The Top 25 Psychiatric Medications: Big Business-and a Price to Pay


Psychotropic drugs are big business: in 2009, roughly 300,000,000 prescriptions were written for these agents.

Psychotropic drugs are big business: in 2009, roughly 300,000,000 prescriptions were written for these agents. Duff Wilson of The New York Timesrecently reported that the newer generation of antipsychotics has become the country’s best selling medications-eclipsing even cholesterol-lowering agents. In fact, antipsychotics accounted for $14.6 billion of the $300 billion spent in this country on medications last year.

Which psychiatric drugs are the most commonly prescribed? John M. Grohol, PsyD recently posted a list of the 25 most frequently prescribed psychiatric drugs on his website. That list compares the relative rankings of these agents in 2005 and again in 2009 and includes the percent change in the number of prescriptions written during those 5 years. Several of the drugs at the top of the top 25 list are off-patent agents now available in generic form.

Xanax (alprazolam) was far and away the most commonly prescribed agent. . . a whopping 44,029,000 prescriptions were written for this anxiolytic agent in 2009. That figure represents a 29% increase in the number of scripts for the drug since 2005. The runner up was Forest Lab’s Lexapro (escitalopram) with 27,698,000 scripts (a 13% increase over 2005). Coming up fast at #7, prescriptions for Eli Lilly’s Cymbalta (first introduced to the market in 2004) grew most rapidly during this period. Although a “mere” 16,626,000 prescriptions were written for Cymbalta, that figure actually represents a 237% growth in scripts since 2005. And AstraZeneca’s Seroquel (quetiapine) for bipolar disorder and depression was prescribed 15,814,000 times in 2009-an 88% increase in the number of prescriptions since 2005.

Agents that saw a decrease in the number of scripts over the 5-years were Zoloft (sertraline, down 28%), Prozac (fluoxetine, down 9%), Effexor (venlafaxine, down 13%), Celexa (citalopram, down 22%), Wellbutin (bupropion, down 73%), and Strattera (atomoxetine, down 42%).

On a related note, AstraZeneca recently agreed to pay $520 million to settle federal investigations into its marketing practices for Seroquel-which last year alone earned the company $4.9 billion in sales. Secretary of Health and Human Services, Kathleen Sebelius noted that the company gave “kickbacks to doctors as part of an illegal scheme to market drugs for unapproved uses.” The company has also been accused of favoring positive research over studies that link the agent with an increased risk of diabetes.

The company released a statement denying the allegations. Glenn Engelmann, AstraZeneca’s US General Counsel, commented that it was in the company’s best interest to resolve these matters and “to move forward with our business of discovering and developing important, life-changing medicines, while avoiding the delay, uncertainty, and expense of protracted litigation.”

AstraZeneca is the fourth pharmaceutical company in the past 3 years to pay to settle federal investigations into illegal marketing of its drugs. According to the Times, Pfizer paid $2.3 billion for off-label promotion of Bextra (a painkiller) and Geodon in 2009. That same year, Eli Lilly paid $1.4 billion to setting investigations into illegal marketing of Zyprexa. In 2007, Bristol-Myers-Squibb paid $515 million to settle investigations into its marketing of Abilify.

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