New Antipsychotics Drugs Aren't Created Equal

Patients Who Do Poorly on One May Show Improvement on Another

From the WebMD Archives

March 1, 2004 -- Schizophrenia patients who fare poorly on the treatment they are on may show improvements in mental function by switching to the drug Geodon, according to the results of three studies sponsored by the drug's manufacturer.

The studies included 270 schizophrenic people who either did not respond well to other medications or experienced unacceptable side effects while on them. When switched to Geodon, many patients showed improvement.

Lead researcher Philip D. Harvey, PhD, acknowledges that the studies had limitations, such as the fact that researchers did not record why individual patients did poorly on other medications.

The findings are reported in the February issue of the journal Schizophrenia Research.

"The point is not to say that this drug is superior to the others," he tells WebMD. "We would never recommend that a patient who is doing well on a particular drug be switched. But if a patient is doing poorly, switching to a new antipsychotic medication can be beneficial."

No Weight Gain

Geodon is among a relatively new class of drugs known as atypical antipsychotics, which are now the most commonly prescribed medications use to treat schizophrenia. Although older antipsychotic drugs treat symptoms of psychosis, the newer atypical antipsychotics are more effective at improving learning, verbal fluency, attention, and memory, which leads to better rehabilitation in patients.

Unlike many of the new drugs, Geodon does not appear to cause weight gain or increase the risk of type 2 diabetes.

In a report released in late January, the American Diabetes Association and two other top health groups warned about these common side effects of the new drugs. The report concluded that the atypical antipsychotics Clozaril and Zyprexa were associated with the most weight gain and increase in diabetes risk and abnormal lipids, while Geodon and the drug Abilify had little or no impact on weight gain, diabetes, or lipid levels.

The joint report recommended that doctors consider whether patients are overweight or at risk for type 2 diabetes when prescribing an antipsychotic medication.

"I think many clinicians out there are beginning to switch their patients to (Geodon or Abilify) for this reason," Harvey says.


In the study, patients were switched to Geodon from either conventional antipsychotics like Haldol or the atypical antipsychotics Zyprexa or Risperdal. All three groups reported improvements in verbal memory and verbal fluency, and many patients switched from conventional drugs also saw improvements in attention and mental function.

In a memory test involving delayed recall, patients switched to Geodon saw improvements of 16%, 19%, and 21% over their performances while on conventional antipsychotics Zyprexa and Risperdal, respectively.

Cost Is an Issue

One of the most troubling side effects of the older class of antipsychotic drugs is the frequent development of movement disorders such as muscle rigidity, tremors, and jitteriness. The newer drugs are believed to minimize these side effects. But new research suggests that low doses of the older drug Haldol may be almost as effective as the newer drugs with few side effects.

The older drugs still have a place in the treatment of schizophrenia, says psychiatrist and antipsychotic drug researcher David Garver, MD, because they cost far less than the newer drugs -- as much as 100 times less than some of them.

"Any mental health system that is trying to survive on a limited budget has a real incentive to use the older drugs," the University of Louisville professor of psychiatry tells WebMD. "In general, they have probably been used in this country in doses that were too high in the past. Recent studies suggest that patients do almost as well on low doses of Haldol as on the newer atypicals."

Haldol is also one of the only antipsychotic medications that can be delivered by injection. This is important because compliance with daily oral medication is very poor among schizophrenic patients. It is estimated that three out of four patients frequently skip doses, which can lead to worsening of symptoms.

"It is a rare schizophrenic patient who will take all of his or her medication," Garver says. "We are recognizing more and more that compliance is a major problem with treatment."

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SOURCES: Harvey, P. Schizophrenia Research, February 2004. Philip D. Harvey, PhD, Mt. Sinai School of Medicine, New York University, New York. David Garver, MD, professor of psychiatry and behavioral sciences; associate chairman for research, University of Louisville School of Medicine; spokesman, American Psychiatric Association.
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