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Accentuate the Positive: Antipsychotics for Depression

Antipsychotics For Depression

Drug companies rarely lie to doctors outright. Their lies tend to be lies of omission. Drug companies subscribe to the popular adage “accentuate the positive, minimize the negative.” Case in point: the use of antipsychotic medications for depression.

The tendency of drug companies to feature their drugs in the most favorable light helped second-generation (atypical) antipsychotics become one of the most popular drug classes in America, with roughly $18 billion in sales in 2011 — not bad for a category of drugs originally developed for schizophrenia. 

Pharmaceutical companies do a superb job shaping and conveying clinical messaging in order to increase sales of their products. It is a proven formula — control what’s communicated, and you control what’s prescribed. This is why drug companies are unlikely to tell consumers that antidepressant drugs like Abilify (aripiprazole) and Rexulti (brexpiprazole) are also used for treating schizophrenia. 

With that in mind, let’s take a look at the Rexulti advertising for major depressive disorder. If you were a patient with depression, you might be inspired to ask your primary care physician or psychiatrist for Rexulti after seeing magazine or TV ads for the drug. However, most folk’s enthusiasm for taking Rexulti would wane considerably if the safety information, which appears in small print at the very bottom of the page, was as prominent as the headline. 

Even more interesting is that the Rexulti consumer website spins the safety information in a less alarming way than the more complete FDA-approved consumer medication guide for Rexulti, which spells out the potential danger of tardive dyskinesia in simpler, clearer, and more direct language:


Rexulti Website Safety Information

Tardive Dyskinesia (TD): Risk of TD, and the potential to become irreversible, are believed to increase with duration of treatment and total cumulative dose of antipsychotic drugs. TD can develop after a relatively brief treatment period, even at low doses, or after discontinuation of treatment. For chronic treatment, use the lowest dose and shortest duration of REXULTI needed to produce a clinical response. If signs and symptoms of TD appear, drug discontinuation should be considered.


FDA Medication Guide

Uncontrolled body movements (tardive dyskinesia): REXULTI may cause movements that you cannot control in your face, tongue or other body parts. Tardive dyskinesia may not go away, even if you stop taking REXULTI. Tardive dyskinesia may also start after you stop taking REXULTI.

The Rexulti safety information is spun in a way that seems more positive and reassuring than the FDA information.  Don’t healthcare deserve the complete truth about the drugs they take? Maybe it’s time to start “accentuating the negative”.

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