Furious Seasons

August 29, 2007

So Much For The Wonder Drugs

Jeff Lieberman, the Columbia University psychiatrist who led the CATIE study, has done an interview with primarypsychiatry.com in which he damn near proclaims the death of atypical antipsychotics. Speaking of various studies of new and old antipsychotics in schizophrenia, he says:

"The advantages of the SGAs to FGAs are appearing less dramatic and consistently, while in other studies the FGAs appear comparable or slightly advantageous."

SGAs are the atypicals, FGAs are the old antipsychotics. The only nice thing he had to say about atypicals was that they induce less tardive diskenesia. Keep in mind that atypicals when introduced in the 1990s were supposed to be the answer to the riddle of schizophrenia--no side effects, no zombieism, perfect control of psychosis. It sure hasn't turned out that way.

And if these drugs are so limited in effect for schizophrenics, then why the hell have the thought leader psych docs set up a treatment paradigm for bipolar disorder and other ailments where these drugs are literally the go-to agent? Why not just use them short term the way old antipsyhcotics were once used in bipolar disorder?

And could someone explain to me why the very high prices on atypicals remain justified?

I smell a rat.

Posted by Philip Dawdy at August 29, 2007 11:17 AM

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Comments

I wish I had the specific references in front of me but I believe it's a myth that the SGA actually cause less TD than the FGA. The only reason they appear to cause less is because the clinical trials were designed and conducted in such a way as to make it look that way, not because they really do. The clinicians were at pains to design trials where this effect would not be demonstrated and they probably had patients on placebo who already had it so bad from earlier treatments that the new drug did not have a very high bar to cross to look better. Ben Carey did an article not long ago which demonstrated pretty clearly that in "real" clinical practice the SGAs are causing all sorts of tremor and muscular irregularities, at least in the kids he was writing about.

Posted by: Sara at August 29, 2007 03:18 PM

Because most of the mood stabilizers are off patent and cheap and the new ones haven't worked out that well, vid. Neurontin. So how's a poor Big Pharma and a poor psychiatrist to make a living if they only give out off patent drugs? (not saying every psychiatrist takes money from drug companies, but we know many do.)

They were doing this with the old anti-psychotics when they still had patents in the '80's and even using off patent ones because there were always some psychiatrists who were not happy with the idea of a person with bipolar disorder who wasn't drugged out of his or her mind. JMHO.

Posted by: Alison Hymes at August 29, 2007 04:37 PM

I wonder if they are stock holders.

Sure as hell there was a plan of action to mainstream antipsychotics into the public medicine cabinet.Soon, people will forget the drugs started off in the trials re: schizophrenia; now it's a standard "cure-all" for bipolar,ADHD,autism, or just about any other NOS or complaint a person has give a doctor.Not just psychiatrists rx antipsychotics.

Look how Cymbalta crawled into the pain management arena with barely a notice.

Ive got news for many: those wonder drugs don't work for everyone they claim to work for, and Clozaril, though just as risky as any other drug with death as a side effect-- is what 60% of patients with schizophrenia use according to a doctor I spoke with that is in care of a residential care facility where people live outside of hospitals.

Posted by: Stephany at August 29, 2007 04:44 PM