Map of life expectancy at birth from Global Education Project.

Tuesday, September 20, 2005

Remember, you read it here first.

Well, unless you happened to read it somewhere else earlier. As we have been saying for a while now, antipsychotic drugs don't work very well, and they have really, really bad side effects. The National Institute of Mental Health funded a multi-site, head-to-head study of 5 anti-psychotic drugs, at a modest cost of just $44 million, intended to compare the newer, so-called atypical antipsychotics (brand names Zyprexa, Risperdal, Geodon and Seroquel), which bring in $10 billion a year for their manufacturers, with each other and with and older drug (brand name Trilafon), which costs a fraction as much.

You can read all about this in the newspaper -- NIMH put out a press release and it's gotten considerable coverage -- but the personalized Cervantes take on all this is that it's pretty much the same old story. The older drugs, called neuroleptics, controlled some of the most debilitating symptoms of schizophrenia, called positive symptoms -- hallucinations, delusions, disordered thinking -- and made it possible for people to function at least well enough to stay out of mental hospitals. Unfortunately, these drugs cause serious adverse effects, notably stiffness, tremors and a really bad one called tardive dyskenesia, characterized by uncontrollable repetitive movements, which can be irreversible.

So drug companies got FDA approval for the new class of antipsychotic drugs, claimed they were safer, marketed them with glowing testimonials if they did say so themselves, and charged a fortune for them. But now, says NIMH, "Contrary to expectations, movement side effects (rigidity, stiff movements, tremor and muscle restlessness) primarily associated with the older medications were not seen more frequently with pherphenazine [Trilafon] (the drug used to represent the class of older medications) . . ." And oh yeah, pherphenazine worked just as well. Zyprexa was slightly better in that fewer people taking it were hospitalized for relapses, but it was much more likely to cause serious weight gain and diabetes -- which is a potentially deadly disease. And like the other atypical antipsychotics, it costs 10 times as much as the neuroleptics.

Bottom line? We've been ripped off, again, by the drug companies with the assistance of the FDA. For people with schizophrenia and people who care about them, I'm afraid there's not a lot of good news here, except that doctors will now understand a little bit better what these drugs can and cannot do. People might as well start with the cheap ones and stay with them if they can, which will lower overall health care costs a bit. But the risk of tardive dyskenesia remains and can't be avoided. Maybe they'll find a better treatment eventually, and meanwhile, hang in there. Schizophrenia can remit in middle age. And there's a lot more we can do to help people with schizophrenia make it, especially supported housing, day treatment programs, and family centered support and respite care. There are far too many people with the disease living on the street and in shelters, and there is no excuse for that.


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buy generic cialis said...

I don't trust drug companies. I feel like they are all trying to get as dumbed as if we were all living in the Huxley's "Brave New World"!

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