Atypical or second generation antipsychotics were hailed as a major advance in the treatment of schizophrenia and other psychoses. These are drugs such as olanzapine, risperidone and quetiapine. They were considered to be better tolerated than the older antipsychotic drugs, like chlorpromazine and haloperidol, and to be less likely to cause movement problems as side effects.

A commentary article in the Lancet in January pointed out that in fact the atypicals are no more effective than the older drugs and are more costly. To quote from the article, "The spurious invention of the atypicals can now be regarded as invention only, cleverly manipulated by the drug industry for marketing purposes and only now being exposed. But how is it that for nearly two decades we have, as some have put it, ‘been beguiled’ into thinking they were superior?¹

This statement is not from critics of psychiatry. The authors are the editor of the British Journal of Psychiatry and the co-director of the National Collaborating Centre for Mental Health, which produces NICE guidelines. They conclude that trials of atypicals have been driven by drug company marketing rather than the interests of patients. It suited doctors and patients to believe that the atypicals were an advance in treatment.

The net ingredient cost to the NHS in England of antipsychotic drugs has increased over the last 10 years by more than two and a half times as a proportion of the NHS budget spent on medication. In 2008 the cost of antipsychotics in England was nearly £277 million. The amount of money spent on these drugs is not insignificant.

Earlier this year, the drug company Eli Lilly, which manufactures olanzapine, agreed to pay $1.4 billion dollars in settlement for the marketing of their drug for conditions for which it did not have a licence. The US Department of Justice pointed out that the monetary settlement was the largest amount paid by a single defendant in its history.

Drug companies are investor owned businesses motivated for profit, which is very different from the aim of providing the best quality care for patients. They want to increase sales. Some companies are obviously also prepared to expand their marketing strategy into shady areas. However much we all wish for a simple, quick, cheap, painless and complete cure, we need transparency about the effectiveness of medication.

1. Tyrer P & Kendall T. The spurious advance of antipsychotic drug therapy. Lancet 2009; 373: 4-5