Comments: High Off-Label Use Of Antipsychotics For Depression In VA System
One of my main Google searches that gets to my blog is "seroquel withdrawals" and interesting, that in the last 2 years the stat meter consistently shows the navy and pentagon doing those google searches.
Posted by Stephany at July 22, 2009 12:09 AM
I agree. I smell a rat. VA is the world's largest integrated health care system ever, anywhere. They have, and use, the opportunity to achieve great cost savings through restricting prescribing practices - controlling the range of drugs they buy, etc. They have in the past - I don't know about current practice - encouraged the prescription of pills at double the dose needed, and provided pill-cutters to vets, so that the VA can save money by having a vet take half a pill each day in the cases where this saves money.
So, it is surprising to see such off-label prescribing. But who knows who is schmoozing whom. The VAs generally do allow drug reps. A former director of the dallas VA had banned reps, but that was an uncommon policy for a VA hospital.
Posted by medsvstherapy at July 22, 2009 06:22 AM
The phrase I routinely hear from the two Seroquel reps when they visit my office is: "If you see residual untreated depressive symptoms, we want you to think about Seroquel."
Of course, they'll say they're talking about symptoms of bipolar depression (for which Seroquel is, ahem, "approved") but this wording clearly indicates they're trying to get doctors to make the depression = Seroquel connection. Shady? Yes. Illegal? Unfortunately, no.
Posted by SteveBMD at July 22, 2009 07:33 AM
The VA will have a lot to answer for when the death rate increases among soldiers just as the suicide rate has increased among soldiers because of the blatantly high use of antidepressants given to them.
As co-founder of www.SSRIstories.com I was very interested in the new atypical antipsychotics since they are half antidepressant.
Although I did not have the time to search everyday for news stories about violence & suicide with all the atypicals, I have been doing some research for several years on the types of diseases the atypicals cause to the individuals taking them. Of course, everyone knows now about the diabetes and metabolic syndrome disorders caused by the atypicals.
Probably less well known is the stats pointing to a possible increase in cancer deaths among the users of atypicals.
I had to study the atypicals via the disease model of "schizophrenia" [usage of atypical antipsychotics] since they were the studies that were most accessible and most reported on by epidemiologists. This first Website shows that in 1986 people with schizophrenia had a lesser chance [adjusted for age] of developing cancer. They were at .59
http://www.ncbi.nlm.nih.gov/pubmed/12223244
This second Website shows that by 1999 [seven years after the introduction of the atypicals], the cancer rate for schizophrenics was at .99 -- in other words-- about equal to the general population.
http://bjp.rcpsych.org/cgi/content/abstract/187/4/334
This third Website shows that by 2003 the cancer rate was 1.5 for those diagnosed as schizophrenia
http://www.oncolink.com/resources/article.cfm?c=3&s=8&ss=23&id=16312&month=06&year=2009
This article from the New York Times, written in 1992 right before the introduction of the atypicals, is interesting in that it may point to a possible explanation for the decrease in cancer among schizophrenics.
http://query.nytimes.com/gst/fullpage.html?res=980DE2D61638F932A0575BC0A962958260&sec=health&pagewanted=print
Also, this Website reports on the sudden cardiac deaths for those on typical and atypical antipsychoitcs. The chart shows: typical low dose is 1.30, typical moderate dose is 2.01 and higher doses are 2.42
For the atypical antipsychotics, this chart shows that a low dose was 1.59, a moderate dose of an atypical was 2.13 and a higher dose was 2.86.
http://pn.psychiatryonline.org/cgi/content/full/44/5/1
God bless the soldiers.
Posted by Rosie at July 22, 2009 01:04 PM
My hunch (not as an expert on veterans, but as a mom, and as someone who has worked with institutionalized children in youth, and with special ed kids as a volunteer now) is that the reason atypicals are being prescribed for depression is not to treat the depression itself, but to tone down some of the possible manifestations of depression in young males: namely, irritability, possible aggression and violence directed at oneself (suicide attempts) or family members. Forgive my painting with a broad brush, but at least some depressed men act angry rather than sad, and this is very threatening to many people. In addition, calling someone's difficulties "depression" is less stigmatizing than labelling them with a bipolar or a personality disorder diagnosis (atypicals are frequently prescribed for the latter).
I have read that in prisons, violent prisoners are sometimes prescribed lithium and other mood stabilizers, not always to treat unequivocally diagnosed bipolar disorder, but to minimize aggression. At least, that is the rationale.
Societies generally prefer tranquillizing people they cannot immediately heal. Hence the vast numbers of prescriptions currently written for atypicals for children (mostly boys) with conditions like autism, possible bipolar, and various conduct disorders.
It's appalling. But with such inadequate meds and not enough clinicians and people unable to afford care, even when available, such stop gap measures are inevitable.
Posted by retriever at July 22, 2009 04:20 PM