antipsychotics

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Study Ignites Debate Over Non-Drug Treatment For Schizophrenia

Antipsychotic medications (Wikimedia Commons)

Antipsychotic medications (Wikimedia Commons)

By Alexandra Morris
CommonHealth intern

Antipsychotic drugs are typically the first-line treatment for the roughly one percent of people who have schizophrenia — often in conjunction with psychotherapy. But for patients who are not helped by the drugs or cannot tolerate their side effects, what’s left?

Last month, the Lancet published a study looking at the effects of cognitive therapy on patients with schizophrenia who refused to take medication – and prompted a heated debate within the mental health community.

Cognitive therapy involves one-on-one meetings between a patient and a therapist to discuss ways to change thinking and behavior in response to their symptoms.

Patients in the study were randomly assigned to receive either treatment as usual — ranging from no treatment at all to psychosocial support and other methods — or treatment as usual plus cognitive therapy. The researchers found that by the end of the study, the patients who received cognitive therapy had reduced psychiatric symptoms as compared to those who did not receive cognitive therapy.

Sounds reasonable, no? But initial media coverage included headlines claiming that cognitive therapy was an effective alternative to antipsychotic treatment. The Guardian posted “At last, a promising alternative to antipsychotics for schizophrenia,” and Science magazine wrote, “Schizophrenia: Time to flush the meds?” BBC News reportedly posted a headline “Schizophrenia: Talking therapies ‘effective as drugs.’”

Shortly after the study hit the press, bloggers were off and running (from PLOS to The Mental Elf), highlighting the limitations in the study design, such as the small sample size of 74 patients and the fact that nearly a third of these patients dropped out of the study partway through. They urged readers not to generalize the effect of cognitive therapy on schizophrenia based on limited evidence.

In fact, cognitive therapy was never compared to antipsychotics in the study. Some patients were even prescribed antipsychotics during the trial as part of their routine treatment. Several of the media reports also failed to mention an important caveat – that the trial was conducted in a specific patient population: those with mild to moderate psychiatric symptoms, as compared to those with severe illness who require hospitalization. The findings therefore cannot be extrapolated to all patients suffering from schizophrenia.

Lead study author Dr. Tony Morrison of the University of Manchester attested to the high drop-out rate. Continue reading

Prescription Nation: 4 Billion A Year, Antipsychotics Lead Psych Meds


To share these mind-boggling (and I use the term advisedly, because so many of these drugs act on the mind) statistics, I’m passing along a press release just in from the American Chemical Society in full:

People in the United States took more prescription drugs than ever last year, with the number of prescriptions increasing from 3.99 billion (with a cost of $308.6 billion) in 2010 to 4.02 billion (with a cost of $319.9 billion) in 2011. Those numbers and others appear in an annual profile of top prescription medicines published in the journal ACS Chemical Neuroscience.

Journal Editor-in-Chief Craig W. Lindsley analyzed data on 2011 drugs with a focus on medications for central nervous system (CNS) disorders. So-called antipsychotic medicines — including those used to treat schizophrenia, bipolar disorder, obsessive-compulsive disorder, Tourette syndrome and some forms of depression — ranked as the fifth most-prescribed class of drugs by sales. Antidepressants, for conditions that include depression and anxiety, ranked No. 7.

XanaxTM, CelexaTM and ZoloftTM were the most-prescribed psychiatric medicines, with other depression and anxiety medications rounding out the top 10. Two antipsychotics were among the 10 drugs that Americans spent the most on, with AbilifyTM in fourth place. Lindsley explains that while antidepressants continued to be the most-prescribed class of CNS drugs in 2011, prescriptions for ADHD medicines increased by 17 percent and multiple sclerosis medications by 22.5 percent in sales from 2010. While expiring patents on major antipsychotics in the next few years will put pressure on drug makers to innovate, the industry should be heartened by the growth of the number of prescriptions and spending.

The full paper is here, including this chart of the top 10 drugs:

Top 10 drugs

Top 10 drugs in 2011 (Source: IMS Health via ACS Chemical Neuroscience)

Must-Read: Globe Series On Children and SSI

No one’s evil. Everyone means well. But many low-income children end up on psychiatric drugs at least in part, it seems, because if they’re medicated, their families are likelier to be approved for hundreds of dollars a month in disability payments.

That’s my takeaway from the first installment of the superlative, nuanced and deeply reported series by Patricia Wen now running in the Globe.

But I’m no expert. I asked for a reaction from Robert Whitaker, award-winning journalist and author most recently of Anatomy of an Epidemic, a new book that investigates the skyrocketing number of adults and children disabled by mental illness.
His response:

“I think the families–and our society–really need to look at the toll that this can take on the child. The child declared eligible for SSI is now going to be medicated on a constant basis–after all, the child is now seen as seriously mentally ill– and often the drug treatment may include a powerful antipsychotic. Over the long term, such drug treatment can cause a host of physical, emotional and cognitive problems, and you are also setting the child on a ‘career path’ of lifelong mental patient. I don’t think the families are thinking about that when they turn to SSI for financial help; they don’t see what that this will do to their child down the road. And our society should also take a look at the extraordinary long-term financial cost of putting a child onto this path of life-long disability.”

Today’s installment of the series describes the heavy use of “speech delay” as a reason to put a child on disability payments, and the frequent failure to follow up on whether the disability remains.