Psychiatric Drugs

The June, 2013 issue of Treatment Guidelines from The Medical Letter will be on Drugs for Psychiatric Disorders. One thing that struck me as we worked on the 3 parts of the issue – drugs for depression, drugs for bipolar disorder, and antipsychotic drugs – was the continuing struggle between newer, more expensive medications and older drugs that have been available for many years in less costly formulations.

The treatment of depression is dominated now by the SSRIs such as Prozac and Lexapro, fighting off inroads made by SNRIs such as Effexor. Controlled trials comparing these drugs with the older tricyclic antidepressants and MAO inhibitors are nowhere to be found in current literature, but some older practitioners still believe there is a place for the older drugs, especially in the treatment of “atypical” depression, a diagnosis that probably didn’t make it into DSM-5, the latest edition of the bible of psychiatric diagnosis.

In bipolar disorder, despite a long list of adverse effects, lithium has reigned supreme for many years for maintenance treatment to prevent manic or depressive episodes, but not without some market pressures. Newer antipsychotic drugs, which also can cause some difficult side effects, are giving lithium a run for its money. And some anticonvulsants, which seem to turn up as possible treatments for all sorts of things that are not epilepsy, are in there pitching as well.

For treatment of psychosis, the first-generation drugs such as Haldol are still in the fight, and articles comparing first- and second-generation antipsychotics continue to appear in the literature. About 1% of the population has schizophrenia, and schizophrenia doesn’t just go away, so this is a huge market. The differences between the first- and second-generation drugs in effectiveness and safety are still debated among psychiatrists. To see where the consensus lies in mid-2013, don’t miss the next issue of Treatment Guidelines from The Medical Letter.

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