By Karl Stark
When they were first introduced in the early 1990s, new antipsychotic medications for severe mental illness were seen as wonder drugs that were safer and more effective than their predecessors.
Sales soared as doctors tried them on new conditions, including dementia, aggression and other behavioral problems. Children and the elderly were among the biggest users.
But now, several studies questioning some of the drugs’ benefits have led many doctors to talk of using them for shorter periods and with tighter monitoring, because of side effects that include sedation, obesity and diabetes.
“You can’t just pop someone on it and see them in a year,” said Jason Karlawish, a geriatric psychiatrist at the University of Pennsylvania.
These drugs, known as atypical antipsychotics, offer a contentious case study of a common pattern in pharmaceuticals. New drugs are typically approved for narrow uses and get tried off-label on conditions that are difficult to treat. Companies’ sales efforts stoke up overall use until the research catches up years later, dulling the early enthusiasm. While some patients are helped, lawsuits are also a common legacy.
The atypicals were originally approved for severe mental illness – schizophrenia and bipolar disorder – which had limited markets.
But under a determined marketing effort portraying them as safer and more effective than their predecessors, the atypicals came to be tried beyond their approved uses for nursing-home residents, prisoners, and children younger than 6 years old…