Why antipsychotics for depression?: When the experts miss the concept!


The idea of recommendation and prescription of second generation of antipsychotics in the treatment of depression (major unipolar depression, bipolar depression, depression in schizophrenia and even a milder depressive condition such as dysthymia) started in early 2000’s. First the experts recommended these agents that are originally synthesized to treat psychotic disorders such as schizophrenia, as augmentation to anti-depressants in the treatment of refractory depressions. (1-3) Soon such studies that are mostly sponsored by pharmaceutical corporations, suggested the use of antipsychotics not as an adjunct, or for the treatment of depression in psychotic disorders, or even bipolar disorder that could be accompanied by psychotic features, but for the treatment of pure unipolar major depression and as the first line treatment. (4) Nowadays it is not uncommon that even primary care physicians, psychiatrists and family physicians prescribe antipsychotics in the treatment of a patient who suffers from a simple depression. The pharmaceutical companies synthesize and market such antipsychotics (e.g. Quetiapine, Aripiprazole, Lorasidone, etc.) (these are these generic names that in different markets are sold under different brand names) have also been able to acquire indication for the treatment of depression for their products. The market sales continue to rise and the treatment indications of these antipsychotics are expanding beyond depression to other psychiatric disorders such as anxiety disorders, PTSD (Post-Traumatic Stress Disorder) and beyond. (5-6)

 A curious and cautious consumer may wonder why he or she should be prescribed an antipsychotic while having no psychotic disorder (delusions, hallucinations, etc.) but a simple depression! This article attempts to explore this wonder and show throughout the history of psychiatry, that the use of antipsychotics have not been limited to the recent time and the second-generation antipsychotics, but such attempt in the past failed over time. The experts might respond to this critic that the new antipsychotics possess such chemical structure that work on the neurotransmitters involved in depression (mainly serotonin and norepinephrine). But our lay patient could respond back that what about the impact of the antipsychotic component of these medications?! If the depressed patient is not psychotic and does not have any imbalance or over-sensitively in his or her dopamine neurotransmission (involved in psychosis) what would be the consequences of taking an antipsychotic that affect this neurotransmission. For example would he or she develop side-effects such as EPS (Extra-pyramidal symptoms) or simply abnormal movement disorders such as tremors and akathisia (restlessness and feet fidgeting, etc?! What about dampening the lay patient’s dopamine system in the brain that he or she needs it for all his or her cognitive faculties, etc.?! Since the poor lay patient could not keep this dialogue long enough against the experts who are masters of twisting the facts around to prove their points of intentions per pharmaceutical giants’ order, this article will strive to do so on the behalf such lay depressed patient and million others across the globe.

Digging the grave of antipsychotics:

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Pathologic fracture: When the bone breaks without trauma!


Bone fractures are most commonly occur after a trauma. But one wonders how bone can break or fracture without or with trivial trauma. Common sense may suggest that a fragile or weak bone can break easily, and that is true and the underlying reason or pathophysiology of pathologic fracture. Pathologic fracture, or the bone fractures without or with minimal traumas, has been known since 19th century.(1) It is caused by weakness in the bone structure, commonly occur due to osteoporosis. (2-3) But it also could be due to other pathologies such as cancers, infections such as osteomyelitis or bone infection, bone cysts, osteomalacia (soft bone) or paget’s disease, or even osteopetrosis (hard bone). (4-11) These fractures could be cause of a wide arrays of infections from venereal diseases, to tuberculosis, and even salmonella, (5-8) or cancers such as leukemia of childhood (9), or a cause of cancer treatment such as radiation. (10) It could also occur in a wide age range from infants and children to adults, and not only in elderly who are more common to have osteoporosis. (11-12) Pathologic fracture could also occur in many bones of the body from long bones of upper and lower extremities, to the hip and vertebrae and a small bone such as lower jaw or mandible. (13)  

 Osteoporosis, known commonly appearing in old age, specially in women has also been known for long that can occur at an earlier due to treatment with corticosteroids, used often for arthritic conditions. (14-15) This is while corticosteroids are paradoxically used also in the treatment and prevention of osteoporotic fractures. (16-17) Although pathologic fractures, specially occur in long bones and in elderly with osteoporosis in the hips, it can also occurs elsewhere including vertebral bones that is again paradoxically corticosteroids are reported to be used for its treatment and prevention. (18-19) Unrecognized such pathologic fractures of the vertebra have also been reported by radiologists without any such reports by the treating physicians in cancer patients, that partly could be due to the cancers and partly due to non-corticosteroid treatments of cancers. (20)


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