Atypical antipsychotics – designed to treat schizophrenia and bipolar disorder – were introduced in 1990, and were heralded by the drug companies as being more effective and safer than the standard antipsychotics.

As a result, drugs such as Seroquel, Zyprexa, Risperdal and Geodon have become the first-line treatment for many psychotic disorders, generating around $10.5 billion a year in sales for the manufacturers.

But a major study – the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) – has discovered that the atypicals are no more effective than the older antipsychotics, and they cost around 30 per cent more.

And they are certainly not safer drugs. So far Eli Lilly, the maker of Zyprexa, has signed a settlement of $690 million that is being paid to 8,000 plaintiffs who have claimed the drug has caused their diabetes.

So how did they get approval in the first place? There are stories swirling around that government officials in the USA received a pay-off from the manufacturers, and that safety records were suppressed.

What we do know for sure is that the drug companies have been the only winners in a gambit that has brought in more than $100bn in sales of the atypicals.

(Source: American Journal of Psychiatry, 2006; 163: 2080-9).