Ring Out the New, Ring In the Old

A study published in today’s American Journal of Psychiatry concludes that when it comes to treating schizophrenia in children, older, less expensive antipsychotic drugs are just as effective as the new ones and they don’t cause certain side effects.

Investigators carried out a multicenter, double-blinded, randomized trial of 119 youth with psychotic symptoms. The children received either Zyprexa (Eli Lilly), Risperdal (Janssen) or molindone, an older drug. The primary outcome was response to treatment at 8 weeks as judged using standard assessment tools.

They saw improvement in 34% of the Zyprexa group, 46% of the Risperdal group, and 50% of the molindone group. These differences were not significant.

Importantly, youths receiving the new drugs experienced marked weight gain-13 pounds in the Zyprexa group and 9 pounds in the Risperdal group. The Zyprexa group also had increased total cholesterol, LDL (bad) cholesterol, and liver enzymes. These changes were not seen in the molindone group, although as expected many of them experienced disordered movement.

Zyprexa and Risperdal have become drugs of choice for children with psychotic symptoms. They are also used widely for off-label treatments such as autism associated aggressive behavior, bipolar disorder and attention deficit disorders.

These drugs are not effective in many children and they have nasty side effects. Clinicians need to follow patients carefully and be prepared to change course.

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