Inside Your Medicine Cabinet

Highest grossing drugs

A reader writes:

I'd like to make a couple comments about your post that I think bear correction. First, Seroquel XR has been available in the US for about four years now. Second, Seroquel XR is an antipsychotic. It's anything but an "upper". If you take one, you won't feel up in any way whatsoever. If it works at all for depression it will be because the user will not care enough to be depressed about anything.

Another writes:

This is hardly a drug that's designed to supplement an anti-depressant. It's an extended-release form of an existing anti-psychotic generally used to treat schizophrenia and acute episodes of mania and depression in bipolar disorder. While for some patients it may work to augment their existing anti-depressant regime, it's not a first-choice option and definitely does not work for everyone.

I was recently prescribed Seroquel XR to deal with a manic episode and it rendered me virtually catatonic.

I was hospitalized and switched to a different anti-psychotic that worked much better for me. It's precisely because everyone responds differently to psychiatric drugs that it's important for patients to have a good relationship with their doctors and a willingness to try various combinations to find the course of treatment that suits them best. It's no secret that drug companies try to find as many uses for their product as possible, but with mental health it's very much the responsibility of the patient to explore those options to ensure they get the best treatment.


Street Carnage doesn't know what the fuck he's talking about. I've been on anti-depressants for 8 1/2 years, requiring three hospitalizations during that time span. I have tried pretty much every anti-depressant drug you can think of, and through those years of trial and error I have experienced many peaks and valleys, but mostly valleys.

My doctor finally put me on Seroquel XR as an add-on to the Zoloft I was already taking last summer. The change was almost immediate, and in a very positive direction. It did not, as Street Carnage seems to imply, give me some sort of "high." It just provided a measure of emotional clarity and calm that I had not experienced in years. After going on the Seroquel XR last August, I became much more productive and started sleeping much better. It is now mid-April and the effect of the drug has by no means dissipated.

A psychiatrist writes:

As with many medications, Seroquel can have a wide range of effects, good and bad. For instance, it can treat tic disorders such as Tourette's Syndrome. There is some evidence that it can also work synergistically with an anti-depressant to treat severe depression that has not responded to an anti-depressant alone. Depression can be fatal, due to suicide, and so it is crucial to treat it in any way possible.

Pharmaceutical companies are notoriously deceptive when it comes to marketing their wares. However, in this particular case, I see nothing wrong with stating that Seroquel can be a useful adjunct to an anti-depressant.

Another reader:

The blog you link to about Seroquel probably has no idea that Seroquel can be used independently of other drugs, and that's it's prescribed for Alzheimer's patients.  My mother is one such case: it helps deal with her continous panic attacks.  It's not a complete cure, but using it means that, for instance, getting her to move from her favorite chair to the commode is merely slightly difficult rather than a continual fight to keep her from collapsing to the floor out of sheer fright.

A clinical professor of psychiatry writes:

The real controversy here is that Seroquel XR has been FDA-approved for new indications, instead of Seroquel.

The extended release XR has little if any added benefit for patients. It was created because the immediate release Seroquel goes generic next year (and is already generic in other countries – US law allowed the Seroquel patent to be extended because it was tested for pediatric use). The FDA should stop approving new indications for slightly modified versions of old drugs, when the purpose of the application is to provide a market for the brand name drug after the generic form is available. And we should stop granting patent extensions on the old drugs. These practices add billions to US drug costs every year without benefit to consumers.

Seroquel and Seroquel XR can be useful drugs for people who haven't responded to conventional antidepressants alone. However, they cause weight gain and can increase diabetes risk, so they shouldn't be prescribed unless multiple safer medications have failed.

Chart on the top-grossing prescription drugs in America via Alexis.