![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ed_uk on September 23, 2005, at 16:33:12
From the Pharmaceutical Journal UK.......
New and old antipsychotics have similar efficacy
First and second generation antipsychotics are comparably effective but both associated with high rates of stopping therapy, according to research published in the New England Journal of Medicine this week (2005;353:1209).
Jeffrey Lieberman, department of psychiatry, Columbia University, New York, and colleagues conducted a randomised controlled trial involving 1,493 patients with schizophrenia. Patients received either the first generation antipsychotic perphenazine (similar to Haldol) or a second generation antipsychotic — Zyprexa, Seroquel or Risperdal for up to 18 months. Geodon was also included following its approval by the US Food and Drug Administration. The primary outcome measure was time to discontinuation of the drug for any reason. Patients’ symptoms were also evaluated.
Overall, 74 per cent of patients discontinued the study medication before 18 months. Discontinuation was highest among the Seroquel group (82 per cent) and lowest among the Zyprexa group (64 per cent).
Zyprexa was considered the most effective drug in terms of rates of stopping therapy — time to discontinuation for any cause was longer in the Zyprexa than the Seroquel (P<0.001) or Risperdal group (P=0.002). Time to discontinuation due to side effects was similar in all groups, however Zyprexa was associated with more stopping of therapy due to weight gain and increases in glycosylated haemoglobin, cholesterol and triglycerides. Results for the other second generation antipsychotics and perphenazine were similar in most respects, say the researchers.
An accompanying editorial (ibid, p1286) notes that Clozaril was omitted because it has already been observed to have superior efficacy. “It would thus seem reasonable to try Zyprexa and Clozaril in any patient with schizophrenia who has not had a full clinical remission of the illness, which includes the reversal of cognitive and psychosocial disabilities. However, it is also prudent to switch treatment from these drugs to one of the others if a metabolic syndrome is threatening the patient’s general health,” it says.
Posted by alexandra_k on September 24, 2005, at 15:26:37
In reply to New and old antipsychotics have similar efficacy, posted by ed_uk on September 23, 2005, at 16:33:12
Uh.. By 'therapy' do they mean taking ones medication?
And by 'drop out rates' do they mean stopping taking ones medication?
Just wondering... I'm kind of interested in therapy (as in talk therapy) for schizophrenia - but they aren't talking about the medications effect on whether one goes along to talk therapy or drops out from talk therapy, are they??
Posted by Declan on September 24, 2005, at 17:51:27
In reply to New and old antipsychotics have similar efficacy, posted by ed_uk on September 23, 2005, at 16:33:12
Hi Ed
Metabolic syndrome as in type 2 diabetes?
How many of us (not when we're in our 20's I guess) don't have that? That's what my nutritional dr diagnosed me with. But of course none of his things really work (for sleep say). Which is why he was such a help. Not an unknown paradox around here.
Declan
Posted by med_empowered on September 24, 2005, at 19:46:51
In reply to Re: New and old antipsychotics have similar efficacy » ed_uk, posted by alexandra_k on September 24, 2005, at 15:26:37
I've had kind of mixed reactions to this study. On the one hand, having taken most of the atypicals, I found it hard to imagine that these were *wonder drugs*; I found it even harder to imagine that all the old drugs could have been *that much* worse. And I'm glad to see that, finally, after billions of $$$ have been spent and shrinks have been going on and on about schizophrenia becoming "a manageable illness," blah blah blah (with no hard statistical backing, mind you) someone has finally taken the time to do a more or less objective comparison to see what was really going. The bad news is...the medications we have now are about as effective as what we had in the 50s; Trilafon (perphenazine), the old drug used as a comparison agent in this study, has been around since 1958. (Interestingly, its part of the ORIGINAL antipsychotic/antidepressant combo: Triavil, which is perphenazine+elavil). I think maybe its time to focus more on therapy and psychosocial interventions, and lay off the meds so much. This study makes clear what lots of people have suspected for a long time: despite all the hooplah, the neuroleptics really aren't that great. For alexandra..you might want to look up the Soteria project, which ended in the 70s, I think...the data's really good though (loren mosher, the soteria guy, was once head of the NIMH, and the study design was *excellent*, especially for a psychiatric study). From what I understand, some people, including the author of "Mad in America" are trying to set up a new Soteria House somewhere in Alaska...since its drug-free and they use mostly non-professional support staff, they've been facing a bit of a battle in getting everything OK'd (also, drug companies have WAY more power and influence now than in the 70s, so they stand to lose a lot if this project produces good, cost-effective results). As much as I dislike the neuroleptics, I don't think medications *can't* play a role in treating schizophrenia; I just don't think any of the "antipsychotic" meds we have right now are really going to help that many people. Some studies in the past indicated that high-dose benzos helped calm people down, reduced depression, and allowed them to function. There's also some evidence that certain stimulants (like Provigil) could improve cognition in those with schizophrenia or other disorders. I think medication will only help when psychiatry moves from a domineering, kind of fascist framework of "controlling symptoms" and "reducing behavioral disturbances" towards "empowering people" and "improving quality of life". I mean, lets face it: neuroleptics and antidepressants were both introduced in the 50s. Since then...the suicide rate has risen, violence has become more common, and both schizophrenia and depression remain largely as disabling as ever, despite widespread medication-based "therapy". I think if medical treatment of emotional issues is going to be useful for anything besides selling pills, its going to have to take on a more humane, patient-centered perspective; otherwise, at some point, people (and their governments and insurance providers) are going to get sick and tired of paying out $$$ for pills that don't seem to be doing very much for improving life. Just my opinion.
Posted by alexandra_k on September 24, 2005, at 23:54:30
In reply to Re: New and old antipsychotics have similar effica, posted by med_empowered on September 24, 2005, at 19:46:51
hmm...
i think that meds are effective in some respects...you don't typically see as many catatonic people as you used to (meds and ect)
you don't see as many floridly delusional people as you used to (meds)
you don't see as many (as severely) depressed people as you used to (meds and ect)but yeah, their ain't no 'wonder drug'.
i do think...
that the newer anti-p's are very different from the older anti-p's to take. from a first person experiential pov. i guess i'm mainly thinking of chlorpromazine (which is admittedly one of the oldest) but that is way different to take (and a hell of a lot more sedating) than the newer ones (respiridal, seroquel etc)but... dunno.
i dunno.
i don't really know anything about meds....
;-)i guess what i thought...
(though i don't know where i got this)
was that meds were terrific (generally) for reduction in the POSITIVE symptoms of schizophrenia...
but that meds were not really of much assistance with respect to the NEGATIVE symptoms.
(though even that distinction is controversial...)I dunno.
Posted by ed_uk on September 25, 2005, at 9:51:01
In reply to Re: New and old antipsychotics have similar efficacy » ed_uk, posted by alexandra_k on September 24, 2005, at 15:26:37
Hi
>By 'therapy' do they mean taking ones medication?
Yep!
>And by 'drop out rates' do they mean stopping taking ones medication?
Yep!
~ed
Posted by ed_uk on September 25, 2005, at 9:52:16
In reply to Re: New and old antipsychotics have similar efficacy, posted by Declan on September 24, 2005, at 17:51:27
Hi Dec,
>Metabolic syndrome
Obesity, hypertension, raised triglycerides, low HDL cholesterol, insulin resistance etc.
~Ed
Posted by ed_uk on September 25, 2005, at 10:03:42
In reply to Re: New and old antipsychotics have similar effica, posted by med_empowered on September 24, 2005, at 19:46:51
Hi Med,
>I think medication will only help when psychiatry moves from a domineering, kind of fascist framework of "controlling symptoms" and "reducing behavioral disturbances" towards "empowering people" and "improving quality of life".
We need to get rid of some of the jargon. When a *medication fails* to help a person, why do we say that '*med_empowered failed* a trial of Zyprexa'??
~ed
Posted by SLS on September 25, 2005, at 10:06:14
In reply to New and old antipsychotics have similar efficacy, posted by ed_uk on September 23, 2005, at 16:33:12
> New and old antipsychotics have similar efficacy
I don't know if this same claim can be made with these drugs if one looks at mood disorders instead of schizoid disorders.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.