What prescription drugs do we take and why are we taking them? Get a glass of water, choke down your horse pills, and take a look at the 10 most prescribed psychiatric drugs, 10 most prescribed drugs overall, and the 10 most profitable drugs, followed by a bit of analysis (though maybe what you need is psychoanalysis).

Top 10 most prescribed drugs psychiatric drugs the United States (according to IMS Institute for Healthcare Informatics in 2009)

Rank Brand Name Generic Name # of U.S. Prescriptions Use 10 Valium Diazepam 14,009,000 Anxiety, Panic disorder Benzodiazapene – Positive allosteric modulation of GabaA Receptors – (Facilitates GabaA inhibition in use dependent manner) 9 Effexor XR Venlafaxine 14,992,000 Depression,Anxiety, Panic disorder – “Off-label” for diabetic neuropathy and migrane Serotonin-norepinephrine reuptake inhibitor (SNRI) – increases serotonine and norepinephrine 8 Seroquel Quetiapine 15,814,000 Schizophrenia, Bipolar disorder, “add-on” for Depression “Atypical antipsychotic” – Blocks dopamine, serotonin, adrenergic and histamine receptors 7 Cymbalta Duloxetine 16,626,000 Depression,Anxiety, fibromyalgia, diabetic neuropathy Serotonin-norepinephrine reuptake inhibitor (SNRI) – increases serotonine and norepinephrine in a use dependent manner 6 Desyrel Trazodone 18,873,000 Depression, Bipolar Depression (sometimes), Anxiety Predominantly a 5-HT2A receptor antagonist, also 5-HT1A partial agonist and Selective Serotonin Reuptake inhibitor (SSRI) 5 Prozac Fluoxetine 19,499,000 Depression, Anxiety, OCD, Bulemia, PMDD Selective Serotonin Reuptake inhibitor (SSRI), 5-HT2C receptor antagonist, σ1 Receptor agonist 4 Zoloft Sertraline 19,500,000 Depression,Anxiety, OCD,PTSD, PMDD Selective Serotonin Reuptake inhibitor (SSRI) – Weak σ1 receptor agonist and α1-adrenoreceptor antagonist 3 Ativan Lorazepam 25,868,000 Anxiety, panic disorder Benzodiazapene – Positive allosteric modulation of GabaA Receptors – (Facilitates GabaA inhibition in use dependent manner) 2 Lexapro Escitalopram 27,698,000 Depression,Anxiety Selective Serotonin Reuptake inhibitor (SSRI) 1 Xanax Alprazolam 44,029,000 Anxiety Benzodiazapene – Positive allosteric modulation of GabaA Receptors – (Facilitates GabaA inhibition in use dependent manner)





It’s a little crazy, pun totally intended, how much we’re prescribing SSRIs, when some meta analyses say they aren’t much better than placebo. Placebo effects are probably doing something very physiological in this case, by relieving anxiety. I would say that sugar pills would be a lot cheaper and save us money, but I don’t think we need more sugar either. Maybe, we should go Germany’s route and prescribe St. John’s Wort for mild depression?

Top 10 most prescribed drugs in the United States overall (according to IMS Institute for Healthcare Informatics in 2011)

10. Hydrochlorothiazide (various brand names) lowers blood pressure — 47.8 million

9. Generic Glucophage (metformin) diabetes drug — 48.3 million

8. Amoxicillin (various brand names) antibiotic — 52.3 million

7. Azithromycin (brand names include Z-Pak and Zithromax), antibiotic — 52.6 million

6. Generic Prilosec (omeprazole), antacid drug — 53.4 million (does not include over-the-counter sales)

5. Generic Norvasc (amlodipine besylate), angina/blood pressure drug — 57.2 million

4. Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone — 70.5 million

3. Lisinopril (brand names include Prinivil and Zestril), blood pressure drug — 87.4 million

2. Generic Zocor (simvastatin), cholesterol-lowering statin drug — 94.1 million

1. Hydrocodone (combined with acetaminophen), opiate/painkiller — 131.2 million

This list doesn’t contain any psychiatric drugs–Xanax just barely misses the cut–but the #1 drug, hydrocodone, is psychoactive. However, while our #1 psychiatric drug did not make it into the top 10 most prescribed, our #8 drug, the atypical antipsychotic Seroquel clocks in at #6 on the drugs we spend the most money on (shown bellow).

Also of note, is the #1 most prescribed drug for teenagers. Can you guess what it is? Methylphenidate, Ritalin, the ADHD medicine. I’m most surprised it’s not adderall at this point.

According to ABC news: “The United States makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids — and 99 percent of the world’s hydrocodone, the opiate that is in Vicodin.” Our use of hydrocodone and other opiate painkillers has many issues: such as diversion and abuse and use as a bandage in chronic pain or injury instead of treating underlying issues (where it may even make pain worse in the long term). Another startling new trend, is the spike in newborns born dependent on opiates:

The best sellers are often generic drugs, so it is also interesting to see where “big pharma” is making the most money:

Top 10 drug we spend the most money on in the United States overall (according to IMS Institute for Healthcare Informatics in 2011)

10. Epogen, injectable anemia drug — $3.3 billion

9. Actos, diabetes drug — $3.5 billion

8. Crestor, cholesterol-lowering statin drug — $3.8 billion

7. Singulair, oral asthma drug — $4.1 billion

6. Seroquel, antipsychotic drug — $4.4 billion

5. Abilify, antipsychotic drug — $4.6 billion

4. Advair Diskus, asthma inhaler — $4.7 billion

3. Plavix, blood thinner — $6.1 billion

2. Nexium, antacid drug — $6.3 billion

1. Lipitor, cholesterol-lowering statin drug — $7.2 billion

Note the atypical antipsychotics Seroquel and Abilities. One meta-analysis of antipsychotics, showed they have questionable benefit over the now-generic typical antipsychotics, and were not a cost-effective answer. The studies analyzed all suffer from the same difficulties that genetics studies of schizophrenia do, because patients are so heterogeneous and diagnoses are somewhat subjective. Atypical prescriptions are probably too high, due to advertising and “newer is better” kind of thinking, but because the disorders are heterogeneous, I’m glad that we have more drugs to choose from and try out with individual patients.

Also, I’m also shocked that antacid drugs can make that much money, but I guess it’s in a different ballpark than Tums.

References / Further Reading

Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. New England Journal of Medicine, 358(3), 252-260. Massachusetts Medical Society. doi:10.1056/NEJMsa065779

Hanrahan, P., Luchins, D. J., Fabian, R., & Tolley, G. (2006). Cost-effectiveness of atypical antipsychotic medications versus conventional medication. Expert Opinion on Pharmacotherapy, 7(13), 1749-1758. Expert Opinion. doi:10.1517/14656566.7.13.1749