(not actually jim thome)

enter: Seroquel (or Abilify, or Zyprexa or whatever people are pushing these days). they’re all second-generation anti-psychotics. what this means is dubious, and poorly defined (other than “they came out after Clozapine”). these drugs do have something in common: they’re all extraordinarily profitable. Abilify, in particular, was the most profitable drug in the world when the patent expired in 2014- Seroquel, Zyprexa and Risperdal weren’t that far behind.

these drugs are supposedly for treating schizophrenia, which, while not rare, isn’t a particularly common condition- the reason they make so much money is uses other than schizoprhenia. Seroquel, for instance, is used on-label for

-psychosis

-major depressive disorder

-manic episodes

-insomnia

-panic and anxiety disorders

(there’s an old nurse’s maxim- if a drug has three or more indicated uses, it sucks at all of them)

all this for a drug which mechanically is effectively just a strong antihistamine and more or less just causes severe sedation, and weight gain. (other AAPs do impact transmitters other than the H1-histamine ones, but Seroquel is one of the most common AAPs given for depression adjunct or monotherapy, and happens to be very, very selective for histamine neurotransmitters)

this writeup is specifically about the use of antipsychotics in depression, though the use of them in panic disorders and other shit like Abilify for childhood autism (??????) is also concerning. why would drugs that mostly cause sedation and weight gain work in depression?

here is the Montgomery-Asberg assessment for depression, or the MADRS. 

http://narr.bmap.ucla.edu/docs/MADRS.pdf 

the MADRS is dogshit (actually, all “objective” assessments for depression are). The important thing to note here is several symptoms listed can be treated purely with any sedative or anti-anxiety drug without treating any core depressive symptoms, e.g. agitation, anxiety, insomnia, etc. 

a meta-analysis of Seroquel in particular showed a general improvement of 5 points. not only is this not very much, but 5 points can be easily gained with any sedative, because insomnia and agitation are on the scale. it’s worth noting that weight loss and low appetite are also on the scale, and many of these drugs (H1-blockers) will cause severe weight gain, and also improve the score.

5 points is not a lot. if you suffer from severe depression, and your doctor says “you got five points better”, you’d find a new doctor. 5 points is, however, enough evidence for the FDA to approve your treatment as monotherapy for depression. i’ll leave it to you to decide if this is a good idea.

TLDR: Seroquel, and most anti-psychotic drugs, “treat” depression by making you sleepy and causing you to gain weight, because this is an effective way to “game” the scores used to assess depression, and get your very expensive drug approved to treat a very common condition. 

You could almost certainly get Benadryl “approved” as an antidepressant by the FDA with this.

i’ll close with this paper, which is a good one to read: 

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403

of note is this quote:

“Atypical antipsychotic medications for the adjunctive treatment of depression are efficacious in reducing observer-rated depressive symptoms, but clinicians should interpret these findings cautiously in light of (1) the small-to-moderate-sized benefits, (2) the lack of benefit with regards to quality of life or functional impairment, and (3) the abundant evidence of potential treatment-related harm.“

“observer-rated depressive symptoms” are an euphemism for depression scores, as explained above. “lack of benefit with regards to quality of life or functional impairment” is science-speak for “yeah, nobody actually got better”. the last sentence should be self-explanatory.

thanks also to Dr. Ken Gilman, whose publishings “Atypical Psychotics and Humpty-Dumpty” and “The Miracle of Seroquel” are incredible reading.

https://psychotropical.info/anti-psychotics/