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Are new antipsychotics overused?

If someone had asked me a few weeks ago what's the top-selling class of drugs in the United States I never would have guessed it's the new generation of drugs to treat schizophrenia. But that was before I talked to Randall Stafford, MD, PhD, who just published a study that not only documents the widespread use of these drugs (they're called atypical antipsychotic medications), but also shows that they're very likely being used unwisely.

Instead of being prescribed for the purpose originally approved by the FDA, they're given for anxiety, dementia and a host of other psychological ailments. That would be fine if there were good evidence that they help. But Stafford's study, published today in Pharmacoepidemiology and Drug Safety, convinced me that for the most part there isn't. And the drugs carry the risk of serious side effects - weight gain, diabetes and heart disease - and they're super expensive. Some of the most widely used in the class are Abilify, Risperdal, Seroquel and Zyprexa, each of which have annual U.S. sales topping $1 billion.

When I interviewed Stafford for my article about this, I asked him why doctors prescribe them despite the lack of good evidence. He said it's probably the result of marketing - both legal and illegal - and ingrained cultural biases:

"Physicians want to prescribe and use the latest therapies - and even when those latest therapies don't necessarily offer a big advantage, there's still a tendency to think that the newest drugs must be better."

Interestingly, doctors often don't even realize that the drugs they're prescribing lack FDA approval for that particular use. The first author of Stafford's study, Caleb Alexander, MD, at the University of Chicago, found in a previous survey of physicians that the average respondent accurately identified the FDA-approval status of drugs for a given condition just over half the time.

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