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what are the new atypical antipsychotics used for?


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1 hour ago, jt07 said:

I think Rexulti is not approved for bipolar disorder although it is used off-label mostly for bipolar depression.

Correct. I believe official FDA approval for Rexulti is MDD. Pdoc thinks it was so that they could market to a larger group of individuals and save time in the approval process by not going for the BP dx. It does, however, work extremely well for BP depression :)

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22 hours ago, jt07 said:

I think Rexulti is not approved for bipolar disorder although it is used off-label mostly for bipolar depression.

My doctor seems to think I should try one of these new ones- I am surprised because I am a manic person, not a type 2 bipolar (mostly depressive symptoms). Do doctors get kickbacks from big pharma for pushing meds?? 

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23 hours ago, Yuna said:

Do doctors get kickbacks from big pharma for pushing meds?? 

IMO, yes, at least some do.....Especially for the shiny new ones that aren't available as generic yet.............Just my opinion.

Edited by CrazyRedhead
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5 minutes ago, CrazyRedhead said:

IMO, yes, at least some do.....Especially the shiny new ones that aren't available as generic yet.............Just my opinion.

How? I mean explain how this works. Does the doctor prescribing the med get a $check from the pharma company for each new script written? 

18 hours ago, Iceberg said:

Vraylar is technically for mania but had some reports of helping negative symptoms (Doctor seemed to think so) 

Latuda is for BP depression but I've used it at really high dose for mixed symptoms 

Vraylar for negative symptoms of bipolar or schizophrenia? What do you mean "negative symptoms".   

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28 minutes ago, Yuna said:

How? I mean explain how this works. Does the doctor prescribing the med get a $check from the pharma company for each new script written? 

Here's some articles that explain better than I could,  how docs get kickbacks from pharmaceutical companies:

http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

http://www.businessinsider.com/what-drugs-are-doctors-paid-the-most-to-promote-2015-1

http://www.thehealthyhomeeconomist.com/is-your-doctor-getting-drug-kickbacks/

In fact, below is a link to a database of all docs who received kickbacks from pharma companies.......Just type in your doc's name, and your state, and it will search to see if your doc has gotten any kickbacks.....:

https://projects.propublica.org/docdollars/

Edited by CrazyRedhead
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Rexulti seemed to work too well for my depressive features, even once we ramped up to the max 4 mg dose. It's almost as if it induced some mania for me. This happened on two separate occasions but was also dependent on the other meds on board (no more antidepressants have been used for a while). 

I wondered if it didn't get a bipolar indication because it doesn't work for mania or makes it worse like in my experience for more people. It didn't make sense to me why they would do the schizophrenic studies and skip the bipolar one to do the MDD ones. My pdoc explained that without the successful schizophrenia studies they wouldn't be able to classify the drug as an antipsychotic. Without that - the company can't use the unique classifier and high price point of a high price point antipsychotic class adjunctive antidepressant medication. Without it - it'd just be similar to a serotonin and dopamine modulating antidepressant like, I think - Viibryd (vilazodone) and that small group of friends. It makes me wonder if Viibryd failed schizophrenia trials and therefore lost its classification as an antidepressant, because it's common name certainly sounds like one, right?

Vraylar was great for me for everything but gave me EPS and I had to discontinue. It was unfortunate because it was the only AP ever that ever made me have decreased appetite as a side effect. I'd love to make it work - part of me wonders (hopes?) whether that wasn't some sort of tic instead. 

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38 minutes ago, ByePolarCoordinates said:

I wondered if it didn't get a bipolar indication because it doesn't work for mania or makes it worse like in my experience for more people.

I don't know but I've wondered the same thing. I'm guessing the manufacturer (in Japan) knew that there were reports of Abilify (also developed by the same company in Japan) pushing people into hypomania or mania so with Rexulti they didn't even try for a bipolar indication.

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On 6/3/2017 at 10:39 AM, CrazyRedhead said:

Here's some articles that explain better than I could,  how docs get kickbacks from pharmaceutical companies:

http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

http://www.businessinsider.com/what-drugs-are-doctors-paid-the-most-to-promote-2015-1

http://www.thehealthyhomeeconomist.com/is-your-doctor-getting-drug-kickbacks/

In fact, below is a link to a database of all docs who received kickbacks from pharma companies.......Just type in your doc's name, and your state, and it will search to see if your doc has gotten any kickbacks.....:

https://projects.propublica.org/docdollars/

Explain how this works? Doctors get $$$ for each script that is written from the pharma companies? 

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On 6/3/2017 at 9:39 AM, CrazyRedhead said:

Here's some articles that explain better than I could,  how docs get kickbacks from pharmaceutical companies:

http://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

http://www.businessinsider.com/what-drugs-are-doctors-paid-the-most-to-promote-2015-1

http://www.thehealthyhomeeconomist.com/is-your-doctor-getting-drug-kickbacks/

In fact, below is a link to a database of all docs who received kickbacks from pharma companies.......Just type in your doc's name, and your state, and it will search to see if your doc has gotten any kickbacks.....:

https://projects.propublica.org/docdollars/

I checked out the first NPR link. I don't know if I'd call these "kickbacks" exactly.

"The payments in our analysis include promotional speaking, consulting, business travel, meals, royalties and gifts, among others."

The NPR piece talks about an "association": "ProPublica's analysis doesn't prove industry payments sway doctors to prescribe particular drugs, or even a particular company's drugs. Rather, it shows that payments are associated with an approach to prescribing that, writ large, benefits drug companies' bottom line."

Here's one reason there may be an association:

"Doctors nowadays almost have to go out of their way to avoid taking payments from companies, according to Dr. Richard Baron, president and chief executive of the American Board of Internal Medicine. And those who do probably have greater skepticism about the value of brand-name medications. Conversely, doctors have to work to cultivate deep ties with companies — those worth more than $5,000 a year — and such doctors probably have a greater receptiveness to brand-name drugs, he said.

'You have the people who are going out of their way to avoid this, and you've got people who are, I'll say, pretty committed and engaged to creating relationships with pharma,' Baron said. 'If you are out there advocating for something, you are more likely to believe in it yourself and not to disbelieve it.'"

If that explanation is true, that doesn't mean that Dr. Z prescribes X and receives $100 in return for writing the script.

I used the propublica docdollars tool (I've used it in the past) and my pdoc has received about $500/year from pharma companies for the past 2 years. The breakdown is anywhere from $9-$112 at a time and the category is always food & beverage. One specifically is labeled an "informational meal." I'm not sure what the other food & drink monies are for but I always assumed the drug reps liked to take my pdoc out to lunch or dinner or bring lunch to the office and explain wonderful things about their new drugs to her, plus give her the free samples. Perhaps she has to submit to the food interaction in order to get the free samples?

My pdoc doesn't usually push newer drugs on me unless the cheaper drugs aren't working for me. So I switched to pristiq for a time when we though effexor had pooped out on me after a decade but then I switched back to effexor because I didn't notice much of a difference. And I tried latuda at one time as an adjunct because my pdoc didn't want to prescribe me seroquel because part of my problem was fatigue and sleeping all day. I ended up on abilify, but it had been out for a long time before I went on it. When trying stimulants, I ended up on nuvigil first (vs. the older provigil) because that's what she had sample packs of but if the sample pack had worked out for me, I think she probably would have prescribed provigil first since it was similar and cheaper. Then I tried geneic ritalin. Then generic adderall. Nothing new there.

Edited by aquarian
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