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Introduction:
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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