The Most Popular Drug in America Is an Antipsychotic
alternet.org
alternet.org
I wouldn't be surprised if Ativan/lorazepam is still #1 in terms of prescriptions.
http://www.drugs.com/stats/top100/units
acetaminophen/hydrocodone is #2
budesonide is #1 which is used to treat asthma (in puffers I believe).
I spent some time scraping medication information and learned that pharmacies in the US mine massive amounts of data about pharmaceutical purchases and there are a few billion dollar companies that collect/sell this data. Customer information is "anonymized" of course at the pharmacy level. You can find the sales of the top 100 drugs drugs pretty easily online, but there are thousands of drugs and the data-mining companies charge you to see sales of the smaller ones (from my experience).
As for Rx data, IMS is king. They pay pharmacies, wholesalers, etc to report all of their sales. It's used heavily by pharma companies. I've seen some of the data and it goes all the way down to individual Rxs by doctor. Incredible stuff.
It's about 1/2 way down the page. Of course this is by total number of Rxs, not dollars. Hydrocodone/APAP is pretty cheap. Also it's from 2012, so it might have changed.
> When someone's antidepressant didn't work, Pharma marketers began floating the idea that it wasn't that the drugs didn't work; it wasn't that the person wasn't depressed to begin with but had real life, job and family problems—it was "treatment-resistant depression."
Over-prescription in general seems to come from ill equipped / underfunded facilities. These are places that can't afford to give every person individual therapy. They are communal, so there is lots of personality clashing that goes on inside of the facilities that exacerbates disorders which stem from or are composed largely of adaptive socialization behaviors that become maladaptive in different environments. A person who grew up in poverty or from an abusive environment is going to be angry and depressed. Just because there is no one available to have an intelligent kind of compassion for that person, doesn't make them psychotic. People are afraid of what they don't understand in general. It's easier and cheaper to zonk someone out than actually have to think about or pay how to help them.
I really don't mean to come off so cynical, but some of these public facilities can be blackholes for many of the people they treat, with the possibility of re-traumatizing people on top of the problems they already have.
Oh, and on top of that, the humorous part (read with heavy sarcasm): people at these places are called "clients" and the facility stresses that that specific phrasing is used. No one is called a patient. They are a "client", a consumer.
A client is a more engaged partner in the activity of achieving and maintaining well-being; a patient is a more passive victim of their situation.
That said, I'm sure there exist people who don't experience that. But that doesn't imply that it does not happen.
You have no idea about the level of conflicting messages you receive in these places. The advice is so diluted that it can't be practically applied, it only describes very generally the way the mind functions when it is operating at an average baseline. It doesn't mean it creates mental stability. These places run on belief systems, not science.
I am absolutely certain this is one side of a coin. On the other hand, these are difficult, systemic issues for which places like this serve as a sinkhole for. The people who work there have to deal with this every day, and I'm sure many of them are trying their best and are not abusing the power and authority they have been given over the lives of other people. But that doesn't mean it can't be improved, and it doesn't mean it doesn't warrant a real, socially active and involved discussion.
What's prescribed for people with is are "mood stabilizers" (and all of them but the "gold standard" of lithium were originally developed for other indications like psychosis and convulsions). So people who have true bipolar disorder by definition have manic phases, and they need their mood stabilizer all the time to deal with both that and depression phases.
One dose of thorazine, given by the ER doctor, and the hiccoughs subsided. Thorazine dampens the vagus nerve. This was the intended effect. Less intended was my complete lack of motivation to do anything outside the confines of my apartment for the rest of the weekend. (I also took great interest in my neighbourhood parks, for once.)
> Everyone has heard of "mission creep." In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one.
This is more accurately referred to as "drug repurposing," and it's hardly the unalloyed evil that it's characterized as here. It's true that drug companies love to repurpose existing FDA-approved drugs, both because it saves them money and because it typically permits them to patent the compound again in a new context, but there are nonetheless real benefits to the public at large when a drug whose side effects are comparatively well-characterized over the long term is put into service to treat a different malady.
I had to stop using it because of unacceptable side effects (rapid weight gain and sexual dysfunction), and it took me a long time to find something else that worked as well. The medication that ended up working for me was originally developed as an anticonvulsant. My symptoms lessened over time in adulthood, but if I hadn't had the course correction provided by repurposed 'Big Pharma' medications I would be living a much harder life.
*: I'm not naming medications because I don't want to promote them. What worked for me isn't necessarily what will work for anyone else.
I did name one drug name because if any other atypical anti-psychotic will do the trick it should perhaps be tried, Zyprexa is pretty infamous for weight gain among other things.
But the article is clearly talking about its abuse.
Eli Lilly, Pfizer and AstraZeneca have collectively paid out more than $2.5bn in settlements over the off-label promotion of atypical antipsychotics. The drugs that they unlawfully promoted are now being used widely for the treatment of a variety of conditions for which there is little evidence of efficacy. Lilly were marketing Zyprexa for the treatment of dementia, in spite of having extensive unpublished research showing that it was ineffective.
Atypical antipsychotics are being used by far too many psychiatrists as a catch-all where other lines of treatment have failed - OCD, autism, PTSD, ADHD, anorexia, substance abuse, you name it. In most cases the evidence of efficacy is slim-to-none. That's not medicine, it's quackery. Frankly, I'd be happier if they were prescribing placebo; Nobody has ever died from the side effects of sugar pills.
Consider Lucentis vs Avastin. Ophthalmologists were using Avastin off-label for wet AMD. Genentech was making a huge multifaceted effort to discourage off-label use because they had sunk a bunch of effort/$ into the order-of-magnitude-more-expensive Lucentis for not much of an improvement. Similar situation and different ending with Lumigan (glaucoma/ocular hypertension eyedrops) vs Latisse (eyelash enhancer), where Latisse's patent (afaik) was thrown out because Allergan was trying to patent a known major side effect of Lumigan.
I'm not a fan of misleading promotions of off-label uses either, but I wish there was a middle ground still banning that that didn't also involve more patents and protection.
Anti-bacterial wipes for everything, pills at the smallest sign of illness (even just the sniffles), copious use of sleeping aids, and so on.
In my upbringing (which was kind of 'typically' Dutch), we took medication as a last resort. Even painkillers were not something you took unless your headache was unusually bad.
I have no doubt that this is also changing in Holland, especially when it comes to prescription drugs for psychological issues, but in general it seems a bit healthier to me to allow the body to take care of itself when it can, rather than stuffing it with foreign bodies that often have all kinds of adverse side-effects.
This state of affairs often makes me think about how malleable societies really are, for both good and bad, and how much variation there is even within 'Western-European' nations.
The whole neurotransmitter imbalance hypothesis is itself not proven for Abilify or any other anti-depression drug (like SSRIs). At best, it is a guess since there is no way to measure levels of neurotransmitters in live subjects. At worst it is a lie. Regardless, the method of action is irrelevant if medicines work, but considering the efficacy of such drugs (not very good) and their frequency of prescription (very high) it's not surprising that the medical industry would work so hard to push an unproven theory as fact simply to sell more drugs.
That is: Antipsychotics are for people who experience psychosis, and people who experience psychosis are crazy lunatics, so it's absurd that so many normal people are being prescribed antipsychotics.
Read this, perhaps instead.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518694/
The issue is not that they are portrayed as too "hardcore", but rather in general things like depression are over-simplified and dumbed down to stoke consumer demand for narcotic remedies.
(Trivializing the subject is not a good thing.)
It turns out that certain hospital physicians find it a convenient sleep aide for use in the hospital, and the prescription unintentionally follows the patient, sometimes for months or years.
(Source: I sell software to long-term care facilities and their pharmacists.)
Also, I think banning drug ads and the profession of pharmaceutical sales rep would go a long way toward fixing over-prescribing and medical costs. When the new Congress wants to reform Obamacare, someone should add this ban.
Three days/two nights without sleeping, as in without going to bed at all, should not cause you to hallucinate. That's just a weekend. That's as uncommon as you might think. If you are hallucinating there might be something else going on.
Seroquel is ... interesting in that it hits a histamine receptor harder than anything else; for someone like me, who also suffers from bad allergies, this duel side effect is particularly advantageous.
As far as I know, all atypical anti-psychotics have been black boxed (major league warning) for treating the elderly with dementia, the side effects in them are worse than the benefit.
Insomnia is, in my experience, symptom of low dopamine. You need to exert executive function to intentionally drop trains of thought that are keeping you awake—without enough dopamine to do so, you end up increasingly exhausted but unable to sleep. Vyvanse is the best thing that ever happened to my sleep schedule.
One thing to emphasize from our disparate experiences is that in this arena there aren't "one size fits all" solutions. There are common symptoms which respond to common solutions, sometimes after a search for a particular drug that works with acceptable side effects, then there are people like me where doctors and myself struggle for years to find a set of drugs that provide the best solution (for now) that control but by no means cure my symptoms (like my uncle, this eventually disabled me).
Getting back to the original basis of this discussion, I'm absolutely sure that Amblify when used as an adjunct for current generation antidepressants works from some people with refractory depression, which I can attest is no fun at all, since mine is only partially alleviated, and I have friends who spent years before they found at minimum partial solutions for their more standard unipolar depression. Is it seriously over-prescribed? Who knows? In my experience, there are enough people out there with refractory depression that it might well not be. And I'd certainly try it before e.g. electroshock therapy, which is one of the alternatives if you're desperate enough.
As a side note, I learned cognitive psychology in the '80s (now cognitive behavioral psychology, http://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/03808... is the classic and highly recommended layman's introduction), and it's tremendously useful, and in retrospect ended any benefits from talking therapy, but it's pretty clear that like the 3 particular antidepressants I've tried from two generations of them, only a partial solution for me.
Yes, there has been a major push by Medicare and others to reduce anti-psychotic use in the elderly.
I think the term "Thorazine shuffle," refers to the characteristic locked-knee shuffling gait that develops because Thorazine frequently causes tardive dyskinesia as a side effect.
Edit: ignore this, see below; though, the drug does induce discomfort and restlessness in the limbs that prompts patients to pace around.
So far I have only found lavender oil, sardines and chocolate to work.
http://www.ncbi.nlm.nih.gov/pubmed/16814590 http://www.ncbi.nlm.nih.gov/pubmed/19739671
Not trying to be contrary, but do you have a source?
I think it's more complicated than a simple either-or proposition.
St John's wort is not sold as a medicine so the products you can buy are subject to much lower levels of quality control. St Johns Wort varies in quality across different brands.
Plus St Johns Wort interacts with practically everything.
Sources: http://www.nytimes.com/2010/05/26/health/policy/26herbal.htm...
>16 of the 40 supplements tested contained pesticide residues that appeared to exceed legal limits, the investigators found. In some cases, the government has not set allowable levels of these pesticides because of a paucity of scientific research.
http://www.nytimes.com/2013/11/05/science/herbal-supplements...
>DNA tests show that many pills labeled as healing herbs are little more than powdered rice and weeds.
>Two bottles labeled as St. John’s wort, which studies have shown may treat mild depression, contained none of the medicinal herb. Instead, the pills in one bottle were made of nothing but rice, and another bottle contained only Alexandrian senna, an Egyptian yellow shrub that is a powerful laxative.
http://well.blogs.nytimes.com/2014/10/21/dangerous-dietary-s...
>out of more than two dozen supplements that were pulled from shelves after they were found to contain anabolic steroids or powerful prescription drugs, roughly two-thirds were back on the market a year later with the same illicit ingredients
When I was a in fairly deep depression, the only thing which kept me sane was playing hockey and pushing my cardio to the max every time I stepped on the ice.
The rush of adrenaline and release of endorphins and making my brain engage in something other than why my life is so miserable did wonders for me.
A few years later, I was seeing a psychologist and told her about how hockey in essence saved my life. She posited the same thing. The release of endorphins and adrenaline actually help combat the depression and helped me, at least for periods of time, overcome the feelings of despair and isolation.
There is very little benefit from exercise for people who have depression.
Children and adolescents: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004691...
Adults: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004366...
Exercise is better than a placebo, if the trial is low quality. Once you get better quality trials the benefit is less significant.
There's some evidence that exercise might build resilience against depression in people currently not depressed.
Note: A single stuidy of 200 people is generally better than 10 studies of 50 people because you can't combine raw data from different studies. And treatments for mental issues are generally only useful for sub populations.
Link: http://www.ncbi.nlm.nih.gov/pubmed/19453207
From the abstract:
> ...the current meta-analysis examines the effects of exercise on depressive symptoms in 58 randomized trials (n = 2982). An overall effect size of -0.80 indicates participants in the exercise treatment had significantly lower depression scores than those receiving the control treatment. This frac34; SD advantage represents level 1, Grade A evidence for the effects of exercise upon depression.
Taking an herbal drug can be very helpful psychologically even if it is not proven medically effective (the placebo effect). Just do some research because natural drugs can have harmful side effects too.
By the way, omega-3 from fish oil has strong evidence of an effect on major depression[1], but not the everyday kind. And that doesn't mean take it just in case, it could be bad for you!
If you want natural, I would try tobacco (it can be snuff, no need to smoke, although smoking works faster). For synthesized, try moclobemide.
How would you describe your symptoms?
From my own personal experience, it reduces my anxiety within hours of taking it. And relieves depression in about a week. In the US, you can buy it off the shelf at any CVS/Walgreens. But it's certainly not cheap.
http://en.wikipedia.org/wiki/S-Adenosyl_methionine#Therapeut...