‘Dodging Abilify‘ by Johanna Ryan on RxISK website:
“Editorial Note: This post is by Johanna Ryan, who has a unique ability to capture the American Nightmare
The best-selling drug in the United States isn’t a blood pressure pill, a painkiller or even an antidepressant. It’s Abilify, an antipsychotic agent with $6.3 billion in 2013 sales. Granted, Abilify isn’t the most prescribed pill, but its #1 status is sealed by popularity and high price: the current retail price of a 30-day supply is now a whopping $900, and it’s 23rd in sheer numbers of prescriptions. In 2011 the Medicaid program in my home state of Illinois spent $53.6 million on Abilify for its poorest citizens, more than it spent on any other drug.
I’m not the first to ask, what the hell is going on here? However, my interest in Abilify is personal: Wherever I go in the healthcare system, people have been urging me to take it, and even suggesting there’s something irrational about my reluctance.
Phase 1: Dodging bipolar disorder
A brief word about my situation: I’ve been treated for depression, at times severe, since 1975. Over the years I’ve been unable to work for brief periods, fairly miserable but officially “functional” more often. Still, I’ve never once experienced psychotic symptoms. No voices, no visions, no strange beliefs or fears, and no “manic” periods of wild activity and grandiose plans. Back in the 1980’s I was hospitalized a few times as actively suicidal, and was once given antipsychotics – but only for the first week or so. I didn’t like them then; I felt more passive than truly calm, and unable to complete an intelligent thought.
Having watched the rollout of “new and improved” antipsychotics in the 1990’s that turned out to have just as many problems as the old ones, I still don’t like them. However, it wasn’t until 2006 that I really got skeptical about psychiatric drugs in general. Despite a long trail of meds that had done me no good, stopped working or had miserable side effects, I was always willing to try the next milestone in the march of science – unless it was an antipsychotic.
Ten years ago, the new antipsychotics were easy to refuse. The theory behind giving them to people like me was that repeatedly depressed people might have “bipolar disorder type II”, a mood disorder without actual mania, and should take these drugs as “mood stabilizers.” My longtime psychiatrist, Dr. A, knew me too well to really believe I was bipolar; he told me he thought it made little difference what label he put on my depression since none of them could be verified. Still, he thought these drugs well worth a try. “They’re not necessarily antipsychotics,” he said. “That’s just a label, they’re used for lots of things.” “I know,” I replied, “but they’re still neuroleptics. I want to hang on to all the brain function I can.
“Oh, come on,” he coaxed. “We’re talking about little baby doses here, just a fraction what they give people for schizophrenia.” That sounded somewhat reassuring – but I still said no. (Today I’m glad I didn’t listen to that particular sales pitch, as I’ll explain later.)
Back in those days, I could tell a family doctor, OB/GYN or nurse that Dr. A wanted me to take antipsychotics, and they’d look bewildered. Even flinch a bit. “But you’re not… I mean …” “Right,” I’d say. “Not psychotic. And unless and until I start hearing voices, I’m not touching that stuff. Even if I do start hearing voices, I’m not taking it a day longer than I have to.” They all thought that made sense. …”