasons.


Anonymous said...
This comment has been removed by a blog administrator.
CL Psych said...

Every time I post anything related to antipsychotics, I can count on a certain gentleman to drop a comment. He's got about three canned comments and I suppose I'm tired of seeing them. That would be why I'm deleting the comment

TheLastPsychiatrist said...

I appreciate your criticism of psychiatry being lead by Pharma, but I would like to offer a slightly different position.

I think the problem isn't Pharma, but rather psychiatry. In your post, you lament needing to use an "antipsychotic" to treat anxiety. Fair enough, but what makes Seroquel an antipsychotic, except that it treats psychosis? There's nothing about the chemical itself that makes it only an antipsychotic and not an anxiolytic. You may say, "why use a drug with so many side effects?" and that would be fair, but to say you can't use an "antipsychotic" is precisely the trap of academic psychiatry: categorization and labeling based on semantics.

Can an antipsychotic be an antidepressant? Sure. Can an antidepressant be an antipsychotic? Why does this second question seem less possible than the first?

More here, Seroquel's New FDA Labeling: The Charade Is Revealed if you are interested.

CL Psych said...

I very much agree with the basic tenet of your linked post, that a label is just a label, not a fact. I suppose my general disagreement with Seroquel for anxiety is that it reminds me of putting out a cigarette, still lit and occupying a person's mouth, with a strong blast from a fire hose. Effective, sure. Just a little bit over the top and with some untoward consequences. And frankly I'd bet good money that Seroquel's long term outcomes for anxiety would pale in comparison to CBT or likely other psychotherapies. Thanks for the introduction to your site. I will be looking at your posts in the future.

Anonymous said...

I have bipolar disorder I. This spring I was hospitalized for depression and debilitating episodes of intense anxiety. The depression was responding to treatment but not the anxiety.

My doctor started me on a small dose of Seroquel for sleep. Within two days I noticed the anxiety spikes would start to come on and then suddenly dissipate. It was startling.

I mentioned this to my doctor and he said that, yes, Seroquel can do this. After several months I am weaning of Seroquel and there has been no repeat of the episodes of anxiety.

I know you cannot apply this to everyone in general, but Seroquel has had a major part in my having a life again.

That said, I very much appreciate your blog and points of view on the pharma industry. Thank you.

CL Psych said...


Thanks for your comments. I am certainly glad to hear that you attained some resolution from your anxiety. Should credible evidence emerge from clinical trials suggesting that Seroquel is safe and effective for treating anxiety, I'll mention it. My suspicion is that other treatments, psychotherapy in particular, are certainly safer and, for most people, more effective than Seroquel.

Anonymous said...

What do you suggest for anxiety and sleep. I've have a major depressive disorder for about 16 years. Had to switch to an MAOI, which has helped, but still not sleeping w/o the Seroquel and the standard sleep meds dont' work. I used to take Trazadone for sleep and it worked like a charm. But I can't take it anymore because of the MAOI. I'm still using anti-anxieties, prn, but they don't do anything for sleep.

Any suggestions would be most appreciated.

Anonymous said...

I have struggled with anxiety for more than 10 years. You say Seroquel is like putting out a cigarette with a fire hose. I say that, for me, every other medicine out there was like putting a bandaid on third degree burns. I tried Buspar at varying doses for many years as well as supplementing with Ativan and Klonipin. And I have tried every antidepressent that I could take and that might help (I have major depression as well). Seroquel has been like a miracle for me and could be for other people with problems like mine. I hope that you will consider that you might be wrong and that while therapy is certainly necessary it is not a replacement for medicines that help with balancing chemicals in the brain that are out of balance when a person has depression and/or anxiety disorders.

lensjockey said...

I also have found the first effective help for a disabling and scary condition that I have suffered greatly from - alone with no real understanding (from all others in my life) ALL of my life. My severe anxiety has affected the way others look upon me - ALWAYS in a manner that affects my relationships adversely, and often it has hampered my brave attempts at going out into the world and doing what I feel I want to do. My anxiety and horrifying visions have wiped so much pleasure from my life, it has definitely been a quality of life issue. And Seroquel did something that no other medication I have ever been on did. It makes me sad and feel bad that there are those who really think this medication is not useful for severe anxiety.
I hope this is rethought.

Anonymous said...

Hi there,

I agree with the Pharm being evil.
And also that psychotherapy is almost always better. Sometimes in combination with drugs.

But out here in the netherlands (aka holland) the government doesnt want to spend enough money on healthcare.. So there are more people needing help than that there are people available.

I used to hate the pharm, and psychiatrists.. But now I think at the same time there is nothing else to do. The government needs to come to their senses.. Still that would be symptom reduction, not cause elimination. Or there is some conspiracy, that the pharm and the government work together to get the people hooked.. Who knows?
I think they just rather spend money on weapons and planes, or useless trainrails or whatever..

Anyways, I agree on what you write, and that the pharm plays the game in an evil way, psychotherapy is way better, but not possible because of no money...

So, what now?