Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What does it mean to live in the age of Abilify? 

Steven Reidbord, MD
Meds
March 23, 2015
278 Shares
Share
Tweet
Share

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S.  To be a top seller, a drug has to be expensive and also widely used.  Abilify is both.  It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill.  Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill.  A little more for the higher dosages.  There’s no generic equivalent in the U.S. as yet; Canadian and other foreign pharmacies stock the active ingredient, generic aripiprazole, for a fraction of what we pay in the states.  However, Abilify’s U.S. patent protection expires next month, and aripiprazole may soon be available here at lower cost.

Abilify is an “atypical” antipsychotic.  This is a confusing term, as these are now the drugs typically prescribed for schizophrenia and other psychotic conditions.  The name comes from their atypical mechanism of action, as compared to the prior generation of antipsychotics.  “Atypicals” also play a useful role in the treatment of bipolar disorder, where traditional medications such as lithium require blood level monitoring, and often multiple doses per day.

Antipsychotics are powerful drugs with considerable risks and side-effects.  But psychosis and mania are powerful too.  As with cancer chemotherapy and narcotic painkillers, a risky and/or toxic treatment can be justified in dire circumstances.  It’s also true that one crisis visit to an emergency room, not to mention a psychiatric admission, may cost more than months of Abilify, and can itself be emotionally traumatic.  If Abilify keeps psychosis at bay and prevents hospitalization, the risks are worth it.  The cost is worth it too — if a less expensive generic atypical won’t do.  Several are now available.

As I wrote in 2009, the manufacturer Otsuka tapped a much larger market for Abilify as an add-on treatment for depression.  I objected to the consumer ad campaign that trumpeted this expensive, dangerous niche product for common depression.  While there’s a role for Abilify in unusually severe, unresponsive depression, advertising it widely as a benign “boost” for one’s antidepressant was, and is, irresponsible.  By analogy, the makers of the narcotics OxyContin and Percocet could run ads showing people with bad headaches, and urging fellow headache sufferers to ask their doctors “if Percocet is right for you.”

And these are merely the FDA-approved uses of Abilify.  Atypicals are also widely prescribed off-label for use as non-addictive tranquilizers and sleeping pills, and to treat other psychiatric conditions.  There’s no advertising for off-label use, so the onus falls squarely on prescribers who balance the risks and benefits of these drugs in a manner that research tends not to support.  In short, a costly, risk-laden medication created to ease the awful but relatively uncommon tragedy of schizophrenia is now the top selling prescription drug in America owing to its widespread use in garden variety depression, anxiety, and insomnia.

It’s been said that the top selling drug in any era is a comment on society at that point in time.  Valium held the lead during the 1960s and 70s, suggesting an age of uncertainty and anxiety.  The top spot was taken over by the heartburn and ulcer medication Tagamet in 1979.  Tagamet was the first “blockbuster” drug with more than $1 billion in annual sales. Cholesterol-lowering Lipitor was the biggest seller for nearly a decade after it was released in 1997, the same year the FDA first allowed drug ads targeting consumers.  Pfizer spent tens of millions on such ads — and sold over $125 billion of Lipitor over the years.  The stomach medicine Nexium took over after that.  Without covering all the top sellers, it’s fair to say that Americans spend a great deal on prescriptions to deal with stress and unhealthy lifestyles.  The blockbusters also show how mass-marketing brand name drugs has become a highly profitable business.

What does it say about us that Abilify holds the top spot now?  What does it mean to live in the age of Abilify?  First, that we’re still looking for happiness and peace in a bottle of pills, costs and risks be damned.  Second, that there’s nearly no end to the money the U.S. health care system will spend on problems that can be addressed more economically.  And third, it’s a stark reminder that commercial interests seek to expand sales and profits whenever possible.  They find (or create) new markets, promote products by showcasing benefits and concealing drawbacks, appeal to our emotions instead of our rationality.  This is how business works.  We should not be surprised, yet we ignore this reality at our peril, particularly when it comes to our health.

Steven Reidbord is a psychiatrist who blogs at Reidbord’s Reflections.

Prev

8 reasons why you should marry a female physician

March 23, 2015 Kevin 25
…
Next

Are cardiac risk calculators accurate?

March 23, 2015 Kevin 0
…

Tagged as: Medications, Psychiatry

Post navigation

< Previous Post
8 reasons why you should marry a female physician
Next Post >
Are cardiac risk calculators accurate?

More by Steven Reidbord, MD

  • How drug prices are manipulated

    Steven Reidbord, MD
  • Which is better: Psychotherapy using video or in-person while wearing masks?

    Steven Reidbord, MD
  • Dopamine fasting, debunked by a psychiatrist

    Steven Reidbord, MD

More in Meds

  • The deadly consequences of a shortage: The Pluvicto crisis leaves metastatic prostate cancer patients in limbo

    Matt Drewes
  • The real story of Xylazine contamination in street fentanyl and how we can manage it

    Julie Craig, MD
  • The cannabis education gap: Why patients are left in the dark

    Timothy Byars
  • Are doctors ready to discuss psychedelic therapies with patients?

    Thaís Salles Araujo, MD
  • The rise and dark side of fungi: Exploring health benefits and pathogenic threats

    Sandra Vamos, EdD and Deanna Lernihan, MPH
  • Advocacy and collaboration lead to major patient safety benefits on sterile pharmaceutical compounding: a review of USP’s revisions to Chapter <797>

    Elizabeth Rebello, MD
  • Most Popular

  • Past Week

    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A pediatrician’s journey into integrative medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why allowing yourself to embrace discomfort is necessary for personal growth

      Jillian Rigert, MD, DMD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 34 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Extreme Morning Sickness Factors Into Subsequent Cardiovascular Risk for Moms
  • How Race-Neutral Equations for Pulmonary Testing Affect Patients
  • Anti-VEGF Injections for Diabetic Retinopathy Linked to Systemic Adverse Events
  • Is Berberine Really 'Nature's Ozempic'?
  • More Evidence Backs Gout Benefit for Gliflozin Agents

Meeting Coverage

  • More Evidence Backs Gout Benefit for Gliflozin Agents
  • Reaction to FDA's Approval of Upadacitinib for Crohn's Disease
  • CDK4/6 Extends Reach Into Early-Stage Breast Cancer
  • TAR-200 Led to High Complete Response Rates in BCG-Unresponsive Bladder Cancer
  • More Success for CAR T-Cell Therapy in Rheumatic Disease
  • Most Popular

  • Past Week

    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • A pediatrician’s journey into integrative medicine [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why allowing yourself to embrace discomfort is necessary for personal growth

      Jillian Rigert, MD, DMD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What does it mean to live in the age of Abilify? 
34 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...