According to a freshly published study, one in five depressed patients receiving services through the VA healthcare system in the United States is taking an antipsychotic. Of those taking antipsychotics, 43% were taking them at high doses (schizophrenia doses rather than lower doses typically used in treating depression). The study, published in the Journal of Clinical Psychiatry, excluded patients with schizophrenia or bipolar diagnoses -- this means that the antipsychotics given to the depressed folks weren't mainly used to treat psychosis or mania. The sample size was over 190,000 patients, so one can't fault the study for not including enough patients. The researchers examined drugs taken within one week of their last antipsychotic prescription and found that 24% of patients were taking multiple antipsychotics at that point. The most used medication was Seroquel. This is not suprising. Patients seen in mental health speciality clinics were the most likely to receive antipsychotics. So what are the consequences? Well, let's see. There's the high rate of akathisia and medicore efficacy of Abilify. And there's some tricky research involving Risperdal that seemed to suggest the manipulation of the statistics was more impressive than the actual drug in treating depression. Seroquel's unimpressive efficacy and problematic side effects are also not a ball of fun. And so forth. Isn't "progress" beautiful?
I know what some people are thinking, so before you waste your valuable time with a comment, consider this. I'm aware that many of these patients are suffering much more than a simple case of the blues. That doesn't mean we should throw heavy duty antipsychotics at them, particularly at high doses. Certainly there has to be something else. What might that be? Some psychotherapy, some medications, some case management - I ain't saying it'll be easy. But I'm willing to bet that chucking antipsychotics at them en masse is not the solution.
7 comments:
Right on! These are people not machines, although sometimes I think our government forgets that.
And when they flip out from these drugs who wants to bet it'll be blamed on PTS and not on the faux effacacy of this crap?
I never have felt more depressed than when I was on zyprexa (later seroquel). Deadened, unable to think or feel, no energy to do anything to improve my situation. How this type of chemical is supposed to make people feel more cheerful is beyond me. Maybe it just makes 'patients' quit complaining, and that's why they come up with studies showing (supposed) efficacy.
You make it sound like they were forced to take the drugs whether they were effective or not. If a drug helps your symptoms and you can tolerate the side effects what difference does it make what "class" it's labeled as belonging to? or even what the studies show? (Forget about what the FDA says.) Quetiapine can make a pretty decent hypnotic, especially compared to the likes of zolpidem, and especially for alcoholics and addicts.
Psychiatrist really cost a lot but what most Doctors recommend to their patients are those pills that I think its not necessary to take pill if you have only first session. I think its also better to have second opinion.
Heavy Duty Antipsychotics? Is that a new class? I've heard of second generation, atypical, high potency, low potency, etc. Which ones are classified as Heavy Duty?
Moviedoc,
In this study, 43% of depressed patients who took antipsychotics were taking them at high doses. That meets my definition of 'heavy duty'. And the data aren't so good about these drugs working for depression. There is a new review article out that demonstrates this clearly (though the authors interpret their data in a weird way). More on that in a future post.
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