The huge rise in prescriptions has been sparked by the availability of a relatively new class of drugs called ‘atypical antipsychotics’.
All antipsychotics block the D2 type of dopamine receptor and their effect on the mesolimbic dopamine pathway is what largely causes the reduction in psychotic symptoms.
The older drugs block D2 receptors fairly indiscriminately in the brain, including in the nigrostriatal pathway.
This pathway is involved in movement regulation and blocking dopamine here leads to similar problems to Parkinson’s disease (tremors, rigid and uncontrollable movements) – a type of dementia where this brain area starts to break down due to disease.
The newer ‘atypical antipsychotics’ usually also block serotonin 2A (5HT-2A) receptors in the key movement pathway.
Serotonin normally reduces dopamine release but because serotonin is being blocked, more dopamine is released in the movement pathway with the newer atypical antipsychotic drugs than with the older typical antipsychotic medications.
This means less Parkinson’s-like movement side-effects with the atypicals – a genuine advance – but unfortunately, the serotonin effect causes additional problems with weight gain and often obesity, diabetes and heart problems.
However, these problems are perhaps easier to control and more ‘socially acceptable’ (compare with someone who make strange contorted movements during conversation).
On the commercial side, many newer atypicals are still under patent, meaning one company has sole control over their manufacture and sale, while other companies are not able to make cheaper copies.
Over time, these newer drugs have been promoted, legally and illegally, by drug companies for a wider and wider range of problems – everything from depression to dementia.
Despite limited evidence for their effectiveness in these areas, the sales campaign has been a huge success and the drugs are now being widely prescribed.
Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses – primarily schizophrenia and bipolar disorder – to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis…
What’s especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old – vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.
Antipsychotic drugs have been one of the great advances of 20th century medicine. For the first time we have an effective treatment for psychosis, one of the most disabling of any of the disorders, that works for at least a fair proportion of patients.
The side-effects of both the older and newer drugs, however, are among the worst of any medication and they should genuinely be used with caution.
Unfortunately, the well-being of patients has become secondary to the profit margins of large pharmaceutical companies who continue to promote these drugs to as many patients as possible, regardless of their benefits or adverse effects.
The Aljazeera article tracks this campaign to the point where they have become top selling medications.
Link to ‘How Big Pharma got Americans hooked on anti-psychotic drugs.’
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