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Seroquel, Atypical Antipsychotics for Insomnia, Dementia?

I’m a little dumb-founded whenever I run across a prescribing trend that goes against all of the available empirical evidence for common sense use of a medication. Nowhere is this more evident than with the prescription of atypical antipsychotic medications. It wouldn’t be too far a stretch to suggest that such prescriptions have become like Prozac prescriptions in the 1990s, the latest medication fad.

But atypical antipsychotics, like Seroquel (quetiapine fumarate), are far more complex with far more problematic side effects than drugs like Prozac, and should only be prescribed for on-label use.

The Washington Post’s Amy Ellis Nutt and Dan Keating have the story:

[… A] pill that medical experts say can cause diabetes, heart arrhythmia and potentially irreversible movement disorders continues to be prescribed to many Americans who are only seeking a good night’s sleep or less anxiety by day. Many are probably not aware that it is a drug originally aimed at the delusions and paranoia of schizophrenia.

“The range of problems it causes in terms of deteriorating quality of life makes it not worth it,” said David Healy, a British psychiatrist who has written books on psychopharmacology. Healy says he prescribes Seroquel only for his most seriously ill patients “to be able to function.”

Putting the Numbers into Context

While Seroquel or its generic (quetiapine fumarate) has over 29,000 serious adverse events reported to the U.S. FDA Adverse Events Reporting System (FAERS) since 1998 through 2017, Lipitor, a popular statin medication, has had over 41,000 such events during a similar time frame. Prozac and its generic equivalent has had over 50,500 cases reported since it first was approved in 1988. If we look at just such cases since 1998, we get just over 24,000 events for Prozac and fluoxetine, its generic version.

But Adderall (or amphetamine), a stimulant drug used to treat ADHD, has had less than 5,000 such cases; approximately the same number with Ritalin, another stimulant ADHD medication.

In a vacuum, such numbers are meaningless. But once you understand that the prescriptions for each drug are roughly the same per year (9-12 million), then we begin to understand that certain drugs may have more adverse side effects than others, and experienced by more people.

Which is not surprising, since the maker of Seroquel settled a huge lawsuit for $520 million in 2010 related to its marketing of off-label uses. These off-label indications spanned a range of non-mental health conditions including aggression, Alzheimer’s disease, anger management, dementia, and sleeplessness. The lawsuit also claimed that AstraZeneca promoted Seroquel to physicians who don’t normally treat patients with schizophrenia and bipolar disorder — the only two approved conditions for the drug. It was widely prescribed to older adults for off-label uses, resulting in many adverse events.

Not All Side Effects are Equal

I suppose the problem really comes down to side effects. One of the most problematic side effects of Prozac and similar drugs is a serious reduction in sexual interest. So much so, many people’s relationships were negatively impacted. A person starts to feel less depressed due to the benefits of the drug, but then they have a new challenge to face — inability to perform and a lack of interest in sex. (For men at least, they had yet another medication they could take to solve a part of that problem, Viagra.)

Seroquel’s side effects are more problematic, because they appear to cause additional health problems in many who take it. Taking a drug to solve insomnia but that gives you diabetes (and weight gain) or a movement disorder is a lousy tradeoff for most people.

Sleep problems can be combatted by so many other non-medication efforts, starting with a scientific sleep study conducted in a sleep lab. Long before you start popping a pill to help you sleep, you should get yourself properly assessed by an actual sleep specialist (not just your family physician). Such an assessment will help determine what might be causing your trouble sleeping, and work with you on non-medication solutions to help you enjoy a long night’s uninterrupted sleep.

Being overweight is a serious health problem long-term. It can lead to all sorts of additional health concerns and puts you at greater risk for more diseases other than just diabetes. Efforts to add another medication to Seroquel to help with the weight gain (such as metformin) don’t help much. And while type 2 diabetes could be reversed in some people, it’s not something you want to be facing just to get a good night’s sleep.

Seroquel: Just Use Common Sense

Too many doctors prescribe way too many drugs for off-label uses. That’s their prerogative. But as an empowered patient, it’s important that you understand when you’re being prescribed a medication that’s not been formally approved for that use. That usually means there’s a set of reasons — scientific, money, marketing — that it’s not been approved for that use that should be taken into consideration when deciding whether to take it, or to instead ask your doctor for some other options.

Seroquel, like Prozac before it, is not a cure-all. It cannot solve all the behavioral, sleep, or memory problems physicians think it can. Doctors should become far more skeptical of such off-label uses, and remember that just because a single small study comes out showing it could be used for other condition doesn’t usually mean it should be (at least not without careful consideration and monitoring). Small studies rarely demonstrate real clinical efficacy until replicated, and are usually silent about the severity of adverse side effects in a larger, diverse population.

In short, doctors and their patients need to start using common sense when it comes to prescription medications like Seroquel. It’s not a sleep medication, and should generally not be prescribed just for insomnia or dementia.

 

Read the original article: Popular drug Seroquel, first meant for schizophrenia, reveals ‘off-label’ issues

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