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Re: QoL: Old versus atypical antipsychotics » ed_uk

Posted by yxibow on October 11, 2006, at 10:27:40

In reply to Re: QoL: Old versus atypical antipsychotics » yxibow, posted by ed_uk on October 10, 2006, at 15:05:04

> Hi J
> > is far more tolerable than the sheer hell of akathisia from horrible phenothiazine and other related compounds.........
> In 'CATIE', discontinuation rates were 64% for Zyprexa, 75% for perphenazine, 82% for Seroquel, 74% for Risperdal, and 79% for Geodon. As you can see, less patients discontinued the high-potency neuroleptic perphenazine that Seroquel. In fact, more patients discontinued Seroquel than any of the other APs.
> Ed

A 3 point discontinuation rate between Geodon and Seroquel is within the margin of error. Secondly, if we are quoting scholarly articles,

"It is crucial to point out that equivalent does not mean identical: 25 percent of patients may respond to risperidone and 25 percent to perphenazine, but they are not the same 25 percent. These initial results from CATIE speak to the need for treatment options—not restrictions, such as closed formularies or fail-first requirements."

Psychiatr Serv 57:139, January 2006
Jeffrey A. Lieberman, M.D. and John K. Hsiao, M.D

This is the same investigator in
NEJM 353:1209-1223

Also from the NEJM article

"The fact that a higher proportion of patients assigned to quetiapine and ziprasidone received the maximal dose allowed in the study suggests that these agents are either less effective or require higher doses (Table 2). The dose range of perphenazine was chosen to minimize the potential for extrapyramidal symptoms that may have biased previous comparisons of first- and second-generation drugs"

This suggests to me that the phenothiazine drug used in the study was used at its MED (minimum effective dose).

Have you ever tried a bone chilling dose of Compazine, Ed ? Its staggering.

I'm only glad that there are medications out there that have low EPS levels, regardless of how much I have to use the treadmill.

Yes, Zyprexa has a huge problem with type 2 diabetes in long term use -- I wouldn't suggest it but for short term mania in those especially susceptible to diabetes, but EPS and TD rise markedly up to Risperdal, as well as to old line antipsychotics.

This study also does not focus particularly on affective disorders, where neuroleptics weigh a heavier toll of EPS and TD.

CATIE is a worthwile study, but it doesn't suggest to me that just because 3/4 of patients discontinued atypicals, that as noted it is the not necessarily the same 3/4 that would discontinue non-atypicals. There is no one size fits all.

I'm talking about effects in myself, not what others choose to take, what risks they take in informed consent (old line drugs which have now been out for 50 years show markedly higher TD rates than new medications that have been out for only a decade.)




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