Make New Meds, But keep the Old
When children are diagnosed with a psychotic disorder, doctors very commonly prescribe a newer atypical antipsychotic medication instead of an older, typical antipsychotic medication. Part of the reason for this is that there is an assumption that these newer drugs are more effective, safer and cause less serious side effects than the older ones. The older, typical antipsychotic medications have been shown to cause more movement disorders than the newer ones. Some of these movement disorders, like tardive dyskinesia, can be permanent. Other side effects, like neuroleptic malignant syndrome, can be fatal. On the other hand, newer medications have had side effects of their own, including weight gain, high cholesterol, and other problems of metabolism.
A new study further supports the notion that children with schizophrenia respond as well to older antipsychotic medications as they do to the newer atypical medications, but they have different significant side effects. The article in this month’s American Journal of Psychiatry reinforces earlier findings that the newer medications tested (risperidone and olanzapine) are no more effective than the older one tested (molindone), and that different, significant side effects are experienced by patients taking different medications. The data published comes from the Treatment of Early-Onset Schizophrenia Spectrum Disorder (TEOSS) study. This was a double-blinded study in which 116 children and teenagers aged 8 – 19 with early onset schizophrenia spectrum disorder were randomly assigned to be treated for 8 weeks with either a newer atypical antipsychotic (risperidone or olanzapine) or a typical antipsychotic (molindone). After 8 weeks, there was no significant difference with the three medications in the number of people who showed improvement.
There were big differences in side effects. Weight gain was very different depending on which medication the child was on. The average weight gain for participants taking olanzapine was 13 pounds and 9 pounds for those on risperidone. In contrast, children and teenagers taking molindone in this study gained less than a pound. This difference wasn’t limited to weight gain. In general, participants taking either of the two newer medications (risperidone or olanzapine) had higher cholesterol and insulin levels than those taking the older drug, which could mean problems with metabolism later on if they aren’t corrected. The older drug molindone did cause more children to report symptoms of akathisia, an overwhelming feeling of restlessness and an inability to stay still.
Here’s the bottom line:
- There was no difference in effectiveness between the three medications (risperidone, olanzapine, and molindone)
- All medications caused side effects in many participants. The newer medications caused more weight gain, higher cholesterol, among other effects. The older medication caused more participants to have an inability to sit still (akathisia).
One other point to note is that there is much less research on the use of these medications on children than there is in adults, so it may turn out that one medication may in fact be more helpful than others in treating symptoms or other concerns associated with schizophrenia, but the research hasn’t been done yet. For example, one of the newer medications, clozapine, has been shown to be more effective overall than any other medication for the treatment of schizophrenia.
The results of this study also reinforces the idea that there is no such thing as a perfect medication. All medications have risks of side effects with their use, and people vary in which ones they can tolerate better than others. A future entry can discuss side effects of these medications further.