In 1996, the three second-generation antipsychotics FDA approved at that time – Clozaril, Risperdal and Zyprexa – were prescribed for patients with anxiety disorders in 10 percent of office visits. The bulk of the prescribing for anxiety was with Risperdal and Zyprexa because Clozaril was not (and still isn’t) considered a first-line agent of choice due to potentially serious concerns with agranulocytosis. A decade later, in 2006, prescribing had more than doubled for the treatment of anxiety despite absolutely no evidence that antipsychotics are effective for anxiety disorders and clear evidence that this psychotropic class is associated with severe and even life-threatening side effects. And this mass over-prescribing was done off-label, mind you.
Atypical antipsychotics have clawed their way along to $15 billion in sales per year despite the fact that much of the prescribing is unsupported by scientific evidence, lacks clear rationale and is bringing obesity and its attendant risks more to the problematic forefront.
As alarming as the potential consequences of overuse may be, it is not really surprising. A few supposed psychiatric “thought leaders” have been working in concert with pharmaceutical companies to promote off-label use of these agents for years now. And they’re succeeding because the cavalier use of these drugs is indicative of the lack of caution that now permeates everyday prescribing practices.
This is not an indictment of this psychotropic medication class. Used appropriately, antipsychotics are a godsend to the management of the psychotic spectrum disorders. In fact, acute psychotic features could not be managed effectively without them. But nothing can justify the fact that objective sales data indicate they have become best-sellers.