Atypicals Still Seen as Drugs of Choice for Schizophrenia
Kirn, Timothy F., Clinical Psychiatry News
SACRAMENTO -- Side effect profile determines the drug one chooses for treating schizophrenia, and that means an atypical, said Dr. Stephen Marder, addressing the current controversy over whether the second-generation antipsychotics really are better than older agents.
The controversy, which has been widely debated, comes from a British meta-analysis that concluded there may be little reason to believe that second-generation antipsychotics are better than the older agents. The analysis said that many of the trials that compared an atypical antipsychotic with a conventional antipsychotic drug and found the atypical superior were flawed because they used a high dose of haloperidol (Haldol), which was not necessarily well tolerated.
Moreover, when low doses were compared, the advantages largely disappeared. And, while the new agents have fewer extrapyramidal side effects, they have their own important side effects, such as weight gain.
The authors concluded that the conventional agents should be the first-line agents for schizophrenia because they are less expensive, except in cases in which patients experience extrapyramidal side effects (BMJ 321:1371-76, 2000).
The conclusions of that article are probably correct, but "the tone is misleading," said Dr. Marder, professor of psychiatry at the University of California, Los Angeles. Dr. Marder participated in the 2001 Mount Sinai consensus conference concerning antipsychotic prescribing.
Other analyses have suggested that while the second-generation antipsychotics are obviously effective, compared with placebo, the degree of advantage they have over haloperidol is so small that it may not be clinically detectable or relevant. …