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Study: Newer Antipsychotic Drugs Are Overused

Researchers Say Many Doctors Prescribe Drugs Despite Lack of Evidence of Effectiveness
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Jan. 7, 2011 -- Many people taking powerful psychiatric medications that increase their risk of weight gain and diabetes are prescribed those drugs when there’s little evidence that they will get any benefit from them, a new study shows.

What’s more, experts say that even when these drugs, which are known as atypical antipsychotics, are prescribed as recommended, they may not be safer or more effective than the less expensive, older medications that they’ve apparently replaced.

“Atypical agents were once thought to be safer and possibly more effective,” says study researcher G. Caleb Alexander, MD, an assistant professor in the department of medicine at the University of Chicago Hospitals. “And what we’ve learned over time is that they are not safer, and in the settings where there’s the best scientific evidence, they are no more effective.”

How Drugs Developed for Schizophrenia Became Used as Antidepressants

The first generation of drugs to treat serious mental illnesses like schizophrenia were introduced in the late 1950s and 1960s, but those drugs often had disfiguring and painful neurologic side effects like muscle spasms and tremors and caused involuntary movements like facial grimacing.

In 1989, the first of a newer generation of atypical antipsychotic drugs, Clozaril, was introduced with the promise of being more effective than its predecessors, with fewer side effects. Other medications in the class soon followed, including Abilify, Geodon, Invega, Risperdal, Saphris, Seroquel, and Zyprexa.

“Since there were all these new drugs, and it costs 700 to 800 million to bring a drug to market, drug companies needed to make that money back,” says Jeffrey Lieberman, MD, chairman of the department of psychiatry at Columbia University, who was not involved in the study. “These drugs were marketed aggressively.”

The study, which was published online in the journal Pharmacoepidemiology and Drug Safety, documents what Lieberman and others believe were the effects of that marketing.

Researchers found that the number of office visits in which a doctor documented a patient’s use of atypical antipsychotics more than doubled since the mid-1990s -- climbing from 6.2 million in 1995 to 14.3 million by 2008, making them the top-selling pharmaceutical drug class.

Over time, the way doctors prescribed those drugs changed, too, with doctors becoming more likely to prescribe these powerful medications for conditions in which they had not been rigorously studied or FDA approved, such as anxiety, depression, attention deficit disorder, and for aggression and agitation in dementia patients.

In adults, for example, the use of any antipsychotic medication -- old or new -- remained relatively stable from 1995 to 2001. But from 2001 to 2006 use of the medications doubled, the study showed, indicating that doctors were becoming quicker to turn to these powerful drugs.

In children, the use of the drugs skyrocketed, increasing 800% from 1995 to 2005.

“Time and time again what we see is medications that are prematurely adopted in populations that have little or nothing to gain, and this study is yet another example of how both doctors and patients may overenthusiastically or prematurely adopt medicines beyond the evidence base,” Alexander says.

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