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Antipsychotics: They’re not just for Schizophrenia Anymore!
Like all crazy meds, antipsychotics (APs) are used for conditions other than what they are usually associated with. Or what they were originally developed for. Thorazine (chlorpromazine) was originally developed and used as an add-on to anesthesia: to calm people down prior to surgery, to keep them from puking, and to lower body temperature1. Even reserpine, the original antipsychotic, was developed in Europe as a blood pressure med a couple years ahead of Thorazine, and it was first synthesized in India almost 20 years prior to that and used as an antipsychotic. Oh, and the root of plant from which it was synthesized, Rauwolfia serpentina (AKA Indian Snake root) has been used in India since forever to treat mental illness. But who cares if crazies had to suffer an extra couple of decades until Whitey caught up2.
So, what are antipsychotics, or, to use the application-neutral monicker, neuroleptics these days…
Older first-generation meds like Thorazine (chlorpromazine) and Haldol (haloperidol) are used right along side the newer second-generation and third-generation neuroleptics to treat schizophrenia and related conditions. Invega (paliperidone) is currently the only med with official approval to treat schizoaffective disorder.
Just as most new antiepileptic drugs (AEDs) are being pushed to treat migraines and/or neuropathic pain, most new antipsychotics are being pushed as mood stabilizers, and for the same reason. Just as there is more money in treating pain than there is in treating epilepsy and bipolar disorder, there is more money in treating bipolar disorder than there is in treating schizophrenia.
Adding an antipsychotic to an antidepressant (AD) to boost the efficacy of the antidepressant has been around for about 30 years. Symbyax (olanzapine and fluoxetine) wasn’t the first combination of the two in one pill, Etrafon/Triavil is a combination of the tricyclic antidepressant Elavil (amitriptyline) and the standard antipsychotic Trilafon (perphenazine). Symbyax was just the first drug to hit the market with an approval for bipolar disorder and nothing else, even if it is a combination of two existing meds.
What’s different is the amount of research that’s been done on the AP & AD cocktail, for both bipolar and unipolar depression. And while there’s more money in depression than bipolar disorder, the AD market is over-saturated with meds that are mostly generic. Even the few that are still on-patent, like Cymbalta, are often being sold for applications unrelated to depression, such as neuropathic pain. So the drug companies have seized the opportunity by getting approvals for their expensive APs to be paired with anyone’s generic ADs, or still profitable on-patent meds like Lexapro. It’s a lot cheaper doing it that way than making one pill the way Lilly did with Symbyax. Plus it’s better for the consumer, as you can now mix and match Abilify and various ADs and have your insurance cover it, instead of being stuck with only Prozac and Zyprexa, which is all Symbyax is.
Additionally some APs, such as Seroquel, are approved to treat bipolar depression and not just bipolar mania, which is how most approvals for bipolar work.
Although second-generation APs are frequently prescribed for anxiety disorders, none is approved to treat them. Many of the first-generation APs have been approved to treat generalized anxiety disorder (GAD) or just non-specific “anxiety.” Several FGAs have been approved to treat tic disorders, mainly Tourette Syndrome. Many APs, old and new, are approved to treat “agitation,” which has usually meant, “Keeping grandma in her bed,” or “Make. that. damn. kid. shut. the. fuck. up. already!” (many FGAs carry an approval for “behavioral problems” as well). Fortunately they aren’t used for this nearly as often as they used to be.
Now considered a second- or third-line application, as this was the original purpose for some FGAs, they are still used to handle severe vomiting that doesn’t respond to the drugs that are usually used in hospitals for this, and are in the same or similar chemical class as the APs.
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1 Ask an anesthesiologist, I have no idea why cooling you down makes their lives easier. For all I know phrases like "chill out" originated with anesthesiologists.
2 This is one of several specific reasons as to why I get really pissed off when people equate racism with mental illness. For some reason those in the so-called "liberal media" are especially fond of doing this. I'm looking at you NPR and Keith Olbermann.
Common Uses of Antipsychotic Drugs (APs) by Jerod Poore is copyright © 2010
Page created by: Jerod Poore. Date created: 12 July 2011 Last edited by: JerodPoore on 2014–05–22
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.
Author: Jerod Poore Date Modified: 2015–12–20 Date Published: 2011–07–12