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Consumer Reports: Antipsychotic "add-ons" not worth it for depression


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Despite all the TV ads pushing Abilify, Consumer Reports finds antipsychotic "add-ons" to antidepressants not worth the side effects and cost in terms of efficacy.

 

The "add-on" medications reviewed: aripiprazole (Abilify), asenapine (Saphris), clozapine (Clozaril and generics), iloperidone (Fanapt), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel, Seroquel XR), risperidone (Risperdal and generics), and ziprasidone (Geodon).

 

Ironically, rather than a medical authority, it takes a consumer publication to point this out.

 

http://www.consumerreports.org/health/best-buy-drugs/antipsychotics-for-depression.htm

 

However, the available evidence indicates that antipsychotics aren't very effective at treating "resistant" depression and aren't the best choice for this use for most people. Other options, such as increasing the dose of your antidepressant or switching to a different one, are at least as effective and are safer. Combining two antidepressants may also be an option. And it remains unclear whether antipsychotics are any better than a placebo at preventing a relapse or return of depression over the long-term. Antipsychotics can also cause serious side effects, such as involuntary movements of the tongue, lips, face, trunk, arms, or legs (tardive dyskinesia), significant weight gain, and an increased risk of type 2 diabetes, heart disease, and stroke. In addition, they are very expensive, with some costing more than $1,000 a month.

 

For those reasons, the atypical antipsychotics aren't good first choices as add-ons to antidepressants, especially if you are overweight or have heart disease or diabetes. Our medical consultants recommend they be used cautiously and only after first trying the strategies listed above. In this report, we do not choose any as Best Buy selections. Instead, we evaluate how well the medications actually work at relieving resistant depression and the risk of side effects.

We'd like to point out that tapering off the antidepressant and pursuing non-drug treatments for your mood issues is an option as well.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Or adding non-drug treatments to the antidepressant at the very least. When they say "treatment-resistant" they mean "the ADs aren't working, which they don't in the majority of cases" not that they've actually attempted reasonable treatment--such as, say, psychotherapy, and exercise, and emotional support, and sunlight therapy, and other lifestyle changes.

 

I remember way back in the Dark Ages when ADs were only considered for people for whom therapy didn't work. Nowadays I never hear of people being offered therapy as a first-line treatment for depression. It's always "you feeling a little stressed? Pop this pill. It will help." (Because physicians seem to be the LAST ones getting the news that antidepressants have not been proven to be effective except perhaps in cases of severe depression.)

 

I have a friend with end-stage colon cancer who has been put on an antidepressant. Because obviously his emotional state is due to a chemical imbalance. No offer of supportive therapy, someone to talk to about his feelings about dying.

 

Feelings are clearly a pathological condition. Human beings aren't meant to FEEL things. That might lead to, oh, I don't know, sanity, or something.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

Oct 2022       4.5 mg Lamictal    (off Celexa, off Xanax)   0.95 Valium    Ambien, 1/4 to 1/2 of a 5 mg tablet 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Yeah. Irony is, docs don't consider non-drug therapies until they've bounced a zillion drugs off a person's brain and concluded it's "treatment resistant."

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Yeah. Irony is, docs don't consider non-drug therapies until they've bounced a zillion drugs off a person's brain and concluded it's "treatment resistant."

 

At which point the entire body-brain likely IS "treatment-resistant" and "chemically imbalanced". And who will treat the physical and emotional trainwreck caused by psychiatry?

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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