Latest news with #Schizophrenia
Health Line
23-05-2025
- Health
- Health Line
Caplyta (Lumateperone) Overview
Key takeaways Caplyta (lumateperone) is a prescription oral capsule used to treat certain mental health conditions, including schizophrenia. Experts aren't sure exactly how it works, but they believe it affects two specific brain chemicals to treat certain mental health conditions. You'll usually take Caplyta by mouth once per day. While it should start working soon after you take your first dose, it may take time to notice a difference in your symptoms. Caplyta may cause some side effects. Mild side effects include nausea, weight gain, and headache, and these may go away after a few weeks. Serious side effects include seizures, low blood pressure, and high cholesterol. Caplyta basics Caplyta is used in adults to treat: schizophrenia depression related to bipolar I disorder or bipolar II disorder Caplyta contains the active ingredient lumateperone. (An active ingredient is what makes a drug work.) It belongs to a group of drugs called atypical antipsychotics. Caplyta is a brand-name prescription medication. A generic version of the drug isn't currently available. Caplyta uses Caplyta is used in adults to treat: schizophrenia depression related to bipolar I disorder or bipolar II disorder Caplyta is not used to treat these conditions in children. Schizophrenia causes problems with perception. It's possible for people with schizophrenia to have delusions (believing in something that's false) or hallucinations (seeing, sensing, or hearing things that aren't there). Bipolar disorder causes extreme changes in mood, such as feeling euphoric or manic, energetic, or depressed. Two common kinds of bipolar disorder are bipolar I disorder and bipolar II disorder. With the first kind, you have a manic episode with or without a depressive episode. With the second, you experience depressive episodes and hypomanic episodes (which are less severe than manic episodes). Caplyta is used to treat depression associated with bipolar I disorder or bipolar II disorder. (This drug isn't used to treat mania or hypomania.) For this purpose, it can be used alone or with lithium (Lithobid) or valproate. Although the causes of schizophrenia and bipolar disorder aren't known, these conditions may occur due to an imbalance of chemicals in the brain. It's thought that Caplyta affects two different hormones in the brain, serotonin and dopamine, which may help to decrease the symptoms of these conditions. What are Caplyta's side effects? Like most drugs, Caplyta may cause mild or serious side effects. The lists that follow describe some of the more common side effects that Caplyta may cause. These lists don't include all possible side effects. Keep in mind that side effects of a drug can depend on: your age other health conditions you have other medications you take Your doctor or pharmacist can tell you more about the potential side effects of Caplyta. They can also suggest ways to help reduce side effects. Mild side effects Here's a short list of some of the mild side effects that Caplyta can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Caplyta's prescribing information. Mild side effects of Caplyta that have been reported include: nausea dry mouth dizziness sleepiness or sedation (feeling drowsy or less alert) weight gain headache For more information about some of these side effects, see the 'Side effect focus' section. Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist. Serious side effects Serious side effects from Caplyta can occur, but they aren't common. If you have serious side effects from Caplyta, call your doctor right away. But if you think you're having a medical emergency, immediately call 911 or your local emergency number. Serious side effects of Caplyta or antipsychotic drugs such as Caplyta that have been reported include: neuroleptic malignant syndrome, a rare but serious condition that can occur in people taking antipsychotic medications high blood sugar, which can lead to diabetes high cholesterol or high triglycerides difficulty swallowing seizures problems maintaining body temperature low levels of white blood cells low blood pressure when standing up that can lead to passing out tardive dyskinesia, which causes unusual and unintended muscle movements boxed warnings: risk of suicidal thoughts or behaviors risk of death in older adults with psychosis related to dementia (problems with thinking, memory, and communication) allergic reaction For more information about Caplyta's boxed warnings and allergic reaction, see the next section. Side effect focus Learn more about some of the side effects Caplyta may cause. Boxed warning: Risk of suicidal thoughts and behaviors in certain people Caplyta has a boxed warning for the risk of suicidal thoughts and behaviors in certain people. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). Antidepressant medications may increase the risk of suicidal thoughts or behaviors in children and young adults. This includes Caplyta, which is prescribed to treat depression related to bipolar disorder. Since Caplyta is only approved for use in adults, this risk may affect adults ages 18 to 24 years who take this drug. What might help Before you start taking Caplyta, talk with your doctor about your mental health history. And tell your family and friends about this warning for Caplyta. Your risk of suicidal thoughts or behaviors can be worse at the start of treatment and when your doctor changes your drug dosage. If you notice any symptoms of worsening depression, changes in mood, or suicidal thoughts or behaviors, contact a doctor right away for treatment. Examples of symptoms to watch for include: feeling alone not enjoying activities that used to make you happy thoughts of harming yourself anxiety changes in your sleep patterns If you notice worsening of your mood or that you're having suicidal thoughts or behaviors, your doctor may recommend that you stop taking Caplyta. Help is out there If you or someone you know is in crisis and considering suicide or self-harm, please seek support: Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at Caring counselors are available to listen and provide free and confidential support 24/7. Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7. Not in the United States? Find a helpline in your country with Befrienders Worldwide. Call 911 or your local emergency services number if you feel safe to do so. If you're calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely. If you're not in the same household, stay on the phone with them until help arrives. Boxed warning: Risk of death in older adults with psychosis related to dementia Caplyta has a boxed warning for the risk of death in older adults with psychosis related to dementia. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). Antipsychotic drugs such as Caplyta may increase the risk of death in adults ages 65 years or older with dementia -related psychosis. Dementia is a condition that affects memory. Psychosis involves losing touch with reality. Older adults with dementia-related psychosis who take Caplyta may also have an increased risk of stroke. What might help Due to the risk of death, it's not likely that a doctor would prescribe Caplyta to an older adult with dementia-related psychosis. Before starting Caplyta treatment, tell your doctor about any history of dementia-related psychosis that you have. In this case, your doctor may recommend a different treatment option for you. Weight gain Antipsychotic medications such as Caplyta may cause weight gain. This is because the drug can cause changes in a person's metabolism. Although weight gain wasn't one of the most common side effects of Caplyta, it may still occur in people taking it. What might help Before you start taking Caplyta, your doctor will check your weight and continue to monitor it throughout treatment. If you experience weight gain while you're taking Caplyta, talk with your doctor. They may be able to recommend changes in your diet or exercise routine that can help you with weight management. Headache You may have headaches from taking Caplyta, although this isn't one of the most common side effects of the drug. In studies, only people taking this medication to treat depression related to bipolar disorder reported headaches. This side effect wasn't reported in people taking it for schizophrenia. What might help If you have headaches during Caplyta treatment, talk with your doctor. They may recommend ways to help treat this side effect. For example, your doctor may suggest taking an over-the-counter pain medication, such as acetaminophen (Tylenol), to ease headache pain. Allergic reaction Some people may have an allergic reaction to Caplyta. Symptoms of a mild allergic reaction can include: skin rash itchiness flushing (temporary warmth, redness, or deepening of skin color) A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, usually in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause difficulty breathing. Call your doctor right away if you have an allergic reaction to Caplyta. But if you think you're having a medical emergency, call 911 or your local emergency number. What are some frequently asked questions about Caplyta? Find answers to some commonly asked questions about Caplyta. How does Caplyta work (what is its mechanism of action)? Caplyta contains the active ingredient lumateperone, which belongs to the atypical antipsychotic group of drugs. Caplyta is used to treat schizophrenia and depression related to bipolar disorder. It's not entirely clear how Caplyta works to treat these conditions. Researchers believe the drug affects certain brain chemicals, which decreases symptoms of schizophrenia and depression related to bipolar disorder. » For more about Caplyta's mechanism of action, see this overview on how Caplyta works. What should I know about alternatives to Caplyta, such as Vraylar, clozapine, Abilify, Latuda, and Seroquel? Many different treatment options are available for schizophrenia and depression related to bipolar disorder. Before starting any treatment options, you should discuss with your doctor what may be the best medication for you. The following list includes a few examples of drugs used to treat schizophrenia and depression related to certain kinds of bipolar disorder: cariprazine (Vraylar) aripiprazole (Abilify) lurasidone (Latuda) quetiapine (Seroquel) Clozapine (Clozaril) can be used to treat schizophrenia. Some of these medications can also be prescribed to treat other conditions. These medications may have different side effects and different dosing schedules. Some will likely require different lab tests for monitoring certain side effects. Before you start treatment for schizophrenia or depression related to bipolar disorder, talk with your doctor. They can work with you to determine which medication may be best for your condition. What's the half-life of Caplyta? The half-life of Caplyta is about 18 hours. A half-life is the amount of time it takes for the body to rid itself of half of a dose of medication. So taking your dose of Caplyta every day helps to keep a consistent amount of the drug in your body. Caplyta's price and coupons As with other prescription drugs, the cost of Caplyta can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Caplyta manufacturer's website to see whether it has support options that you qualify for. And check out these tips for saving money on prescriptions. Savings for Caplyta You can visit Optum Perks for price estimates of Caplyta. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits. What is Caplyta's dosage? Your doctor will recommend the dosage of Caplyta that's right for you. Here you'll find commonly used dosages, but always take the dosage your doctor prescribes. Form and strengths Caplyta comes as a capsule that you swallow. It's available in three strengths: 42 milligrams (mg) 21 mg 10.5 mg Recommended dosage The recommended dosage of Caplyta is 42 mg once per day, which you'll take by mouth. The dosage is the same for schizophrenia and depression related to bipolar I disorder or bipolar II disorder, the conditions Caplyta is used to treat. Your doctor may lower your dosage if you take certain medications or have liver problems. Before you start taking Caplyta, be sure to tell your doctor about any medications you may take and health conditions you may have. Questions about Caplyta's dosage Here are some answers to questions you may have about Caplyta's dosage. What if I miss a dose of Caplyta? If you miss your dose of Caplyta, talk with your doctor or pharmacist about the best time to take your next dose. In some cases, they may recommend that you take your dose as soon as you remember. Or they may recommend that you skip the dose you missed and continue with your regular dosing schedule. Will I need to use Caplyta long term? If Caplyta works for you, your doctor will likely recommend that you take it long term. How long does Caplyta take to work? Caplyta begins working as soon as you take your first dose. But since the drug affects chemical levels in your brain, it may take time to notice a difference in your mood. It takes about 5 days for Caplyta to reach a consistent level in your body. How is Caplyta taken? Your doctor will explain how you should take Caplyta. They'll also explain how much to take and how often. Be sure to follow your doctor's instructions. Taking Caplyta You'll take Caplyta capsules by mouth once daily. Try to take your dose of Caplyta at about the same time each day. This helps to keep a consistent level of the medication in your body. Accessible medication containers and labels If it's hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that: have large print use braille contain a code you can scan with a smartphone to change the text into audio Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn't. Also, if you're having difficulty opening your medication bottles, let your pharmacist know. They may be able to put Caplyta in an easy-open container. Your pharmacist may also recommend tools to help make it easier to open the drug's container. Taking Caplyta with other drugs In some cases, your doctor may recommend that you take your dose of Caplyta together with other medications for your condition. For example, to treat depression related to bipolar disorder, your doctor may recommend that you also take either lithium (Lithobid) or valproate with Caplyta. Before you start taking Caplyta, your doctor will recommend the best treatment plan for your condition. Questions about taking Caplyta Here are some answers to questions you may have about taking Caplyta. Can Caplyta be chewed, crushed, or split? No, you should not chew, crush, or split Caplyta tablets. The manufacturer of Caplyta doesn't specify whether the capsules can be opened. So it's recommended that you take your Caplyta dose as a whole capsule. If you have difficulty swallowing your capsules, see these tips for swallowing pills. Or talk with your doctor about using a different treatment for your condition. Should I take Caplyta with food? You can take your dose of Caplyta with or without food. Questions for your doctor You may have questions about Caplyta and your treatment plan. It's important to discuss all your concerns with your doctor. Here are a few tips that might help guide your discussion: Before your appointment, write down questions such as: How will Caplyta affect my body, mood, or lifestyle? Bring someone with you to your appointment if doing so will help you feel more comfortable. If you don't understand something related to your condition or treatment, ask your doctor to explain it to you. Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don't be afraid to ask questions or offer feedback on your treatment. What should be considered before taking Caplyta? Before you start taking Caplyta, it's important to talk with your doctor about other medications that you take. You should also tell your doctor about any medical conditions that you have. Letting your doctor know about these factors will help them determine whether Caplyta may be a safe and effective treatment option for you. Interactions Taking a medication with certain vaccines, foods, and other items can affect how the medication works. These effects are called interactions. Before taking Caplyta, be sure to tell your doctor about all medications you take, including prescription and over-the-counter kinds. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions Caplyta may cause with these items. Interactions with drugs or supplements Caplyta can interact with several kinds of drugs. These drugs include: certain seizure medications, such as phenytoin (Dilantin) and carbamazepine (Tegretol) certain antibiotics, such as ciprofloxacin (Cipro), erythromycin (Eryc), and clarithromycin certain antifungal medications, such as fluconazole (Diflucan), itraconazole (Sporanox), and voriconazole (Vfend) certain heart medications, such as diltiazem (Cardizem) and verapamil (Verelan) certain HIV medications, such as ritonavir (Norvir), nelfinavir (Viracept), efavirenz, and etravirine (Intelence) the antidepressant medication nefazodone the tuberculosis medication rifampin (Rimactane) the lung medication bosentan (Tracleer) the narcolepsy drugs modafinil (Provigil) and armodafinil (Nuvigil) the nausea and vomiting medication aprepitant (Emend) This list does not contain all kinds of drugs that may interact with Caplyta. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with Caplyta. Other interactions You should avoid consuming grapefruit or grapefruit juice while taking Caplyta. Grapefruit can reduce how your liver breaks down Caplyta, which can cause you to have more side effects. In addition, Caplyta can also interact with the herbal supplement St. John's wort. If you're taking this supplement, talk with your doctor before starting Caplyta. Boxed warnings Caplyta has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous. Caplyta's boxed warnings include: Risk of suicidal thoughts or actions in certain people: Antidepressant medications may increase the risk of suicidal thoughts or behaviors in children and young adults. This includes Caplyta, which is used to treat depression related to bipolar disorder. Since Caplyta is only approved for use in adults, this risk may affect adults ages 18 to 24 years who take this drug. For more information about these boxed warnings, see the ' What are Caplyta's side effects? ' section. Other warnings Before taking Caplyta, discuss your health history with your doctor. Caplyta may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you: diabetes an allergic reaction to Caplyta or any of its ingredients high triglycerides or high cholesterol levels low white blood cell levels seizures low or high blood pressure liver problems heart problems a history or risk of stroke difficulty regulating body temperature Caplyta and alcohol There are no known interactions between Caplyta and alcohol. But drinking alcohol while taking this medication may increase your risk of certain side effects. Examples include nausea, vomiting, and sleepiness. In addition, consuming alcohol while taking Caplyta can affect your ability to drive a car. Keep in mind that you should not drive or operate machinery until you know how Caplyta affects you. This is because the drug may cause problems with motor skills, thinking, or judgment, which can impact your ability to do certain activities, including driving a car. If you drink alcohol, talk with your doctor about how much alcohol (if any) is safe for you to drink while you're taking Caplyta. Pregnancy and breastfeeding It's unknown whether Caplyta is safe to take during pregnancy or while breastfeeding. If you can become pregnant, are breastfeeding, or are using birth control, it's important to consider whether Caplyta is a safe choice for you. You can refer to this Caplyta reproductive health article for more information. If you have additional questions, talk with your doctor. What should be done in case of overdose? Do not take more Caplyta than your doctor prescribes. Taking more than this can lead to serious side effects. What to do in case you take too much Caplyta Call your doctor if you think you've taken too much Caplyta. You can also call 800-222-1222 to reach America's Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room. Ask a pharmacist A: It's unlikely that your doctor would change your dose of Caplyta if it isn't working. The manufacturer of Caplyta doesn't recommend any changes to the drug's dosage after a person starts taking it. One study of Caplyta for treating schizophrenia found that a dose of 42 mg resulted in significantly decreased symptoms compared with a lower dose. Another found that a higher dose of the drug didn't result in increased benefits for users. Similarly, in studies of Caplyta for treating bipolar disorder -related depression, Caplyta 42 mg once per day showed a significant decrease in symptoms. If you feel like Caplyta isn't working for you, contact your doctor. They may be able to recommend adding another drug to your treatment or changing to another treatment for your condition. The Healthline Pharmacist Team Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice. Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
The Guardian
16-04-2025
- Entertainment
- The Guardian
‘One minute it's 'would you like to listen to Galaxie 500?', the next humanity's enslaved': can anyone escape Spotify?
Laura Snapes, deputy music editor I was set the task of not listening to Spotify for a week, but Alexis, your task was much worse: only listening to Spotify-created playlists, and the songs it suggested to you based on your listening history. How did that go? Alexis Petridis, chief rock and pop critic One day in the car I just listened to nothing instead of facing it again. When it plays me songs I like, it's not what I want to hear at that moment. That's not to say the music it was recommending wasn't good. One morning it played Schizophrenia by Sonic Youth. I love that song but I didn't want to hear it then. It played me Billie Holliday's Riffin' the Scotch followed by My Bloody Valentine, which clearly demonstrates the great breadth of my music taste – but just because I like it all doesn't mean I want to hear it all together. I didn't like that it was untouched by human hands. I always think that the amazing thing about a record collection is that it doesn't make sense to anybody other than you. And yet when it's presented like that, I find it really jarring and difficult – it's all over the place. LS The algorithm is straining to find the data points that connect all those things, to close the net and make it coherent when it's not. AP The first one I tried had an AI DJ that kept saying 'Ga-lax-ie 500', which sounds like a laxative. I wonder how much of this is to do with my age and these things not having always been in my life, but I find it inherently creepy, both the AI voice and the narrow recommendations based on your own taste. I read enough science fiction in my teens to know that this is very much the thin edge of the wedge – one minute it's all matey 'would you like to listen to Galaxie 500?', the next humanity's enslaved, living underground mining uranium for a robot. There are generated playlists that are meant to be generically adjacent to the time of day you listen to it: 'Wednesday Shoegaze.' Why? Then you have '70s rock hippie afternoon', featuring a lot of music that isn't from the 1970s. There's I Am Waiting by the Rolling Stones, which is from 1965. Expecting to Fly by Buffalo Springfield is from 1967. Eight Miles High by the Byrds is from 1966. How do you generally use Spotify? LS I have mp3s of anything I care about. I pay for Spotify but I try to spend as much or more on Bandcamp or whatever every month, like carbon-offsetting. To some degree, you and I need to have Spotify, like a film critic needs Netflix. But also, artists don't earn anything from me playing their mp3s; if I stream music I already own on Spotify, they're at least getting fractions of a penny and the listener data they need to operate in that ecosystem. And I don't have to listen to ads. How about you? AP Ordinarily my listening isn't centred on Spotify. I use YouTube more for work. I listen to a lot of physical records. Did you listen to a lot of different stuff as a result of not using Spotify for a week? LS Sort of. I subscribe to a lot of music newsletters and inevitably open 20 Bandcamp links a week and shut 15 without listening to them, because there's only so much time. But this week I went through most of them and really loved an album by a Swedish composer called Hugo Randulv. I generally only use Spotify as a discovery tool to listen to albums I've never heard before that I've seen recommended elsewhere or to play old favourites out and about. The only time I cheated was when I ran out of fun music mid-run and put Doechii's last mixtape on, but I bought it when I got home. I never use their playlists. I stopped checking my Discover Weekly because it often recommends things that would be logical for me to like, but I've already decided that I don't. But that doesn't compute with their algorithmic concept that one of these things is just like the other. AP That's the thing – however good the algorithm is, there's something about human taste that it can't quite replicate. Let's look at my 'made for you'. I never usually browse this. Here's my 'reggae mix' … featuring folk legends Shirley and Dolly Collins. LS Wow. With playlists like '70s hippie afternoon', it's like their made-up Spotify Wrapped 'genres', where they're named a) to mimic the language of memes, and b) as a reduction of music down to 'vibes', stripping away historical context. This might be getting a bit Adbusters, but I think the temporal playlists are also about syncing with consumer habits. Your 'get ready with me' playlist, a 'main character energy' walk to Starbucks. And the 'coffee shop' vibe is so prevailing, it's ended up dictating the types of music that get signed: you get more pop-ready, front-facing songwriters such as Phoebe Bridgers and Julien Baker on indie labels – they're obviously great but they're also products that work well in that ecosystem. AP The guy from the label Secretly Group says in the book that they couldn't sign the experimental band Oneida now. It's a really good example of how the competition markers of pop have been brought to bear on all types of music because of Spotify. It's forcing everybody into competition with Ed Sheeran and Sabrina Carpenter, and that's not always your motivation for starting a band or making music. It helps you get on in that world if you look like Sam Fender. LS It can get even more granular. A lot of what I listen to on there is drone, the sound of one organ key being held down for half an hour. But Spotify's idea of ambient is closer to what they call 'perfect fit content' (PFC), as Liz Pelly found out in her book Mood Machine, where they commission muzak-style farms to produce chilled-out music to fit lean-back, mood-based playlists and allegedly pay a lower royalty rate than they do to traditional record labels. Filling playlists with that counts out the artists really invested in those sounds and disciplines who might otherwise stand a chance of making a living from them – there are examples of those playlists being overhauled and musicians losing out on money they had been earning. You found that several jazz playlists seemed to have next to no 'real' artists on them. AP The jazz thing is the ultimate extension of that. On one level, yes, Spotify is giving work to the jazz musicians who produce PFC, and it's hard to get work as a jazz musician. On the other hand, look at Ezra Collective. They're playing Wembley. This is what can happen when listeners are exposed to something exciting and underground. A jazz playlist full of music apparently commissioned for the purpose is actively stopping listeners from being exposed to that sort of thing. Do you ever discover things from Spotify? LS Definitely. I try not to let autoplay run after an album ends, but it has led me to good stuff. Sometimes its persistence has made me change my mind about something. I didn't get Astrid Sonne at first, but I listened to so much Clarissa Connelly – they went to the same experimental Danish music school – that it kept feeding me her, and it clicked. Thinking of massive tech companies, with, say, Amazon, I think most people are aware of the moral conflict in using it – the conditions that packers and delivery drivers work in. Do you think there's that same sense of compunction about what Spotify is doing to artists? AP No. I think there's a vague sense that you don't get paid very well, but the really big stars – the most visible artists – are doing all right. Kate Nash is doing OnlyFans to make money and it's come to something if you've got to do that to keep your career afloat. But in the broader scheme of things, most people see Sabrina Carpenter or the Weeknd and they're doing really well. So I think there's a disconnect in people's minds about this notion that artists aren't being correctly remunerated by Spotify. LS It infuriates me that they've also demonetised any songs with fewer than 1,000 plays. AP Anohni makes a very good point in the book that a record can be really impactful but you only have to listen to it twice. There's loads of music I like, such as extreme electronics, that I'm not going to listen to over and over again. LS I thought the only naive part of the book was the ending, which looks at potential alternatives to streaming. Pelly highlights public libraries in the US that have streaming platforms for local musicians. It's a lovely idea but with the best will in the world it's not the same thing. I think we've seen a lot of larger-scale alternatives collapse. AP Right – who's still talking about Tidal? It seemed to me to be completely unworkable, though I appreciate her trying to put a positive spin on it – 'there is another way' – but I don't think there is. LS I think the most likely outcome is that Spotify will move on from music to a different product, and other solutions will have to be found. It's one reason I've never got rid of my mp3s, because this could all disappear too. Mood Machine: The Rise of Spotify and the Costs of the Perfect Playlist by Liz Pelly is published by Hodder & Stoughton (£22). To support the Guardian and the Observer buy a copy at Delivery charges may apply.
New York Times
26-02-2025
- Health
- New York Times
F.D.A. Expands Access to Clozapine, a Key Treatment for Schizophrenia
The Food and Drug Administration has taken a crucial step toward expanding access to the antipsychotic medication clozapine, the only drug approved for treatment-resistant schizophrenia, among the most devastating of mental illnesses. The agency announced on Monday that it was eliminating a requirement that patients submit blood tests before their prescriptions can be filled. Clozapine, which was approved in 1989, is regarded by many physicians as the most effective available treatment for schizophrenia, and research shows that the drug significantly reduces suicidal behavior. Clozapine is also associated with a rare side effect called neutropenia, a drop in white blood cell counts that, in its most severe form, can be life-threatening. In 2015, federal regulators imposed a regimen known as risk evaluation and mitigation strategies, or REMS, that required patients to submit to weekly, biweekly and monthly blood tests that had to be uploaded onto a database and verified by pharmacists. Physicians have long complained that, as a result, clozapine is grossly underutilized. Dr. Frederick C. Nucifora, director of the Adult Schizophrenia Clinic at the Johns Hopkins School of Medicine, said he believed that around 30 percent of patients with schizophrenia would benefit from clozapine — far more than the 4 percent who currently take it. 'I have had many patients who were doing terribly, who struggled to function outside the hospital, and cycled through many medications,' he said. 'If they go on clozapine, they really tend to not be hospitalized again. I've had people go on to finish college and work. It's quite remarkable.' The F.D.A.'s shift came after years of lobbying by pharmacists, clinicians and relatives of people with schizophrenia, who cataloged the cases of patients who deteriorated after losing access to clozapine. 'There were patients who ended up relapsing into psychosis, patients who ended up hospitalized, patients who became violent,' said Raymond C. Love, a professor emeritus at the University of Maryland School of Pharmacy, who helped organize the effort. When an advisory committee to the F.D.A. reviewed the requirement at a meeting in November, he said, the agency had to expand the public docket to accommodate the number of people who wanted to speak. 'That was how much the outcry was,' he said. 'There were people in tears.' In a statement published on its website on Monday, the F.D.A. said it had determined that the testing regimen was 'no longer necessary to ensure that the benefits of the medicine outweigh' the risk of severe neutropenia. Its prevalence is estimated at around 0.9 percent worldwide and decreases after the first six months of treatment. But Dr. John M. Kane, a leading schizophrenia researcher, said he did not expect a substantial shift in prescribing as a result of the change. Even without the testing regimen, he said, many physicians are hesitant to prescribe clozapine because it requires close monitoring during the early months of treatment. 'Probably 1 in 8 patients in the U.S. who might benefit from clozapine are getting it,' said Dr. Kane, a professor of psychiatry at the Zucker School of Medicine at Hofstra/Northwell. For a portion of them, he said, the medication is 'life-changing.' Psychotic disorders like schizophrenia affect 1 percent to 3 percent of the adult population, but the disease is a crushing burden to society. The illness typically emerges in late adolescence and is characterized bypsychotic symptoms, like hallucinations or delusions, as well as by social withdrawal, cognitive impairment and a lack of motivation. Studies suggest that the risk of suicide for people with schizophrenia is at least 10 times as high as that for the general population. Though many people manage their symptoms with the help of their families, others cycle through incarcerations, homelessness and brief hospitalizations. A 2022 analysis of the economic burden associated with the disease published in The Journal of Clinical Psychiatry estimated the yearly cost at $343.2 billion, largely from caregiving, premature mortality and unemployment. The first antipsychotic medication, chlorpromazine, became available 70 years ago, and was followed by two waves of new treatments designed to alter dopamine pathways in the brain. But the pace of discovery slowed after that, as vast sums of research funding were devoted to investigating the genetics of the disease. Last September, the F.D.A. approved Cobenfy, the first novel antipsychotic treatment in decades.
