Antipsychotics -- The Top-Selling Prescription Drug in the US
Antipsychotics -- The Top-Selling Prescription Drug in the US
If asked to guess what the top-selling prescription drug in the US is, few people would answer antipsychotic medication. Surprisingly, and perhaps disturbingly, antipsychotics are the most commonly prescribed class of medications in the United States, with prescription sales of $14.6 billion in 2009.
Antipsychotics are typically prescribed to treat psychosis, primarily in schizophrenia and bi-polar disorder, although they are increasingly used to treat non-psychotic disorders such as Tourette syndrome and even autism. Psychosis is a disconnection from reality characterized by delusions, hallucinations and disordered thinking. Antipsychotics are believed to act by blocking the chemical receptors in the brain normally linked by the chemical nerve messenger dopamine, and are classified into two groups, typical, or first generation, and atypical, or second generation.
Typical antipsychotics were more or less stumbled upon in the 1950s, when it was realized that a common surgical anesthetic had a potent calming effect on patients suffering from psychosis and the commonly resulting agitation. In fact the first generation typical antipsychotics were so sedating they were known as a "chemical lobotomy". Other adverse side effects included dry mouth, constipation, blurred vision and a troublesome condition called tardive dyskinesia, which causes involuntary and abnormal facial movements such as grimacing and sticking out the tongue, and on occasion other jerking or twisting body movements.
Fortunately the newer, or atypical or second generation antipsychotic medications, introduced in the 70s, have a much lower risk of tardive dyskinesia or other movement disorders such as restlessness, stiffness, tremors, and muscle spasms, although users may experience weight gain, drowsiness, sexual dysfunction and constipation. These can often be addressed by changing the dose of the medication, switching to a different antipsychotic medicine, or treating the side effect with an additional medication.
The use of both typical and atypical antipsychotics, although largely deemed necessary, has always been controversial. Some term it "chemical control", and argue that they are used to reduce those whose thoughts and behaviors are outside of the norm into semi-vegetative "zombies".
Since the mid 1980s, there has been an interesting shift in how people who hear voices are viewed, exemplified by the Hearing Voices Movement. The Hearing Voices Movement takes the position that hearing voices is not in itself a sign of mental illness, but rather an aspect of human diversity. Many in the movement believe that schizophrenia is an unscientific and unhelpful hypothesis which should be abandoned, and reject the use of anti-psychotic meds. They accept a range of explanations for hearing voices outside of the medical or disease model, including a spiritual one. They point out that many people without a mental health diagnosis hear voices, and that 70% of voice hearers began hearing voices after a severe traumatic or intensely emotional event. They seek to understand the meaning of the voices to the voice hearer, and argue that many people learn strategies to cope and live successfully with their voices, often by confronting past problems.
On average, schizophrenics living in non-western countries experience a better outcome than those living in the West. Some researchers attribute this to higher acceptance of their symptoms and greater social connectedness in the East. The Hearing Voices Movement may be on to something.
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