Why are so many anti-psychotic drugs prescribed?

January 14, 2007 7:21 PM

I just read in the NYT that Zyprexa (an atypical anti-psychotic, used to treat schizophrenia and mania) is the fourth-most prescribed drug in the world. Other lists I've seen put similar drugs in the top-ten sellers. How can this be? Are there that many people suffering from these disorders compared to being medicated for high blood pressure, high cholesterol, or any of a dozen other maladies I can think of that appear, on general observation, to be far more common? (And I don't believe, neccessarily, that this is simply doctors overprescribing - because, at least to me, that premise would mean overprescribing all drugs, not just the ones in question, right?)
posted by soulbarn to health & fitness (15 comments total)

As a rule of thumb physicians today seem to prescribe anti-psychotics for a host of issues. Many of which would not of been treated with anti-psychotics in the past. Introvertive types for example.

In my judgement it may be that there is a whole segment of the population being drugged out of there personality type. I would be curious to know if the suicide rate has declined, remained the same, or become elevated over the last ten years as a back lash to this sort of medicating regiment.
posted by bkeene12 at 7:36 PM on January 14, 2007

In adults, this probably has to do with the fact that:
- atypical antipsychotics act as a tranquilizer/heavy sleep aid to the uninitiated
- doctors in the US hate prescribing benzodiazepines for long term use, which means atypical antipsychotics are prescribed as sleep aids in their place

The drug is also perceived as safe to use in children, so it's handed out to them like candy.
posted by crazycanuck at 7:36 PM on January 14, 2007

Just guessing here, but maybe there are a lot fewer atypical antipsychotics out there than blood pressure, etc., meds. So everyone who has any version of psychosis gets Zyprexa, whereas if you have high blood pressure your doctor will choose from hundreds of drugs to prescribe to you.
posted by nixxon at 7:41 PM on January 14, 2007

Similarly, any drug that has a generic version won't be on the list.
posted by smackfu at 7:42 PM on January 14, 2007

Zyprexa's used for a lot of depressed people, especially those with prominent anxiety, hallucinations, disinhibition, insomnia, irritability, or certain other features.

The problem isn't with overprescription, it's with sloppy names for drugs. I prefer the term 'neuroleptic' for these drugs because that doesn't suggest how they're used.

I also doubt it's the fourth most commonly prescribed drug in the world. The USA or Europe, maybe.
posted by ikkyu2 at 9:33 PM on January 14, 2007

In addition to its use for psychotic disorders like schizophrenia, Zyprexa and other atypical antipsychotics are often prescribed for bipolar disorder, as an adjunct in treatment of depression, and for agitation in dementia.
posted by neuron at 9:34 PM on January 14, 2007

I also doubt it's the fourth most commonly prescribed drug in the world. The USA or Europe, maybe.

I'd think you're right ikkyu2, but I also imagine there is a staggering difference in prescriptions per capita between USA/Europe and the rest of the world, so I figure they are very heavily weighted no matter what.
posted by Ynoxas at 10:48 PM on January 14, 2007

zprexa is used on an 'off label" basis by many psychiatrists and doctors of internal medicine when standard ssri antidepressants are not working and the patient is either suicidal, hopeless, lethargic, and/or non functional (not withstanding the symtomology of hallucinations, irrational thinking, etc which are the target of on-label zyprexa use, I'm talking about off label only here). zyprexa does work and it works quickly. In bipolar one, or especially bipolar two, in profound depression. Problem is many patients put on a LOT of weight on this drug. Patients seem to like the effects all except for the weight one.
posted by Lylo at 12:34 AM on January 15, 2007

Other lists I've seen put similar drugs in the top-ten sellers. How can this be?

One possibility is that they are counting differently. One list may be the top ten by value, another the top ten by number of patients, another the top ten by miligrams of drug sold, etc.
posted by sindark at 3:55 AM on January 15, 2007

I also doubt it's the fourth most commonly prescribed drug in the world. The USA or Europe, maybe.

Zyprexa is the top selling drug for Eli Lilly, one of the largest drug companies. They sold $4.4 billion worth in 2005, 1/2 in the US and 1/2 outside.
posted by smackfu at 6:27 AM on January 15, 2007

Could it be something to do with anti-psychotics typically being taken for a longer period of time than other types of drugs and therefore having lots of prescriptions despite fewer users? Just a guess, rather than any actual knowledge on my part!
posted by prentiz at 8:02 AM on January 15, 2007

Even Lilly's own promotional site for Zyprexa lists hints vaguely at side effects that are actually pretty damn bad. (Bad enough that most of the first page of Dogpile results are from a sector of the populace that I'd rather have drugged.) I don't need any help in getting morbidly obese and diabetic, thanks much, not to mention any neuroleptic's usual high risk of extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome. This is why I'd rather put up with screeching "voices" telling me bad things.
posted by davy at 11:27 AM on January 15, 2007

See what www.crazymeds.org has to say on Olanzapine ]zyprexa[.

Why are they prescribed so much¿

This page explains...

"Zyprexa (olanzapine) is your best bet for a calm-you-the-hell-down-in-a-crisis med there is on the US market."

Otherwise, I thought it was for bipolar/mood disorders.
posted by alicesshoe at 3:54 PM on January 15, 2007

The sites I've read have said Zyprexa, "is the 7th some say 5th largest drug sell in the world" so that news article could be wrong but, it's definitely in the top 10.

To expand on Lylo said. After Zyprexa was approved Eli Lilly could only market the drug as a treatment for schizoprenia and bipolar disorder but, doctors can prescribe it in any way they see fit because prescriptions for patients are unregulated/unmonitored for the most part. Part of the claim made against the company is that they encouraged their sales reps to recommend the drug be used for conditions like autism, PTSD, depression and, dementia which are not on the FDA's approved list of uses. Its how you go from treating 1% of the population to whatever it is (a lot I'd imagine).

Using drugs "off label" is a common occurrence eg: Prozac for chronic pain, clonazepam (an anti convulsant) for anxiety or parkinsons, botox for migraines ... the list is endless.
posted by squeak at 7:58 PM on January 15, 2007

Also, many drugs for more common ailments, such a high cholesterol, indigestion, blood pressure etc... are available over the counter, so wouldn't count as prescription drugs.

Putting aside 'drugs' such as nicotine and alcohol, I would guess Aspirin is the worlds most popular medication, for example.
posted by dflock at 4:19 PM on January 16, 2007