What happens when the drug pipeline for common mental health concerns — such as depression, anxiety and bipolar disorder — starts to dry up?

“Most psychiatric drugs in use today originated in serendipitous discoveries made many decades ago,” according to a recent article on Science News by Laura Sanders. And it’s true — we can trace back today’s most popular psychiatric drugs to discoveries made over 30 — and in some cases, 40! — years ago.

Because of the heady cost of drug development — costing hundreds of millions of dollars to bring a new drug to market — most pharmaceutical companies have been playing it safe these past few decades. They’ve been working on developing “me too” drugs — subtle molecular changes to existing compounds.

Which means the pipeline is darned near empty of truly new drugs likely to come out in the next 5 to 10 years for the most common types of mental illness.

Although this will not come as news to anyone who’s been on any one of the most common psychiatric medications prescribed — such as Celexa, Lexapro, Cymbalta, Prozac, Xanax, Paxil, Effexor, etc. — getting off of a psychiatric medication can be hard. Really hard.

Much harder than most physicians and many psychiatrists are willing to admit.

That’s because most physicians — including psychiatrists — have not had first-hand experience in withdrawing from a psychiatric drug. All they know is what the research says, and what they hear from their other patients.

While the research literature is full of studies looking at the withdrawal effects of tobacco, caffeine, stimulants, and illicit drugs, there are comparatively fewer studies that examine the withdrawal effects of psychiatric drugs. Here’s what we know…

Medications used to treat mental disorders continue to enjoy the best sales they’ve had ever. Meanwhile, psychotherapy usage continues to decline.

We started tracking the top 25 psychiatric medications prescribed in the U.S. back in 2005, with the help of IMS Health and their innovative Xponent service, which tracks the vast majority of prescriptions dispensed in the U.S.

The top 5 are below, while the rest of the list follows.

It’s common to have some concerns and worries about being pregnant, having a healthy child, giving birth, and parenting your little one, according to Pamela S. Wiegartz, Ph.D, and Kevin L. Gyoerkoe, PsyD, in their book, The Pregnancy & Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions and Compulsions.

However, for some moms-to-be, anxiety becomes so severe and distressing that they’re unable to function day-to-day.

It’s only recently — over about the last decade — that researchers have begun exploring anxiety in pregnancy. Consequently, much more work is still needed.

But here’s what we do know.

If companies are people, my friend, like Mitt Romney famously described in Iowa in August 2011, then we’re feeling a little bad for our fellow person called Janssen Pharmaceuticals, a division of health care giant Johnson & Johnson.

They just got dinged with a $158 million settlement in a Medicaid fraud case in Texas for “making false or misleading statements about the safety, cost and effectiveness of the expensive anti-psychotic medication Risperdal, and improperly influencing officials and doctors to push the drug.”

But we won’t feel too badly, because Janssen got off easy with this one. They don’t have to admit to any liability with the settlement, and Johnson & Johnson — who made billions off of the sale of Risperdal — will barely blink their corporate eyeballs as they make out the check.

Dear Mrs. ——–

You have asked me about the cause of your mood disorder, and whether it is due to a “chemical imbalance”. The only honest answer I can give you is, “I don’t know”—but I’ll try to explain what psychiatrists do and don’t know about the causes of so-called mental illness, and why the term “chemical imbalance” is simplistic and a bit misleading.

By the way, I don’t like the term “mental disorder”, because it makes it seem as if there’s a huge distinction between the mind and the body—and most psychiatrists don’t see it that way. I wrote about this recently, and used the term “brain-mind” to describe the unity of mind and body.1 So, for lack of a better term, I’ll just refer to “psychiatric illnesses.”

Now, this notion of the “chemical imbalance” has been much in the news lately, and a lot of misinformation has been written about it—including by some doctors who ought to know better 2. In the article I referenced, I argued that “…the “chemical imbalance” notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”1 Some readers felt I was trying to “re-write history”, and I can understand their reaction—but I stand by my statement.

People with Alzheimer’s disease often suffer not only from the debilitating effects of the disease itself, but also from the secondary psychological effects. Delusions and hallucinations appear in up to 50 percent of those with Alzheimer’s, and as many as 70 percent demonstrate aggressive behaviors and agitation. Both caregivers and family members are distressed by these symptoms, and so everyone is motivated to treat the person with Alzheimer’s with antipsychotic medications.

The problem?

Antipsychotic medications haven’t always been well-researched on older populations, and fewer still on people with a disease like Alzheimer’s. And when the research has been done, the results are often underwhelming.

Last week, I had the opportunity to report from SAMHSA’s annual Voice Awards in Hollywood and to interview one of the consumer leadership award winners. Frederick Frese, Ph.D. is a psychologist with more than 40 years experience in public mental health care. Until 1995, Frese was Director of Psychology for 15 years at Western Reserve Psychiatric Hospital. Now he is the Coordinator of the Summit County Recovery Project, serving recovering consumers in and around Akron, OH.

Dr. John M. Grohol: So you’ve had a distinguished career, but it all seemed to start with your diagnosis of schizophrenia when you joined the Marines.

Dr. Frederick Frese: Actually, I was in the Marine Corps for about four years when I had the diagnosis and was discharged. Then spent 10 years, in 10 different hospitals, being hospitalized and re‑hospitalized, at one point being committed as insane. Then I went back to school, got my doctorate, became a psychologist functioning in a state hospital. I was actually director of psychology. I was being told not to tell anybody about my condition.

But one day, and thanks in large part to the last lady you just interviewed, Pam Hodge… She changed the laws in Ohio and encouraged persons in recovery to sit on mental health boards and become open about their conditions. So I did.

Since then, I’ve had quite a career. I’ve given over 2,000 talks. I’ve had movie contracts. No movie, but I’ve had a couple contracts!

I remain astounded that psychiatrists and pediatricians think it’s occasionally appropriate to prescribe adult atypical antipsychotic medications — like Risperdal — to children younger than age 5.

Last week, The New York Times covered the story of Kyle Warren, a boy who began risperidone (Risperdal) treatment at age 2. Yes, you read the right — age 2.

He was rescued from this unbelievable prescription by Dr. Mary Margaret Gleason through a treatment effort called the Early Childhood Supporters and Services program in Louisiana. Dr. Gleason helped wean young Kyle off of the medications from ages 3 to 5, and helped understand that Kyle’s tantrums came from his stressful and upsetting family situation — not a brain disorder, bipolar disorder, or autism.

Imagine that — a child responding to a family situation that is stressful and involves his two primary role models — his parents.

After carefully reviewing the limited amount of research in this area, Psych Central recommends that parents should never accept an atypical antipsychotic medication prescription for a child age 5 or younger. If your doctor makes such a prescription, you should (a) look for another doctor and (b) consider filing a complaint with your state’s medical board against the doctor.

You’ve been diagnosed with a mental disorder and have been in treatment now for years. You’ve done both psychotherapy and psychiatric medications, and now it’s time to try to live life drug-free. You’ve successfully ended your psychotherapy treatment, but now you’re looking for advice and information about how to end your psychiatric medications.

My first suggestion to you would be to talk to your doctor or psychiatrist. Nobody should go off of any medication without first getting their doctor’s consent and, hopefully, cooperation (or, if not their consent, at least their grudging acceptance that it’s your body and you can do with it what you want). Ideally, you’re seeing a psychiatrist for your psychiatric medications and not just your family doctor. If you are just seeing your family doctor, you may need a little more help than someone seeing a psychiatrist, because psychiatrists have much greater familiarity with helping people get off of the medications they previously prescribed to them. (In my experience, I’ve found many family doctors simply have little clue about the idiosyncrasies of discontinuing psychiatric medications, because of their unique tapering properties.)

A while back, a reader asked me if I’d cover the topic of intimacy complications with regard to antidepressants.

Ah. Yeah. Every time I write about this controversial topic, I usually get hammered by the left, right, and center. This is obviously delicate ground, so let me tread lightly.

In a recent Johns Hopkins Health Alert called “The Challenge of Antidepressant Medication and Intimacy,” I read this:

While sexual dysfunction is a frequent symptom of depression itself (and successful treatment of depression may eliminate it), antidepressant medication can sometimes worsen or even cause sexual problems. In fact, sexual dysfunction is a potential side effect of all classes of antidepressants.

Schizophrenia is one of those mental disorders that many people seem to confuse with …