Oh boy. Here we go again. A study published online ahead of print at the Journal of Clinical Psychiatry notes that among Oregon Medicaid patients who received a prescription for an atypical antipsychotic:
- 52% had a depression diagnosis
- 34% had an anxiety diagnosis
- 15% had a PTSD diagnosis
But only 15% had a schizophrenia diagnosis and 27% had a bipolar diagnosis. So... the majority of atypical scripts were written off-label. Seroquel was the most frequently prescribed atypical, followed by Zyprexa, then Risperdal.
Doses less than what are typically given to treat schizhophrenia or bipolar disorder (subtherapeutic dosing) were quite common. As in 86% of Seroquel scripts were subtherapeutic, 59% of of Risperdal scripts, and 48% of Zyprexa prescriptions. Wait, am I calling for higher doses of these drugs? That doesn't sound like me at all, right? Don't worry, I haven't lost my mind (I think).
Here's the deal. The authors suspect that a lot of these low-dose prescriptions are being written to manage agitation and as sleep aids. The authors note that there are likely less expensive/more effective medications for such conditions. Not to sound too cavalier, but one could also recommend behavioral treatment to help with sleep as well. Nah, that's crazy talk -- not enough money to be made in that.
Primary care docs were more likely than psychiatrists to dish out low-dose antipsychotics. I guess that the Viva Zyprexa marketing blitz was a success after all. Thanks to Daniel Hartung and collagues for their study, which provides another insight into the wonderful world of atypical antipsychotics as a treatment for everything imaginable. Sorry to beat a dead horse with my zillionth post about the topic of atypicals, but isn't this getting just a teeny bit out of control?
I would say so. About six years ago one of our students was having a lot of difficulty sleeping. His mother took him to a psychiatrist. After a ten or fifteen minute "evaluation" the doctor proscribed Risperdal, which is a pretty big time anti-psychotic, and at that time, not often used for teenagers. When the mother told me this, I was astounded that such a powerful drug, that had been subjected to no safety studies regarding children, would even be considered.
This boy was a heavy smoker, a heavy pot smoker, lived in a emotionally chaotic home, ate terribly, and drank lots of soda. The good doctor apparently knew none of this. Or cared.
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