The best-selling drug in America isn’t what you think—and it’s a whole lot more powerful than you’d expect.
Quick: what’s the top-selling drug in the United States?
Prozac? Viagra? Maybe something for heart disease?
Nope—Abilify, the powerful anti-psychotic medication that’s now widely used to treat depression. From April 2013, through March 2014, sales of Abilify (official name, aripriprazole) totaled $6,885,243,368—that’s right, almost $6.9 billion. That’s more than all other major anti-depressants combined.
And yet, the FDA says that the way Abilify works is “unknown.” Unknown! As in, we have no idea why this medication seems to help people with bipolar disorder. But go ahead and try it anyway, since it seems to work somehow.
Abilify’s makers, Otsuka America, say they know. As noted (and critiqued) in the medical journal PLOS Medicine, Abilify’s advertisements say that the drug works “like a thermostat to restore balance.”
A spokesperson for Otsuka denied that the advertising is at odds with the science. “Our promotional activities,” the company said, “focus on the description of the mechanism of action of aripiprazole as it is written in the USPI,” the standardized United States Product Insert.
But what the USPI says is that “The mechanism of action of aripiprazole… is unknown. However, it has been proposed that the efficacy of aripiprazole is mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors.” In other words, there’s a “proposed” theory, but no evidence to establish it.
Then again, I suppose most people don’t know how their thermostats work either.
Interestingly, the PLOS Medicine article noted, Otsuka makes the same claim for schizophrenia as it does for bipolar disorder. Which is a telling point. Abilify is actually a powerful anti-psychotic given to people with severe mental illness. While Abilify’s advertising depicts it as a kind of supplement to antidepressants, with sad women giving it a try when mother’s little helper no longer seems to help, Abilify actually is like a bazooka to conventional anti-depressants’ revolver. Critics such as Britain’s Joanna Moncrieff have argued that anti-psychotics don’t treat anything at all; they just zone people out so they don’t notice much. They’re effective in the short term, but essentially, that’s because they are really just powerful tranquilizers.
This makes sense for their primary use: antipsychotics like aripiprazole are administered to seriously ill people like schizophrenics. Abilify is a close cousin of Thorazine. Yet, now it’s the most profitable drug in America.
In fact, the present trend has been going on for some time. Two years ago, Dr. Richard Friedman wrote in The New York Times about the disturbing rise in the prescription of antipsychotics for routine complaints like insomnia. Since then, Abilify has risen from the fifth-most-prescribed drug to the top of the heap.
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