The scenario: Mr. Showalter couldn’t fall asleep one night thanks to some noisy construction outside his Flatbush Avenue apartment, so his girlfriend suggested he take one of these pills she happened to have lying around.
“It’s a chill-out pill,” she told him, reassuringly. “It’s nothing.”
Mr. Showalter swallowed the drug. Moments later, he nearly passed out in the middle of relieving himself. He woke up the next morning dazed and feeling as if “someone has stuffed a bath towel inside my brain,” he said.
“What the fuck did you give me last night?” he asked his girlfriend.
“Oh, yeah, it’s this thing called Seroquel. It’s just, whatever,” she replied nonchalantly, prompting Mr. Showalter to Google it.
He recalled his findings to the amused audience.
“Seroquel is a drug that they give to schizophrenics who are freaking out,” he said. “It’s for naked white men who are running around thinking they are Jesus. Not mildly annoying Brooklynites who need to catch a little shut-eye!”
Or isn’t it?
Antipsychotic medications—more specifically, a newer generation of such drugs known as “atypical antipsychotics”—are creeping their way into the zeitgeist in the form of “add-on” treatments for depression. Call them antidepressant boosters, if you will.
“It’s a practice that is becoming more common and is generating a fair amount of interest,” said Dr. Mark Olfson, a psychiatrist at Columbia University Medical Center.
Doctors have long prescribed antipsychotics as augmentation treatments for the seriously depressed. But for the first time, one of them is being marketed in prime time.
IT BEGAN LAST October, when commercials shilling a drug called Abilify started popping up. Approved by the F.D.A. in 2002, Abilify was originally developed to treat schizophrenia and manic episodes. (Not that you could discern as much from the ads.) But in November of 2007, the F.D.A. gave its makers, Bristol-Myers Squibb, approval to market the drug for an expanded use (for “when your antidepressant alone isn’t enough,” the company would go on to coo), making it the first antipsychotic medication with such latitude.
‘I was struck by the name. It’s like: “You will be a person of greater ability.”’ —Writer Daphne Merkin, on Abilify
And in April, an F.D.A. advisory committee recommended that the agency grant the same permission to AstraZeneca for the marketing of Seroquel XR, a sustained-release version of Seroquel, which, as Mr. Showalter discovered, is used to treat schizophrenia and bipolar disorder. (Neither AstraZeneca nor the F.D.A. would comment on when Seroquel XR might be cleared for marketing as an antidepressant add-on.)
Meanwhile, the prescription rates of these two drugs, and of antipsychotics in general, are on the rise. According to data provided by the pharmaceutical intelligence firm IMS Health, Abilify prescriptions dispensed in the U.S. shot up from 2.8 million in 2004 to 6.7 million in 2008; Seroquel prescriptions from 10.5 million to 16.3 million; and overall antipsychotic prescriptions from 43.8 million to 52.7 million. At the same time, several recent studies, one published by Dr. Olfson in the August 2009 issue of The Archives of General Psychiatry, have found that antidepressants are now the most commonly prescribed class of medications in the U.S.
“Patients will come in and say, ‘Do I need that medication that has the commercial that says, “If your antidepressant isn’t working, ask your doctor about this?”’” said Dr. Amanda Itzkoff, a psychiatrist on the Upper East Side, who described her core group of patients as “career” women and men between the ages of 18 and 40. “It took a little while for those commercials to really infiltrate, but it’s been picking up in the past four months or so.”
One such commercial begins with a pale middle-aged woman, bathed in hues of gray, walking through a grassy yard and pulling closed her cardigan as she muses, “I’m taking an antidepressant, but I think I might need more help.”
A moment later, after being told that “approximately two out of three people being treated for depression still have depression symptoms,” we see a husky fellow agonizing over some paperwork: “I’m on an antidepressant, but I’m still not where I want to be with my symptoms.”
Next comes the sell: Talk to your doctor about adding Abilify! And then, as the suddenly cheery woman traipses around a colorful party, we hear about the potential risks and side effects. Like dizziness upon standing; increases in white blood cells; seizures; impaired judgment or motor skills; trouble swallowing; high blood sugar, extreme in some cases, which could lead to death; high fever, stiff muscles and confusion that may be signs of a life-threatening reaction; and—here’s the kicker—uncontrollable muscle movements that could become permanent. Yes, it’s possible you could end up with a perpetual grimace on your face.
Some saw the commercial during a recent episode of Saturday Night Live and thought it was one of the show’s classic marketing spoofs. Wrote one befuddled blogger: “The ad tells me that if I am depressed, taking an antidepressant and am still feeling depressed, well then what I need is a heavy duty antipsychotic tranquilizer to shake me out of my doldrums. What the Fuck!”
“I find the Abilify ads rather astonishing,” said the journalist Daphne Merkin, who wrote a 7,500-word piece about her own depression for The New York Times Magazine back in May.
Ms. Merkin said she first heard about Abilify from fellow New Yorker Elizabeth Wurtzel, author of the 1990s depression manifesto Prozac Nation. “I was struck by the name,” she said. “It’s like: ‘You will be a person of greater ability.’ It will make your abilities available!” She added it to her existing antidepressant in July of 2008, a few months before the commercials started airing. It’s been helpful, and she hasn’t had any problems with side effects so far, she said. But she suggested there’s something alarming about the fact that ads for an antipsychotic medication now seem as normal as those for the latest nail polish.
“With Abilify, there seems to have been some kind of turning point in the fact that this type of drug has been blurred into the available smorgasbord of medication,” she said. “Now, it’s actually just right out there with all your other Pristiqs and Prozacs and Zolofts. I mean, it’s not like there’s a commercial for Thorazine. Like, ‘Hi, I’m not feeling well today, let me gulp down some Thorazine and be muted for the next two years!’”
Sonia Choi, a spokeswoman for Bristol-Myers Squibb, said the company believes “that the Abilify consumer advertising campaign is appropriate and provides an important service, informing the approximately two out of three adults diagnosed with major depressive disorder who do not experience adequate relief from antidepressant treatment, that additional help may be available.”
But at least one New Yorker with depression is skeptical.
“I’m not opposed to the idea of adding an antipsychotic if it’s useful, but I do think they are preying on the culture of people who are willing to just take anything to stop feeling bad,” said 27-year-old Randall Lotowycz of Park Slope. (He said he was a little freaked out when one doctor suggested adding an anti-epileptic drug to his Prozac regimen.)
“Everything in our culture is about how to do things easier and more quickly and to add on,” said Mr. Lotowycz. “If you’re willing to just add on and add on, you’re not really addressing what the problem is.”