Harvard Mental Health Letter

Antipsychotic drugs: The costs and benefits

More disappointing news has emerged from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), a National Institute of Mental Health–funded project involving more than 1,400 patients with chronic schizophrenia. In its first phase, the study raised doubt whether the antipsychotic drugs that now dominate the market, called second-generation or atypical antipsychotics, are more effective or safer or have fewer side effects than older, less expensive drugs.

Further analysis, reported in the American Journal of Psychiatry, is confirming that the newer drugs may not offer enough benefits to justify their cost.

The CATIE researchers judged the real-world value of a medication by the length of time patients continued to use it before quitting or switching to another drug — an objective standard that takes account of both effectiveness and side effects and reflects the judgment of both patients and physicians. The original analysis showed that the first-generation drug perphenazine worked as well as the newer drugs quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon). Olanzapine (Zyprexa) was slightly more effective but also had more side effects.

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