Psychiatric drugs: a booming business

Sarah Herman

The top 25 psychiatric drugs of 2009, according to quantities of US prescriptions, have been published and the chart reveals that approximately 300 million prescriptions were written for these 25 medications during 2009 alone. Clearly psychiatric drugs are a booming business.

Indeed, The New York Times reported that the newer generation of psychiatric drugs have become the best-selling medications in the entire US - even overshadowing cholesterol-lowering agents. During 2009, overall US prescription drug sales hit $300 billion and psychiatric drugs accounted for $14.6 billion of this.

The top 25 list of prescribed drugs was compiled by PsychCentral, in conjunction with IMS Health, and is the first to have been released since their previous list in 2005. They noted that the entire US population rose by approximately four percent from 2005-2009, in order to put the psychiatric drug percentages into perspective.

Last year, Xanax (alprazolam) was by far the most commonly prescribed psychiatric medication, with a staggering 44,029,000 scripts being written for this psychiatric drug alone. This marks a 29 percent increase in the use of Xanax over the space of four years. Xanax was followed by Lexapro (escitalopram), with 27,698,000 prescriptions; an increase of 13 percent for the depression and anxiety treatment.

The most astounding growth margin was seen by Cymbalta (duloxetine), which came seventh in the list with 16,626,000 scripts – an increase of 237 percent since 2005. In eighth place was Seroquel (quetiapine), a bipolar disorder treatment, for which prescriptions accelerated by 88 percent from 2005, reaching 15,814,000 by 2009.  

A few of the psychiatric drugs did, however, see a fall in prescriptions over the five-year period. These included Zoloft (sertraline, down 28 percent), Prozac (fluoxetine, down nine percent), and Wellbutin (bupropion, down 73 percent). The largest declines were of psychiatric drugs that have recently gone off-patent.

Uses of psychiatric drugs

Psychiatric drugs are prescribed for a variety of conditions, including depression, schizophrenia and bipolar disorder and are designed to stabilise mental disorders. However, the reasons behind the rising distribution and use of these drugs is unclear: are more people suffering from mental disorders, or are doctors just more likely to prescribe these drugs than they were in the past?

Some sectors of society in which the use of psychiatric drugs is increasing may come of something of a surprise.

For instance, at least one in six military servicemen/women are now taking at least one psychiatric drug, according to the Navy Times. A Military Times investigation of electronic records acquired from the Defense Logistics Agency (DLA) revealed that the DLA spent $1.1 billion on psychiatric and pain medications between 2001 and 2009 and that there was a 76 percent rise in military use of psychiatric drugs during this time.

Dr. Grace Jackson, a former Navy psychiatrist, said: "It's really a large-scale experiment. We are experimenting with changing people's cognition and behavior."

In fact, the Military Times' investigation discovered that a number of drugs which were developed to treat bipolar disorder and schizophrenia are now commonly used to treat symptoms of post-traumatic stress disorder (PTSD), such as headaches, nightmares, nervousness and fits of anger.

"Off-label" use of this nature is legal, but critics believe that this practice is an issue of serious concern due to the fact that these drugs have not been approved by the Food and Drugs Administration (FDA) for the conditions they are being used for.

Interestingly, the two psychiatric drugs which have seen a dramatic increase in usage in the US military are Seroquel and Risperdal. In the army, prescriptions of these jumped up by 200 percent and annual spending on them quadrupled from $4 million to $16 million. In the US as a whole, between 2005 and 2009, prescriptions increased by 88 percent and 45 percent, respectively.

A practice which has been actively discouraged in the US is the exceptionally high number of psychiatric drug prescriptions being given to elderly people living in nursing homes. Although these drugs can help behavioural problems, many of them are prescribed "off-label" and can have a fatal effect on the elderly people taking them. However, although the FDA instituted a "black box" warning to doctors to stop prescribing these drugs, studies found that in 2008 antipsychotics still represented nine percent of all prescriptions in this group.

Illegal marketing of psychiatric drugs

Although Seroquel prescriptions saw the second largest increase from 2005 to 2009, in April 2010 its producer, AstraZeneca, agreed to pay $520 million to settle charges that the pharmaceutical company illegally marketed and promoted Seroquel for uses that had not been approved for by the FDA, including Alzheimer's disease, anxiety, dementia, depression and PTSD.

Secretary of Health and Human Services, Kathleen Sebelius noted that the drug firm gave "kickbacks to doctors as part of an illegal scheme to market drugs for unapproved uses."

AstraZeneca denied the allegations but agreed to a five-year program to ensure compliance with US laws.

This was the fourth pharmaceutical company in the past three years to pay to settle federal investigations into illegal marketing of its drugs; three of the four charges were for the marketing of psychiatric drugs.

In 2007, Bristol-Myers-Squibb paid $515 million to settle investigations into its marketing of Abilify and last year Eli Lilly paid $1.4 billion to settle investigations into illegal marketing of Zyprexa, both of which are psychiatric drugs. These drugs were placed at numbers 15 and 20 respectively on the list of top psychiatric drugs in the US last year.

Countless people across the US benefit from psychiatric drug descriptions and the advent of second-generation/atypical antipsychotics in the 1990s led to increased use and more effective results. Although the business is booming and extremely profitable for the pharmaceutical industry, it is also important that these firms remember and reflect upon the FDA's Public Health Advisory for atypical antipsychotic medications and the potential side-effects these can have on certain groups of people.  

Related links:

Leading Lilly Forward | Asterand PhaseZERO - a solution for Drug Development | Accelerating drug discovery and development | All in the Mind | A Bright Outlook