The labeling on the atypicals notes a number of onerous side effects, usually particular to each med, but often involving more than one med. The main effects include:

• Sedation: All but Risperdal (and its derivative Invega) are horse tranquilizers.
• Sexual dysfunction: About half of men and women taking antipsychotics complain of sexual dysfunction. Risperdal appears responsible for most erectile failures, and is responsible for raised prolactin levels (hyperprolactinemia), which turns off ovaries and testes function, increasing risk of breast lactation and breast enlargement (which also effects men).
• Weight gain and diabetes risk: The drug companies were in denial for years. In 2003, the manufacturers finally bit the bullet and added warnings of diabetes risk to the labeling of all the atypicals. Zyprexa and Clozaril represent the most notorious of the weight-gainers.

Through the years, I dutifully reported on all these developments and more in my email newsletter, "McMan's Depression and Bipolar Report." They have also been up on my website, McMan's Depression and Bipolar Web, for years, and receive prominent mention in my book, "Living Well with Depression and Bipolar Disorder," published in late 2006 (with my manuscript submitted to the publisher in early 2005).

This information could be readily found in professional journals, in the mainstream media, and on the very labeling of the meds that psychiatrists prescribed, not to mention the most important source of all - patients. Since the beginning of time, distressed "end users" have been telling their psychiatrists everything they need to know.

But with the industry spending $15.7 billion on promoting prescription drugs in the US (in the year 2000), psychiatrists seemed to be listening instead to the well-groomed drug detailers who took them out to dinner and plied them with free gifts. Doctors adamantly deny they are influenced by these practices, but demonstrable changes in prescription patterns in the wake of industry largesse tell an entirely different story.

Yet, at this year's APA I detected what could be the beginnings of a major sea change. Yes, there is a time and a place for antipsychotics, came the message, but we need to be far more cautious. What gives? Are psychiatrists finally getting smart? What's different this time?

To be continued ...