Meet The New Anti-Depressants, Worse Than The Old Anti-Depressants

UPDATE: Mere hours after I posted the following, AstraZeneca filed a supplemental new drug application for Seroquel XR, the extended release version of Seroquel, for treating depression under 3 different indications: monotherapy, adjunct therapy, and maintenance therapy in adult patients. Monotherapy and maintenance? With an anitpsychotic? That's a tectonic shift in depression treatment. If anyone thinks I was overstating the push for antipsychotics in my original post below, then think on the idea of people with depression taking an antipsychotic for life. ECT almost--almost--begins to look friendly by comparison.

The Last Psychiatrist offered his usual wise contrarian take on the British study showing that anti-depressants are essentially spendy placebos. Last's big concern is that this is a set-up for the use of antipsychotics to replace, or become add-ons to, anti-depressants. The timing of his post is delicious--Brit study comes out this week, American study saying loosely the same thing only with all 12 anti-depressants came out in January, and Abilify was approved by the FDA as an add-on treatment for depression last November. J&J/Janssen has been studying Risperdal for depression like maniacs and Seroquel is already approved for bipolar depression.

I'm not sure if Last has had a visit from a sales rep touting antipsychotics for depressed patients. But I wouldn't be shocked if it happens soon. Right now, Abilify's website doesn't even list the drug's new indication. Bet than changes soon and maybe they'll give us some TV ads too. Seroquel's is more up to date.

Anyway, Last writes:

"People are completely missing the point of this paper and all the other recent re-investigations, the true social and clinical consequences of them. For example: they're saying antidepressants are no good. Ok. What do you think doctors are going to use instead? Psychoanalysis? Nothing? They're going to prescribe antipsychotics. Are you listening to me? I'm not even saying this is clinically wrong to do, but do you not see the setup? Abre los ojos, man."

I believe you, jefe. My eyes have been open for a long time on this front, but I've kept semi-mum on this topic lately because I've spent so much time railing against how crappy antipsychotics are for schizophrenia and acute bipolar disorder and how willing their makers are to market them off-label for dementia that I wanted to back off for a while.

But, yes, depression is the big mental health market to pharma companies and they want to own it by any means necessary. It's a $20 billion market worldwide and antipsychotics are like an $18 billion market now. If I were a pharma exec, I'd be looking to marry those two markets pronto. And if they can't kick ass on depression, then they are going to get antipsychotics used for everything under the sun from social phobia (aka, shyness) to anxiety to whatever they can think of.

There at least 50 completed or ongoing trials of Seroquel and depression listed on clinicaltrials.gov. AstraZeneca isn't doing all that research for nothing. And here's one for Risperdal being used to augment Celexa in a 6-month study of recurrent depression.

Now, why would J&J/Janssen be dumping money into researching a drug for depression when that drug is about to come off-patent? Because they smell a market. There are other Risperdal for depression trials too. And if Risperdal's being trialed for depression, can its kid brother Invega be far off? Probably not.

And why would Lilly be studying Zyprexa as an add-on for depression, especially if that trial ends about 18 months before the drug comes off-patent, unless they knew something? In fact, Lilly has 52 studies of Zyprexa and depression listed in the clinical trials registry.

Yes, indeed, say hello to the new anti-depressants. Much scarier than the old anti-depressants, which can already be plenty bad. Why do I say that?

Because the atypical antipsychotics are simply not safe for long term use--why do you think Lilly and other companies are charging ahead on glutamate receptor drugs?--and it's hard to recommend them, in an ethical sense, even for schizophrenia (I'd make a different case medically and legally). Because you use these drugs long enough at whatever dose and if you don't develop diabetes, high blood sugar, strange heart beats and so on, then you can look forward to extreme weight gain, facial tics, muscle plasticity, spontaneously moving lips and maybe some nice limb rigidity. The scariest side effect of them all is how these drugs are enervating over time--they simply suck the life and soul out of patients.

I don't care if you are talking about Zyprexa, Risperdal, Seroquel, Geodon, Abilify or Invega, some of that symptomology will pop up if you take these drugs long enough. This is the nastiest class of psych meds on Earth, psychiatry's nuclear arsenal and the atypicals already have two sets of black box warnings. They make anti-depressants look like harmless placebos by comparison and make the feds' continued blocking of studies of medical marijuana for depression look downright cruel. If you think Risperdal and Seroquel are well-researched harmless drugs, then why is LAPD investigating the reported doping of Britney Spears by her manager with both of those drugs and why has Seroquel become a drug of abuse among teens?

And, the atypicals don't seem to work so swell for treating depression. Check out this slamming of the Risperdal ARISE study by CL Psych. Speaking of placebo, psychologist Bruce Levine had a nice piece on Alternet yesterday pointing out that anti-depressants are essentially faith-based medicine, given their provably large placebo effect. He's using faith in the sense that it was used by William James and I largely agree with his point.

I unfortunately speak from first hand experience when it comes to the problems with the atypicals. I was one of the guinea pigs in the first half of this decade when docs were giving these to patients off-label to treat depression and bipolar depression. The experience was not a pretty one (ever had TD or EPS folks?), but I prided myself on being a good, compliant patient because everyone told me that non-compliant patients always got in trouble--that is until I realized that being compliant was getting my body and mind in trouble and wasn't doing squat to address depression.

Over time, I walked away from these nasty meds and I've never felt better. In fact, with a complete lack of what you might call clinical depression since tossing aside the atypicals almost three years ago, you might even say I'm better than well, to use Peter Kramer's very shopworn phrase.

But that's a story for another day. Until then, abre los ojos, people.

Posted by Philip Dawdy at February 29, 2008 12:03 AM
del.icio.us Digg it reddit