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
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
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
"We are currently revising our practice parameter for schizophrenia and
will take into account all data, including this new information," Baker
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
The second-generation drugs were developed in large part to avoid these side
effects, which can include tics, rigidity, and even an irreversible,
Parkinson's-like syndrome that can be crippling.
Jamaison Schuler of Eli Lilly tells WebMD that the eight-week treatment arm
of the study was far too short to assess the risk for the well established,
long-term side effects.
"Physicians balance such potentially disabling and irreversible movement
disorders associated with many first-generation antipsychotics with the
potential metabolic adverse events associated with the second-generation drugs
when considering what therapy is best for each patient," he says.