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What happened to all the drug breakthroughs? Whenever Americans complain about the high cost of prescription medicines, they are told that their “investment” in brand-name drugs will lead to crucial advances in hard-to-treat diseases. This promise remains largely unfulfilled.

During the past few decades, pharmaceutical manufacturers have consolidated. Giant firms swallowed smaller corporations. Bigger was supposed to be better, and it was supposed to lead to innovative compounds on pharmacy shelves.

Nowhere is the disappointment greater than in the dearth of effective treatments for mental illness. There are dozens of drugs on the market for schizophrenia, depression, bipolar disorders and Alzheimer’s disease. Americans spent more than $25 billion on such medications last year. None of the available medications is a clear breakthrough, and most have serious side effects.

Second-generation antipsychotics were launched with great fanfare roughly 20 years ago. Drugs such as clozapine (Clozaril) and risperidone (Risperdal) were supposed to be much better than older drugs like chlorpromazine (Thorazine), haloperidol (Haldol) and thioridazine (Mellaril).

The side effects from these older medications were unbearable for many patients. Some people felt like zombies because of the sedation, confusion and extreme restlessness. These drugs could produce uncontrollable muscle tics that made people grimace or stick out their tongues. Such movements were frequently irreversible, even after the drug was stopped. Side effects of dizziness, dry mouth, constipation, urinary retention, blurred vision, fainting, heart palpitations, seizures and sexual problems added to the patients’ woes.

Clozaril, Risperdal and the medications that followed them, such as aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and ziprasidone (Geodon), were supposed to be easier to tolerate. Many patients and physicians also expected that they would be more effective.

But even these new “atypical” antipsychotics have serious side effects, such as weight gain that may trigger diabetes and heart disease. Sadly, these pricey medicines don’t seem to work any better than older drugs (Journal of Clinical Psychopharmacology, October 2012).

As disappointing as the antipsychotics have been, drugs to treat Alzheimer’s disease are worse. Recent studies have produced dismal results when it comes to improving memory and ability to function.

Even antidepressants have come under scrutiny. Though millions swallow pills such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft) and venlafaxine (Effexor), many find that the drugs are only moderately effective or lose their antidepressant power after a time.

Side effects of such antidepressants include nausea, dizziness, fatigue, dry mouth, insomnia, anxiety, sweating, blurred vision, headache and sexual difficulties, to name just a few.

Stopping such drugs can be challenging because of “discontinuation syndrome,” also known as withdrawal.

Americans with mental illness deserve better. It’s time drug manufacturers became more creative in their search for new treatments.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them via their website: www.peoplespharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”