Here We Go: Seroquel For Depression And Anxiety

Seroquel was approved by the FDA for bipolar depression in October. Since then, I've noted that AstraZeneca is trialing the drug for a host of conditions, clinical depression and anxiety among them (and it's for kids too!). Apparently, the trials have gone well for the FDA's lame efficacy hurdles because a British report has it that the company will move for approval of the antipsychotic for depression--and anxiety too--in 2008.

No antipsychotic has ever been approved for depression, although they are obviously used for psychotic depression off-label, but that's because of the psychosis. The total depression market is $16 billion or so and of course AZ wants a slice of the pie. Indications for depression and anxiety could increase sales from $3.5 billion a year to $5 billion. And this drug will be prescribed for long-term use. Short-term (as in days to a few weeks), it has its uses but I fail to see why a doctor would want a patient to take an antipsychotic for depression for anything more than short-term use.

The drug has really nasty side effects, especially cognitively. Here's an account of one patient who took a little extra Seroquel the other night and couldn't make it to work the next morning. The drug's weight gain problems are almost as legendary as Zyprexa's.

Diabetes? Off-label marketing? Well, there's a federal class action lawsuit afoot, states are suing and there's a Congressional investigation in the offing. Sounds like a drug with a clean history to me.

What's more, there continue to reports of people using Seroquel as a drug of abuse. You can get high--or maybe it's low--from a drug that knocks people out! In fact, a bus driver in Pennsylvania was busted for buying some from a teen who'd swiped it from his mom. And, of course, there are reports in psych journals of people using it in prison.

Given all of that, I foresee a train wreck in our culture if the drug ends up being widely used for depression and anxiety. There are plenty of bipolars who've been given the drug for agitation, for example, who've run into tolerance problems on the drug and all sorts of fifth of whiskey head in the morning problems. And let's not forget it's use as a sleeping pill.

But that sort of real world experience has no bearing on how the FDA considers the drug for supplemental approvals. The real world is anecdotal and unscientific. If the drug can beat a placebo by a little bit, well then that's rock solid science.

BTW, let's not forget about the study of Seroquel for public speaking. I swear, this drug will be in the water supply someday.