If I were to ask you what the single top-selling therapeutic class of prescription drugs in America was, what would you say? Pain relief drugs? GI drugs? Supplements? Nope. The answer is: antipsychotics. According to IMS Health, Inc., “Antipsychotics remained the top-selling class of medications in the U.S., with 2009 prescription sales of $14.6 billion.”
Really? Until recent years I always thought antipsychotics were hard-core drugs reserved for serious psychiatric diagnoses: schizophrenia, bipolar disorder, delusions, hallucinations and thought disorders. Today it seems everyone is being prescribed these drugs – unruly kids, elders with dementia, and the average working person suffering from too much stress. Just about everyone knows someone who is on one of these drugs because our medical and educational systems make it difficult to refuse them. My partner’s son, for example, was precocious, too quick for the pace of his teacher’s lesson plans and bored in school. So he found ways to entertain himself, as bored children will tend to do. The school administration branded him with ADHD and demanded that he be put on Ritalin or be expelled. He was snatched out of that school in a heartbeat and sent to a boarding school in his parents’ native Britain where the answer to every behavioral issue was not necessarily a pill. Today this problem child is a happily married father of three with a degree in physics and a job in the aeronautical field. The option of alternative schooling is not open to every parent, however. Another child I know may not fare so well. Suffering from insomnia, he wandered around the house all night. So his mother took him to a pediatrician and got talked into a diagnosis of bipolar disorder. The last time I saw him he sat at the table staring out from behind wide, blue eyes, strangely quiet and seemingly devoid of emotion. No doubt he’s easier to manage. He’s six.
Little wonder we’re using drugs more often to address difficult behavior problems – the pharmaceutical industry developed a new class of medications in the 90’s known as “atypical antipsychotics”. Zyprexa, Risperdal, Seroquel and the more recent Abilify are hyped as more effective than old-school drugs like Haldol and Thorazine. And they don’t cause tremors. AlterNet.org calls the atypicals the “bright new stars in the pharmaceutical industry’s roster of psychotropic drugs – costly, patented medications that made people feel and behave better without any shaking or drooling.” By 2009 Seroquel and Abilify were number 5 and 6 in annual drug sales, with 20 million prescriptions written for the top three atypicals.
Maybe the U.S. is suffering from mass psychosis. Or maybe the cause of the explosion in antipsychotic use isn’t about psychosis at all. It’s not news that drug companies woo physicians into prescribing their drugs with gifts, junkets, and money for research. Psychiatric treatment is subjective. There’s no biological test for mental disorders and with all the influence from Big Pharma, of course the treatment of choice has become chemical in nature. Add to that the fact that health plans won’t pay for traditional therapy anymore and it’s eay to see why a shocking 389,000 children and teenagers were treated last year with Risperdal alone. Of those, 240,000 were twelve or younger. Twelve. Most of these kids had been diagnosed with attention deficit disorder. Research in the Journal of the American Academy of Child & Adult Psychiatry found that the number of children five years and younger – some as young as two years old – receiving antipsychotic meds has doubled in recent years. These are some of the most powerful and dangerous drugs in the drug industry’s arsenal: antipsychotic drugs that in most cases are not even approved for use in children.
Sickeningly, a 2009 study in The New England Journal of Medicine found that 18 out of 20 psychiatrists who wrote the American Psychiatric Association’s clinical guidelines for the treatment of depression, bipolar disorder and schizophrenia have financial ties to drug companies. Mental illness is now the leading cause of disability in children because under Big Pharma’s influence the criteria for mental illness have simply been expanded so almost everybody has one. The over-prescription of antipsychotics amongst the elderly is as troubling as over-prescription in kids; neither group makes its own choices about what drugs to take. Their vulnerability makes them targets to be tranquilized when they have problems. Alternative treatments, on the other hand, require an investment of time and thought. And health insurance plans, including Medicare and Medicaid offer little in the way of coverage.
Increasingly, psychiatrists are moving away from cognitive therapy and into medication management. Insurance companies DO pay for that. But medications don’t solve behavioral problems, they just slow down the person who takes them. Children don’t always fall under the category of a pervasive developmental disorder. Rather than risking the health of these kids and incurring the long-term cost of the damage these drugs can cause, health plans should audit physicians to see if the meds are needed. And here’s an idea: compile guidelines for diagnosing and treating mental illness on the basis of an objective review of scientific evidence – not on whether the shrinks writing them get speaking fees from Eli Lilly or an ego-stroking award from Merck.