Older antipsychotics give better quality of life?

609408_pills.jpgAn independently-funded study on the impact of older and newer antipsychotic drugs, published in the Archives of General Psychiatry, has found that the older and cheaper drugs seem to lead to a better an equal quality of life.

Antipsychotics are generally used to treat delusions and hallucinations in a number of mental disorders, but are most used by people diagnosed with schizophrenia.

The study has caused barely a whisper in the mainstream media but is interesting for a number of reasons.

The first is that it was not funded by a drug company. Studies funded by the pharmaceutical industray are more likely to report favourable results, so independent studies, although rare, are valued in the literature.

Also, it was a well-designed study, running as a randomised controlled trial – the ‘gold standard’ for evaluating treatment effects.

Finally, it produced some surprising findings.

Even psychiatrists who are typically suspicious of drug-company claims that the newer drugs have ‘less side-effects’ (the evidence suggests they just tend to have different ones) will admit that the older generation of antipsychotic drugs produced permanent and unpleasant undesired consequences, including uncontrollable facial contortions and movement problems (something called tardive dyskinesia).

The presence of these might be thought to lead to a worse quality of life than the side-effect of the newer antipsychotics, which, although serious (typically an increased risk of diabetes, heart problems and obesity) can be at least partly dealt with by diet and exercise changes.

There’s a ongoing discussion at the British Medical Journal website, with lots of ‘damn the data, I know my experience’ type comments, but what this study suggests is perhaps that we need a better understanding of what people value in their lives, the impact of these drugs on how people live, and how to most appropriately measure life ‘quality’.

It’s also worth noting that these older drugs are now barely-profitable compared to the newer ones. The fact that independently funded studies tend not to produce as much supporting evidence for the most marketed medications suggests that a healthy skepticism about drug company marketing is a must.

UPDATE: Neuroshrink has added a fantastic commentary on this post, including some clarifications on things I missed and misinterpreted from this study. See the comments for more.

Link to study abstract.
Link to BMJ discussion.

2 thoughts on “Older antipsychotics give better quality of life?”

  1. A couple thoughts:
    First, the study does NOT show that first-generation (“typical”) antipsychotics lead to better quality of life, it actually only failed to prove that atypicals have better outcomes than typicals. In fact, the P-values and confidence intervals indicate that there was no statistically significant difference in outcome between the two. (Also note that the typical antipsychotic used in the study was most often Sulpiride, which may be better tolerated and have fewer significant side effects than other typicals, specifically Haldol. Sulpiride is unavailable here in the US and I have no direct experience with it. The results of this study, though, may not simply be generalizable across the Atlantic.)
    Additionally, the study looked at outcomes up to one year, which is far better than the standard 8 weeks the drug companies do, but remember that risks of the dreaded tardive dyskinesia continue to increase as exposure to typical antispsychotics is extended.
    This is an important result, as it refutes (as did the excellent CATIE study last year) the preconception many psychiatrists have that atypicals are safer and therefore generally “better” drugs.
    Secondly, I agree with the writer here that we need to reassess what our patients think of as “quality of life.” I am not sure whether I would choose EPS or TD over diabetes for myself, but I certainly might. And the movement disorders, including TD, that can be disconcerting to others, and communicates the stigmatizing label of “psychotic mental patient” to those who recognize it, are often not bothersome to the patient himself. He may be perfectly comfortable while twitching and blinking away, so one cannot generalize about what types of side effects would most affect a patient’s “quality of life.”
    Sorry if this is tough to slog through, I cannot tell if paragraphs will be preserved when this posts, or how to ensure it.

  2. Eli Lilly 3Q 10% profit rise is nearly all from psyche drugs including zyprexa.
    How have they schemed to squeeze more money from their zyprexa cash cow when pill production has actually gone down?
    ANS-Eli Lilly profiteers have jacked up the price of zyprexa to the federal govt,from the Medicare D payouts.
    Eli Lilly is a big drug company that puts profits over patients.
    They covered up findings that their Zyprexa has a TEN times greater risk of causing type 2 diabetes
    Only 9% of Americans trust big pharma,right around the same rating as tobacco companies.
    Daniel Haszard Eli Lilly zyprexa drug caused my diabetes http://www.zyprexa-victims.com

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