Antipsychotic Medications

 Antipsychotic Medications 
(Still under construction with links to material on the old webpage)

 

FDA Warnings
“Atypical” Antipsychotics in Elderly Patients with Behavioral Disturbances
See, also, Inspector General Testimony & Report, below
“Typical” Antipsychotics for Behavioral Problems in Older People with Dementia
See, also, Inspector General Testimony & Report, below
Risperdal in elderly patients with dementia may be associated with strokes (Canada)
[Antidepressants and Young Adults (18-24)]

“Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents”
Report of the U.S. Inspector General, May 2011.

“Overprescribed: The Human and Taxpayers’ Costs of Antipsychotics in Nursing Homes”
Testimony of U.S. Inspector General, Senate Special Committee on Aging, November 2011.Ray, W., et al. “Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death.”
New England Journal of Medicine, Vol. 360 (January 15, 2009).

ABSTRACT “Results – Current users of typical and of atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs […] For both classes of drugs, the risk for current users increased significantly with an increasing dose. […]Conclusions – Current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death.”

Ballard, C., et al. “The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial.” The Lancet Neurology, Early Online Publication, 9 January 2009.

Interpretation: “There is an increased long-term risk of mortality in patients with AD [Alzheimer’s disease] who are prescribed antipsychotic medication; these results further highlight the need to seek less harmful alternatives for the long-term treatment of neuropsychiatric symptoms in these patients.”
“Antipsychotic drugs for dementia: a balancing act.” www.thelancet.com/neurology Published online January 9, 2009: “High levels of prescription of antipsychotic drugs for neuropsychiatric symptoms in dementia are putting many vulnerable patients at risk of death and other adverse events. A randomised placebo-controlled trial, [the Ballard study noted above] published in this issue, is the first long-term follow-up study to show that patients with Alzheimer’s disease (AD) on antipsychotic drugs are at increased risk of mortality. Patients with AD in care settings in the UK who received antipsychotic treatment for 12 months were significantly more likely to have died by the 24-month and 36-month follow-up periods than were patients who received placebo. These findings highlight the urgent need to review current practices and promote alternative approaches to care for people with dementia.”

Sikich, L., et al. “Comparison of First- and Second-Generation Antipsychotics in Early-Onset Schizophrenia and Schizo-affective Disorder.” Am J Psychiatry,September 15, 2008 (Abstract)

“Risperidone and olanzapine did not demonstrate superior efficacy over [moban] for treating early-onset schizophrenia and schizoaffective disorder. Adverse effects were frequent but differed among medications. The results question the nearly exclusive use of second-generation antipsychotics to treat early-onset schizophrenia and schizoaffective disorder. The safety findings related to weight gain and metabolic problems raise important public health concerns, given the widespread use of second-generation antipsychotics in youth for nonpsychotic disorders.”

Gottstein, J. “Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations As a Matter of Course.” 25 Alaska L. Rev.  51 (2008). [See Part III, pp. 59-68]

“This Part examines the long-term medical effects of these drugs. Drawing substantially from an affidavit by Robert Whitaker filed in a September 2007 forced medication case, the following presents evidence that the drugs cause a host of debilitating side effects, including the increased likelihood that those administered them will become chronically ill. It also presents the evidence that the newer drugs are no safer and have no greater efficacy than the older drugs. In sum, patients resisting these drugs are not crazy for doing so.”

Gill, S., et al. “Antipsychotic Drug Use and Mortality in Older Adults with Dementia.”
Annals of Internal Medicine, Vol. 146. Iss. 11 (2007)

“Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics.”

Olfson, M., et al. “National Trends in the Outpatient Treatment of Children and Adolescents With Antipsychotic Drugs.” Archives of General Psychiatry, Vol. 63, June 2006

“There has been a sharp national increase in antipsychotic treatment among children and adolescents in office-based medical practice. Second generation antipsychotics are being widely prescribed, and emerging empirical evidence provides a base of support that is limited to short-term safety and efficacy.”


Second-Generation Antipsychotic Medications Appear To Offer Little Advantage Over Older Drugs For Patients Requiring Change In Treatment.” Archives of General Psychiatry (2006)

“Among patients with schizophrenia whose medication is changed because of ineffectiveness or harmful side effects, second-generation antipsychotic drugs do not appear to offer significant benefits compared to first-generation antipsychotic drugs[.]”

Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia” New England Journal of Medicine, Vol. 353, No. 12 (2005)[aka “CATIE” – “Clinical Antipsychotic Trials of Intervention Effectiveness”]. See, also, NEJM EditorialHarvard Mental Health Letter (1/2006), and the “CATIE” website.

“The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study. Conclusions: The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons. Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism.”

Whitaker, R. “Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America.” Ethical Human Psychology and Psychiatry, Volume 7, Number I , Spring 2005

“Over the past 50 years, there has been an astonishing increase in severe mental illness in the United States. The percentage of Americans disabled by mental illness has increased fivefold since 1955, when Thorazine-remembered today as psychiatry’s first “wonder” drug-was introduced into the market. The number of Americans disabled by mental illness has nearly doubled since 1987, when Prozac-the first in a second generation of wonder drugs for mental illness-was introduced. There are now nearly 6 million Americans disabled by mental illness, and this number increases by more than 400 people each day. A review of the scientific literature reveals that it is our drug-based paradigm of care that is fueling this epidemic. The drugs increase the likelihood that a person will become chronically ill, and induce new and mote severe psychiatric symptoms in a significant percentage of patients.”

Whitaker, R. “The case against antipsychotic drugs: a 50-year record of doing more harm than good.” Medical Hypotheses (2004) 62, 5–13

“Although the standard of care in developed countries is to maintain schizophrenia patients on neuroleptics, this practice is not supported by the 50-year research record for the drugs. A critical review reveals that this paradigm of care worsens long-term outcomes, at least in the aggregate, and that 40% or more of all schizophrenia patients would fare better if they were not so medicated. Evidence-based care would require the selective use of antipsychotics, based on two principles: (a) no immediate neuroleptisation of first-episode patients; (b) every patient stabilized on neuroleptics should be given an opportunity to gradually withdraw from them. This model would dramatically increase recovery rates and decrease the percentage of patients who become chronically ill.”

Mossman, D. “Unbuckling the ‘Chemical Straitjacket’: The Legal Significance of Recent Advances in the Pharmacological Treatment of Psychosis.” 39 San Diego L. Rev. 1033, 1077-78 (Fall 2002). See, also, Implications for Rogers Proceedings

“Psychiatrists in the U.S. think that the newer antipsychotics should be the drugs of first choice for patients suffering from their first episode of schizophrenia and also should be used to treat all patients with established diagnoses of schizophrenia unless there is a good reason – a patient’s personal preference, record of excellent response to an older drug, or need for an injectable preparation – to prescribe a conventional agent.”