Old VS. New Antipsychotics

Second generation antipsychotics may be just about the same results

(RxWiki News) Over three-fourths of the U.S. population taking antipsychotics takes those from the second generation. But, are they any better and do they have fewer side effects?

A recent study combed through antipsychotic case studies to see whether there were medical differences between first- and second-generation antipsychotics. Results showed that little to no differences existed.

"Tell your doctor about all Rx side effects."

Lisa Hartling, PhD, assistant professor in the School of Public Health at the University of Alberta in Canada, led a study to compare first-generation antipsychotics (FGAs) to the second-generation antipsychotics (SGAs).

For the study researchers looked into 10 electronic databases to find 114 studies involving 22 comparisons of FGAs to SGAs in taken by patients from 1974 to 2012.

They were looking for side effects to the drugs and rated them low, moderate or high.

Side effects for ‘core illness symptoms’ included: delusions, inability to organize thoughts, hallucinations, emotional withdrawal, social withdrawal, avoidance of or not caring about relationships, anxiety, depression, sloppy motor skills, disorientation and lack of attention.

Other health side effects included: diabetes, death, major metabolic syndrome, and tardive dyskinesia (involuntary, repetitive movements).

At the time of the research, 20 FGAs and SGAs were U.S. Food and Drug Administration approved for use on the market.

In 2003, around 75 percent of U.S. patients on antipsychotics were taking SGAs.

It takes 17 years for a drug patent to expire and then generic drug makers can duplicate the formula and provide the market with a less-expensive option.

In 2003, 93 percent of the $2.83 billion in antipsychotic revenue came from SGAs.

Results of the study showed little different between FGAs and SGAs for most side effects.

Authors said, “The strength of evidence from these studies was generally low or insufficient, with considerable variation in scales and subscales used to measure symptoms.”

When it came to negative symptoms like hallucinations, inability to organize thoughts and hallucinations, the SGAs did show a slight advantage in some of the studies.

All other side effects presented negligible differences between FGAs and SGAs.

Authors admitted that all of the studies they evaluated had a risk for bias, 68 percent of the studies were funded by the pharmaceutical industry.

Further research is necessary to determine whether SGAs are really improvements over FGAs.

This study was published in August in the Annals of Internal Medicine. Funding for this study was provided by the Agency for Healthcare Research and Quality, no conflicts of interest were found.

Review Date: 
August 17, 2012