Newer Antipsychotics No Better in Kids
Older Drug Works as Well as New Drugs, and Without the Weight Gain, Study Shows
Sept. 15, 2008 -- Widely prescribed, newer-generation antipsychotic drugs are no more effective for the treatment of schizophrenia in children and teens than older, cheaper drugs, a government-funded study shows.
Under the direction of the National Institute of Mental Health (NIMH), researchers compared two of the newer drugs, known as atypical antipsychotics, to an older-generation antipsychotic.
They found no major differences in treatment outcomes, but big differences in side effects among young patients taking the newer and older drugs.
The findings are similar to a larger NIMH study in adults with schizophrenia, published in 2005.
Weight Gain With Zyprexa
Children and teens who took the newer drugs Zyprexa and risperidone gained about 13 pounds and 8 pounds, respectively, during the two-month treatment part of the study.
The Zyprexa-treated patients also experienced increases in total cholesterol, LDL "bad" cholesterol, insulin, and liver enzymes. Such metabolic side effects in addition to risk for obesity "generate considerable long-term risks for diabetes and cardiovascular disease," the researchers noted.
The patients who took the older antipsychotic drug molindone (also known as Moban) experienced no weight gain, but did have more akathisia (movement disorder involving restlessness and need to fidget).
"All three of these drugs have different side effect profiles, but the newer drugs are much more likely to cause weigh gain," says psychiatrist and study researcher Linmarie Sikich, MD of the University of North Carolina.
Sikich points out that almost all children and adolescents now treated for schizophrenia start treatment on the newer, atypical drugs.
She adds that the American Academy of Child and Adolescent Psychiatry (AACAP) -- the nation's leading pediatric mental health organization -- recommends the second-generation drugs as the first-line treatment for schizophrenia in children and teens.
"At the very least, we think these results mean AACAP needs to revisit these guidelines," she says.
Erin Baker, a spokeswoman for AACAP, tells WebMD that the group is doing just that.
"We are currently revising our practice parameter for schizophrenia and will take into account all data, including this new information," Baker tells WebMD.
Zyprexa Manufacturer Responds
A spokesman for Zyprexa manufacturer Eli Lilly says the new study paints an incomplete picture of the side effect profile of molindone and other first-generation drugs.