Does anyone remember Thorazine? It was an antipsychotic given to mentally ill people, often in institutions, that was so sedating, it gave rise to the term "Thorazine shuffle." Ads for Thorazine in medical journals, before drugs were advertised directly to patients, showed someone's Aunt Hattie in a hospital gown, zoned out but causing no trouble to herself or anyone else. No wonder Thorazine and the related drugs Haldol, Mellaril and Stelazine were called chemical straitjackets.
But Thorazine and similar drugs became close to obsolete in 1993 when a second generation of antipsychotics which included Risperdal, Zyprexa, Seroquel, Geodon and Abilify came online. Called "atypical" antipsychotics, the drugs seemed to have fewer side effects than their predecessors like dry mouth, constipation and the stigmatizing and permanent facial tics known as TD or tardive dyskinesia. (In actuality, they were similar.) More importantly, the drugs were obscenely expensive--100 tablets of Seroquel cost as much as $2,000, Zyprexa, $1,680, and Abilify $1,644.
With new names and less stigma, Pharma marketers devised ways to market the drugs to the whole population not just mentally ill people. Only one percent of the population, after all, has schizophrenia and only 2.5 percent has bipolar disorder. But thanks to these marketing ploys, Risperdal was the seventh best-selling pharmaceutical in the world in 2007 and currently Abilify is the top selling of all prescription drugs right now in the U.S.
Here are some of the ways Big Pharma made antipsychotics everyday drugs.
Everyone has heard of "mission creep." Some say it is going on right now with the U.S.' war against Isis. In the pharmaceutical world, approval creep means getting the FDA to approve a drug for one thing and pushing a lot of other drug approvals through on the coattails of the first one. Though the atypical antipsychotics were originally drugs for schizophrenia, soon there was a dazzling array of new uses.
Seroquel was first approved in 1997 for schizophrenia but subsequently approved for bipolar disorder, psychiatric conditions in children and finally as an add-on drug for depression like Abilify. The depression "market" is so huge, Seroquel's last approval allowed the former schizophrenia drug to make $5.3 billion a year before it went off patent. But before the add-on approval, AstraZeneca, who makes Seroquel, ran a sleazy campaign to convince depressed people they were really "bipolar." Ads showed an enraged woman screaming into the phone, her face contorted, her teeth clenched. Is this you, asked the ads? Your depression may really be bipolar disorder said the ad.