Skip to main content Accessibility help
×
×
Home

The rise and fall of the atypical antipsychotics

  • Tim Kendall (a1)

Summary

The antipsychotics brought hope and optimism to people with schizophrenia and to those who care for them. There have been successive classes of antipsychotics used by the pharmaceutical industry to persuade doctors and patients that ‘new’ is better. Evidence is growing that the primary purpose of these fabricated classes is for marketing. It is time we stopped using these expensive labels – they are all just antipsychotics.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The rise and fall of the atypical antipsychotics
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The rise and fall of the atypical antipsychotics
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The rise and fall of the atypical antipsychotics
      Available formats
      ×

Copyright

References

Hide All
1 Girgis, RR, Phillips, MR, Li, X, Li, K, Jiang, H, Wu, C, et al. Clozapine v. chlorpromazine in treatment-naive, first-episode schizophrenia: 9-year randomised clinical trial. Br J Psychiatry 2011; 199: 281–8.
2 Spielmans, GI, Parry, PI. From evidence-based medicine to marketing-based medicine: evidence from internal industry documents. Bioethic Inq 2010; 7: 1329.
3 Leucht, S Kissling, W, Davis, JM. Second-generation antipsychotics for schizophrenia: can we resolve the conflict. Psychol Med 2009; 39: 1591–602.
4 National Collaborating Centre for Mental Health. Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care (updated edition). British Psychological Society and Royal College of Psychiatrists, 2010.
5 Elkes, J, Elkes, C. Effect of chlorpromazine on the behaviour of chronically overactive psychotic patients. BMJ 1954; 2: 560–5.
6 Kerwin, RW. Clozapine: back to the future for schizophrenia research. Lancet 1995; 345: 1063–4.
7 Hippius, H. The history of clozapine. Psychopharmacology 1989; 99: S35.
8 Healy, D. The Creation of Psychopharmacology. Harvard University Press, 2002.
9 Janssen, PA, Niemegeers, CJ, Awouters, F, Schellekens, KH, Megens, AA, Meert, TF. Pharmacology of risperidone (R64766), a new antipsychotic with serotonin-S2 and dopamine D2 antagonistic properties. J Pharmacol Exp Ther 1988; 244: 685–93.
10 National Institute for Clinical Excellence. Guidance on Use of Newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia. Technology Appraisal no. 43. NICE, 2002.
11 Geddes, J, Freemantle, N, Harrison, P, Bebbington, P. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 2000; 321: 1371–6.
12 Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209–23.
13 Jones, PB, Barnes, TRE, Davies, L, Dunn, G, Lloyd, H, Hayhurst, KP, et al. Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006; 63: 1079–87.
14 Leucht, S, Corves, C, Arbter, D, Engel, RR, Li, C, Davis, JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009; 373: 3141.
15 Whittington, CJ, Kendall, T, Fonagy, P, Cottrell, D, Cotgrove, A, Boddington, E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 2004; 363: 1341–5.
16 Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252–60.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

The rise and fall of the atypical antipsychotics

  • Tim Kendall (a1)
Submit a response

eLetters

Dedicated follower[s] of fashion(1)

[Please note - this letter is in reaction to not only editorial by Kendall but also that of Leucht & Davis]

How many countless millions have been - and continue to be - squandered, how many psychiatrists in low and middle income countries haveerroneously felt that they are giving a second class service to those who cannot afford expensive drugs(2), how many guidelines have appeared ridingsafe bandwagons of their own making(3) before we allow ourselves to look coolly at best evidence? In 1999, before NICE began to spend 1.4m pounds per year on this and related topics(4) the Centre for Reviews and Dissemination in York (UK) published Effectiveness Bulletins including onefocusing on drug treatments for schizophrenia.(5) This bulletin, using best available evidence, states "The newer 'atypical' antipsychotics may be a further refinement, but not a revolution, in the care of those with schizophrenia." This caused reaction that was less to do with judicious use of evidence than impassioned overvalued ideas.(6) It was clear that, again, the profession - as well as consumer groups - had been - to use Prof Peter Jones' gentle chiding description - "beguiled"(7) into failing to consider best evidence in a way that was most advantageous for people with schizophrenia, their carers and funders of care.

Independent and systematically compiled best available evidence on the effects of treatments such as the antipsychotic drugs continues to be maintained.(8) The confidence of the message of 1999 has increased and developed but, largely, not changed. Something is worryingly wrong if we need reminded as late as 2011 that antipsychotic drugs are not all the same.(9) After all, even advertising has, for every successive Janssen antipsychotic since 1958, been assuring us that the new drug is "equally clinically effective [but] with a different side-effect profile".

It is evident that psychiatry has had few leaders in the last decadesthat are prepared to think and then act based on judicious use of best evidence. (10) Far too many of us have been dedicated followers of fashion. This leaves us prey to those who lobby for the latest treatment, be they stylishly packaged drugs with poorly reported lists of adverse effects, seductive therapies often with no consideration of potential harm, or trendy but untested re-configurations of care.

References

1. Davies R and the Kinks. Dedicated follower of fashion. 1966 [Accessed 2011 Oct 6]. Available from: http://www.youtube.com/watch?v=TQAR-nx4w88&feature=youtube_gdata_player

2. Adams CE, Tharyan P, Coutinho ESF, Stroup TS. The schizophrenia drug-treatment paradox: pharmacological treatment based on best possible evidence may be hardest to practise in high-income countries. Br J Psychiatry. 2006 Nov;189:391-2.

3. Taylor D, McConnell H, McConnell D, Kerwin R. The South London and Maudsley NHS Trust 2001 Prescribing Guidlines. 6th ed. London: Taylor & Francis; 2000.

4. Kendall T. The rise and fall of the atypical antipsychotics. British Journal of Psychiatry. 199(4):266-8.

5. Drug treatments for schizophrenia [Internet]. [Accessed 2011 Sep 15];Available from: http://www.york.ac.uk/inst/crd/EHC/ehc56.pdf

6. Schizophrenia drug dispute intensifies [Internet]. BBC. 2000 Dec 3 [Accessed 2011 Oct 6];Available from: http://news.bbc.co.uk/1/hi/health/1049798.stm

7. In Antipsychotics, Newer Isn't Better [Internet]. 2006 Oct 3 [Accessed 2011 Oct 6];Available from: http://www.washingtonpost.com/wp-dyn/content/article/2006/10/02/AR2006100201378.html

8. The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd;1996 [Accessed 2010 Oct 19]. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD002830/abstract.html

9. Leucht S, Davis J. Are all antipsychotic drugs the same? British Journal of Psychiatry. 2011;199(4):269-71.

10. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *