January 18, 2007Bad News For Atypicals Becoming TypicalHere we have yet another round of bad news for the atypical antipsychotics. In this case, the federal government's Agency for Research Healthcare and Quality is out with a study claiming that there is not enough evidence to support off-label use of the atypicals--licensed for schizophrenia and, mostly, acute mania in bipolar disorder--in depression, dementia, OCD, PTSD and personality disorders. States the report: "Overall, however, researchers found that much of the scientific evidence for off-label use of antipsychotics was of insufficient quality because studies were too small or lacked scientific rigor. Review authors evaluating the potential benefits and risks of the medications also found strong evidence that atypical antipsychotics can increase chances of adverse events. Some of the drugs increase risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems." I don't think there is very good evidence for the long-term use of these drugs in bipolar disorder, although its clear they have a role to play in managing acute mania. But that would make these alleged "wonder drugs" essentially the same as the old antipsychotics, and that would really cut into Big Pharma's revenues if the drugs were only used short term. In addition, there are now several studies establishing that these drugs are no better than older antipsychotics for the long-term treatment of schizophrenia. Here's what the report said about using them in depression: "For patients who don't benefit from selective serotonin reuptake inhibitors (SSRIs), the supplemental use of atypical antipsychotics was not helpful, according to research. No studies showed the drugs provided a clear benefit for patients with major depressive disorder with psychotic features. Evidence is conflicting for bipolar depression." Seroquel is approved for use in bipolar depression (and acute mania) while Zyprexa is licensed for maintenance of bipolar disorder (ie, treating acute mania and bipolar depression), but it sounds like one branch of the federal government isn't buying the FDA's licensing. Soon, I will post on another government-funded review of these meds which shows that the evidence for how well the wonder drugs work in schizophrenia and mania is moderate, meaning not as overwhelming as the pharma companies and many researchers and docs would like patients to believe. I think it's time for the use of these drugs to be de-emphasized, given their expense, nasty side effects and limited scientific evidence for their use. And would someone please explain to me why we are using these drugs in children without appropriate scientific evidence for their use. Posted by Philip Dawdy at January 18, 2007 02:17 AM
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I have a lot to say about antipsychotic use in kids and adults; but will make one comment: Seroquel has done nothing with regard to decreasing my depression. The depression, and mania cycled exactly the same as if I was off of Seroquel. What Seroquel did do for me: Slammed me down to sleep longer than I ever usually slept at night, leaving me to deal with a 3 hour fog in the morning. Feeling like you can't start your day until noon? I'd rather have that kind of hangover from booze. Just for the record, in case someone from AstraZeneca is reading this: After a 3 month personal trial on this med: it failed. I am now reducing it and increasing Lamictal. Goal being to use in emergency situations only as in "short term use'. Read it and weep. Posted by: Stephany at January 18, 2007 08:34 AM"And would someone please explain to me why we are using these drugs in children without appropriate scientific evidence for their use." $$$$$ Posted by: Marissa Miller at January 18, 2007 10:56 AMRe: children and medications: Readers must also know, that if alarmed at the use of antipsychotic medications in kids--do not forget they are being used in autistic kids as well. Just to calm them down. Been there and still doing that. Posted by: Stephany at January 18, 2007 05:13 PMI still dither about medication. Many of my pals have taken that road, but I still feel that mine are too young and that there are no longitudinal studies. There again, when I read Temple Grandin say how her life was improved by them I start leaning towards the other edge of the fence. Every one should read about Temple Grandin. Her personal story is fascinating; and I would also be inclined to listen to what she has to say re: medication use; I would especially like to know her thoughts on this entire topic of medication use in any child. Posted by: Stephany at February 23, 2007 06:56 PMThe finite length of patent protection being a bit of a bugbear for big pharma meant that they needed to do their best put the 'A' into 'Atypical' in the early studies of Risperdal, Clozapine, Zyprexa etc. Not only are the pharmas' claims that these drugs are more effective difficult to sustain, their claims that they have less severe side-effects are also the product of an experimental sleight of hand. By comparing the 'atypicals' to the nastiest of the 'typicals', e.g. Haldol, Prolixin/Modecate, they were able to paint a far rosier picture of their benignity than was warranted. Risperdal, for example, flattens the tyres and fogs up the windscreen as effectively as chlorpromazine. Prescribed it as a teenager, I remember feeling trapped within my own body, appalled at my inability to just get up and do something, anything, hence exacerbating my sadness. The thought of putting an even younger child into a prolonged and demoralising state of detachment just beggars belief. In fact, the black box warnings placed on medications regarding their use in paediatric populations should to placed around psychiatry per se. Inducting a child into the psychiatric system in any way whatsoever runs the risk of severely compromising their psychosocial development, regardless of whether medication is prescribed. Concepts such as free will, personal responsibility, natural resilience, and the self in relation to others are corrupted, and 'behaviour modification' mostly takes the form of the subtle eliciting of symptoms that are 'expected' to emerge but have not yet done so, not to mention the child picking up from other patients all sorts of new ways to deal with their distress that otherwise might never have occurred to them, like, say, cutting themselves. Hence more diagnoses, more medications, and a further downward spiral. Apologies for submitting a somewhat discursive rant as my first comment on this blog. No, I'm not a Scientologist - I've just been through it all and only barely survived. I look forward to reading other posts and comments. |
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