What next after SSRIs?

An interesting post from CL Psych:

Psychiatry is Entering the Manic Phase

Well, those aren’t my words. It’s actually the Last Psychiatrist, who stepped up to the plate and blasted a mammoth shot to left center with his post. I’m going to quote a few choice snippets…

But without academics pushing SSRIs, their use will wane–and, importantly, so will their support of the diagnosis “Major Depression.” This is going to sound controversial, inane, but it will happen.

Look for upcoming articles finding that “Depression” is overdiagnosed, that it is really just– life. Look for articles that now find SSRIs aren’t that effective after all, that the old “10% better than placebo” is a statistical trick with little clinical utility. That they are way overused in kids.

You might say, wait, isn’t the decline of polypharmacy a good thing; that SSRIs are overused in kids; that they aren’t that great; and that depression is overdiagnosed? All of this is true, but this isn’t psychiatry finally coming to its senses; this is psychiatry entering the manic phase. Sure, it’s less SSRIs for kids; but it’s more antipsychotics.

Because simultaneously there will be articles pushing the idea that recurrent unipolar depression is really bipolar depression; that there are common genetic or heritability patterns; that the epidemiology and course is similar, etc. The move will be to squeeze out MDD into “life” and bipolar. This done, antipsychotics become first line agents. Oh, and look for antipsychotics to get FDA approvals for kids.

Brief History of Diagnostic Trends: When benzos were the big drugs, everyone had anxiety. When the SSRI era was born, depression was the disease of the day. When depression was saturated, the move was on to raise awareness about social anxiety, generalized anxiety, PTSD, etc, as the SSRIs still had patent life to spare, and hence markets to conquer. The new frontiers are depression with pain, for which Cymbalta is allegedly the drug of choice (despite rather meager supportive evidence), and bipolar, for which Seroquel, Abilify, Zyprexa, and Risperdal/Invega have already made significant inroads. Lilly cleverly tried to expand the bipolar market with the Viva Zyprexa and Zyprexa Limitless campaigns, but it was just the first step in a much larger campaign.

2 Responses to “What next after SSRIs?”

  1. truthman30 Says:

    What next after SSRI’s… ?

    Triple Reuptake inhibitors…. ( triple whammy brain damage)

    http://truthman30.wordpress.com/2007/03/03/seroxat-link-2-gsk-neurosearch-jargen-buss-lassen-and-seroxat-paroxetine/

    NeuroSearch and GlaxoSmithKline form strategic RD alliance

    19 December 2003 – Announcement

    PDF version

    NeuroSearch and GlaxoSmithKline (GSK) today announced a five-year research and development alliance. The alliance comprises a number of research programmes within ion channels and the treatment of diseases of the central nervous system (CNS) including depression, anxiety, and schizophrenia. The new alliance combines NeuroSearch’s innovative research and development, and strong technology platform with GSK’s research, development, and commercial strength.

    The option agreement gives GSK access to new drug candidates from NeuroSearch’s research and development within the defined area. This includes the Phase II triple monoamine re-uptake inhibitor NS2359, the Endovion programme and several other research programmes. The existing collaboration with GSK in depression disorders is integrated in the new agreement.


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