Karen Steichen

In the 1990s, there was a small, quiet revolution in American health care that promised to be as far reaching as the advent of antidepressants like Prozac. The revolution involved a new class of medications called atypical antipsychotics, designed for the treatment of schizophrenia.

The atypicals were an instant hit with doctors and schizophrenics alike. Initially, the drugs treated schizophrenia far better than older drugs like Thorazine and Haldol had done. In mental-health circles, atypicals were sometimes referred to as "the silver bullet," the breakthrough to a centuries-long quest to effectively treat the most vicious of mental illnesses without turning patients into zombies.

But now this is a revolution in trouble.

The new meds don't work as well for schizophrenics as their initial rock-star status suggested, according to recent research. Questions about their effectiveness are now being raised. At the same time, these very same meds are being handed out like candy to a different class of patients: the millions of Americans with bipolar disorder, or good old manic-depression. We are not talking about people in psych hospitals or on the brink of suicide. We are talking about people with plain vanilla bipolar disorder—the kind where you can't sleep and are wound up for days but are a long way from diving off a bridge or running naked down the street.

In other words, fairly regular, mainstream Americans now take the most powerful mood-altering drugs in all of psychiatry. Last year, 23 million prescriptions were written for these drugs. Sales this year are expected to hit $10 billion, three times what they were in 2000. Atypicals are the fourth largest class of patented medications in America.

Patients aren't taking them for a few days or weeks, either. Doctors expect their bipolar patients to take these drugs for years, much the same as they've taken traditional mood stabilizers, like lithium, which tamp down mood swings. In fact, there's a growing rumble in the psych world that researchers would like to use atypicals to replace mood stabilizers altogether.

Yet there is no comprehensive scientific evidence to support this paradigm shift. Zero. The psychiatric industry says this isn't a problem because real-world treatment has always outpaced research. But if you happen to be a patient, it's a very big problem—atypicals have the worst side effects of any drugs used to treat bipolar disorder. As a patient, I've experienced this shift firsthand, sometimes as a willing test subject. So, I have a question: Without scientific evidence, why are doctors prescribing these meds so freely and expecting patients to take them for so long?

For the past 15 years, psych meds have been touted as the answer for every flaw of mood, feeling, and behavior in American society. We are in the midst of what's called the psychopharmacological revolution, a shift from the days of nasty meds that didn't work well to new generations of meds that aren't nasty and work very well. That's the hype, at any rate. But the revolution isn't playing out as advertised.

Even the habitually cautious National Institute of Mental Health (NIMH) now says that psych meds—including atypicals—only work 50 percent of the time.

But the mental-health world is congenitally incapable of being skeptical about how psych meds work in patients' lives. Doctors quickly become wedded to new therapies, and patients follow. As a result, a new treatment paradigm for millions of bipolars is charging ahead when researchers, doctors, and patients ought to be very cautious.

A new class of drugs for treating mental illness, atypical antipsychotics are becoming more widely used. Sales this year are expected to hit $10 billion. (Jay Vidheecharoen)

Bipolar patients should be asking why doctors want them to use meds long term that regularly generate debilitating side effects in both bipolars and schizophrenics—the kind of side effects that can mess with a patient's life almost as much as the underlying illness. Last summer, Eli Lilly quietly and with little media notice settled a lawsuit for $750 million. The suit alleged that patients had injuries, including diabetes, caused by Zyprexa, the top-selling atypical in the world. Reportedly, 23 patients have died as a result of using the drug.

All psych meds generate side effects, but atypicals even more so. On these meds, patients can gain 20 to 40 pounds in a year. Blood sugar levels shoot upward. Cholesterol goes up as well. The question of side effects is important not only because of short-term comfort, but because of patients' long-term physical health. Extreme weight gain and altered blood cholesterol levels, for example, give rise to what doctors call the "metabolic syndrome," a fancy way of saying underlying cardiac and respiratory problems can be caused by these medications over time.

That's not speculation, either. Recently published long-term data on schizophrenics taking atypicals showed weight gain on the order of 2 pounds a month, for example. Researchers say the same dynamic is present in bipolars. Any patient who takes atypicals can tell you all about those effects. To date, however, there have been no long-term studies of the effects of these medications on bipolar patients. There are other effects, too, life-reducing ones. The daylong grogginess that comes with atypicals like Seroquel. Cognitive slowing. Risperdal's tendency to stiffen faces. An odd sense that somehow you aren't the same person you were before. There's something about the immediacy of sensation that changes. Nothing is as vivid as it was before. You feel calm and diluted at the same time.

The goal of mental-health treatment is to enhance human life, not limit it.