Features of Some Popular Antipsychotic Medications
Although they are more popular, the newer antipsychotic drugs may not always be better than the older ones. In fact, one government-financed study — which was not sponsored in any way by pharmaceutical companies — concluded there was little difference between four atypical antipsychotic drugs (Risperdal, Seroquel, Geodon, and Zyprexa) and one older drug, perphenazine. The report in the New England Journal of Medicine found that all of the drugs were effective at decreasing debilitating symptoms of schizophrenia.
Zyprexa surpassed the others in controlling symptoms for a longer time, but one of its side effects — weight gain — was a serious drawback. In fact, side effects had a large impact on the study. Nearly three out of every four patients participating in the study stopped taking their first assigned drug. They blamed side effects or other sources of discomfort. Those patients, however, went on to take other medications that they tolerated better and that produced better results for them.
An important lesson from this study is that you should persevere in the search until you find the medication that works best for you with the lowest side effect profile. Follow your physician's recommendations, but don't rule out any drug candidate, old or new, in your joint effort to find a medication that will help.
The First of the Atypical Drugs
Clozapine (Clozaril) was the first of the antipsychotic medications to be called an atypical drug because it did not produce the neurological side effects associated with the older drugs. It has the striking advantage of being effective in the 10 to 30 percent of patients who do not respond to other medications. Some psychiatrists think it is often overlooked and underused as a treatment option.
When other drugs fail to help a patient, clozapine often does help, although it may take longer than other antipsychotic medications to prove its effectiveness. One advantage is that it does not seem to raise prolactin levels, which are linked to lack of sexual drive, breast enlargement, and milk production and disruption of the menstrual cycle in women. In one out of 100 people, clozapine may cause agranulocytosis, towering the number of white blood cells that the body uses to fight infection. Besides this potentially serious side effect, it can also produce sedation, excess salivation, and seizures in a small number of people. With proper monitoring, however, clozapine remains a useful option for patients who cannot tolerate other medications or do not respond to them. It was also found to be more effective in getting rid of suicidal thoughts, and for that reason may be a good option for a patient who is chronically struggling with suicidal thoughts or behavior.
Risperidone is another atypical antipsychotic and is less likely to produce extrapyramidal symptoms in lower doses than are the first generation drugs. It may cause drowsiness or insomnia and it may increase prolactin production.
Olanzapine is also an atypical antipsychotic. While it can produce significant weight gain, blurry vision, problems with excretion, and drowsiness, it rarely causes neurological problems. Prolactin levels may increase in patients using olanzapine, but to a lesser degree than is observed with the typical antipsychotics.
Quetiapine has an even lower risk of producing extrapyramidal side effects or elevated prolactin levels. It can cause dizziness, dry mouth, stomach upset, and drowsiness in some users.
Ziprasidone is another atypical antipsychotic agent that is less likely to cause extrapyramidal side effects, but it may raise prolactin levels like other drugs in its class. According to an FDA warning about Geodon, it should not be taken by patients with certain heart conditions. Because Geodon may affect heart function in some people, it is important not to mix it with other medicines that do the same. Patients who are susceptible to dehydration or electrolyte imbalances may be at greater risk for this side effect. Be sure to let your doctor know about all the medications you are taking.
If you develop an infection that requires antibiotics, make sure your doctor knows that you are taking Geodon in order to avoid any serious drug interaction. Like other medications in this group, it can also cause weight gain in some people, although this side effect may be milder and less frequent for Geodon than it is for some of the other drugs, like Zyprexa.
This drug might produce restlessness, nervousness, anxiety, sleeplessness, and nausea, among other side effects, in some people.