Wednesday, April 11, 2007

Psychiatry is Entering the Manic Phase

Well, those aren't my words. It's actually the Last Psychiatrist, who stepped up to the plate and blasted a mammoth shot to left center with his post. I'm going to quote a few choice snippets...

But without academics pushing SSRIs, their use will wane--and, importantly, so will their support of the diagnosis "Major Depression." This is going to sound controversial, inane, but it will happen.
Look for upcoming articles finding that "Depression" is overdiagnosed, that it is really just-- life. Look for articles that now find SSRIs aren't that effective after all, that the old "10% better than placebo" is a statistical trick with little clinical utility. That they are way overused in kids.

You might say, wait, isn't the decline of polypharmacy a good thing; that SSRIs are overused in kids; that they aren't that great; and that depression is overdiagnosed? All of this is true, but this isn't psychiatry finally coming to its senses; this is psychiatry entering the manic phase. Sure, it's less SSRIs for kids; but it's more antipsychotics.

Because simultaneously there will be articles pushing the idea that recurrent unipolar depression is really bipolar depression; that there are common genetic or heritability patterns; that the epidemiology and course is similar, etc. The move will be to squeeze out MDD into "life" and bipolar. This done, antipsychotics become first line agents. Oh, and look for antipsychotics to get FDA approvals for kids.


And polypharmacy will only be reincarnated-- in the form of multiple simultaneous antipsychotics (Abiliquel, anyone?), with preposterous pharmacologic justifications ("this one acts on serotonin, so it's the antidepressant, and this one on dopamine, so it's the antimanic.") If anyone says that to you, stab them.
Nice to see a great post by another person who has noticed the sea change toward antipsychotics, er, "broad spectrum psychotropics." And bipolar disorder -- Oh yes, some academics have been saying for years that many cases of depression were bipolar in disguise, and now we're finding that more and more folks are jumping on that bandwagon. How convenient.

Brief History of Diagnostic Trends: When benzos were the big drugs, everyone had anxiety. When the SSRI era was born, depression was the disease of the day. When depression was saturated, the move was on to raise awareness about social anxiety, generalized anxiety, PTSD, etc, as the SSRIs still had patent life to spare, and hence markets to conquer. The new frontiers are depression with pain, for which Cymbalta is allegedly the drug of choice (despite rather meager supportive evidence), and bipolar, for which Seroquel, Abilify, Zyprexa, and Risperdal/Invega have already made significant inroads. Lilly cleverly tried to expand the bipolar market with the Viva Zyprexa and Zyprexa Limitless campaigns, but it was just the first step in a much larger campaign.

Again, here's the link to the Last Psychiatrist's post.

1 comment:

Anonymous said...

Risperidone (anti-psychotic, 5-ht2A antagonist) was approved last October for autistic children with "aggression". Risperidone has serious side-effects (weight gain, diabetes) and does not help with the core interpersonal difficulties of autism. Scary that these drugs could soon be prescribed to tranquilize tantrum-throwing little kids.