Second Generation Antipsychotics no Better for Children & Adolescents
Just because it's newer doesn't mean it's better. This is the message to come from recent studies that have examined the therapeutic effects of the latest generation of antipsychotic medications on children and adolescents. Not only are the remedial effects no better than older generation drugs but patients simply appear to swap one set of side effects for another.
Report author, Dr. Linmarie Sikich, an assistant professor of psychiatry at the University of North Carolina at Chapel Hill, believes that the current guidelines for treating early-onset schizophrenia are wrong. Current guidelines suggest using the newer drugs first but Sikich says, "you should seriously consider using the older drugs first . . .based on what side effects are likely to be most concerning."
Dr. Sikich compared the effects of molindone, an older generation antipsychotic, with two of the so-called second generation drugs olanzapine and risperidone. All the medications reduced symptoms in a very different fashion but they produced very different side effects.
Both olanzapine and risperidone caused dramatic weight gain of up to 17 pounds in just eight weeks. Weight gain is a high risk factor for cardiovascular problems such as heart disease and stroke. It is also related to onset of diabetes. When tested, patients were found to have higher than normal levels of bad cholesterol, increased levels of insulin and fatty deposits in the liver. By contrast, patients taking molindone actually lost a little weight, but had a series of other side effects to contend with.
Older antipsychotic drugs are known for their powerful side effects. These include muscular stiffness, cramps, rigidity and other Parkinson-like symptoms. Because of this, patients on the trial had to take additional drugs to counteract the effects.
Disappointingly, none of the drugs were found to be particularly effective. "By the time we got to a year, only 10 to 20 percent of the kids were able to stay on the medicine a whole year. Whereas we believe this illness is likely need lifetime treatments," said Sikich. "It reminds us that the medications we have may be necessary but not sufficient. We need to do much better both with psychosocial treatments as well as coming up with a third-generation of medicines that are far more effective."
Meanwhile, the focus of attention needs to move from an assumption that newest is best towards the patient, their needs, and what works best for them.
The full report is available in the September 15 online edition of the American Journal of Psychiatry.